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Physicians Gastroscopy TrainingEFFEKTRANCT04898803

How Effective Can a Simulator-Based Training Course For Beginners In Endoscopy Be Made?

An observational study of Physicians Gastroscopy Training, run by Universitätsklinikum Hamburg-Eppendorf at 2 sites in Germany.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The aim of the study is to clarify whether physicians training for gastroscopies benefit from a modified training course. The duration and type of optimized use of training simulators as part of a basic gastroscopy course can lead to a higher level of competence in patient examinations (main target parameters) than… Read more about this study

Who is it for?
Ages 18 years and olderHealthy volunteers can take part
Conditions the study is for
Physicians Gastroscopy Training
What is being tested?
conventional DGVS training and extended simulator training
How many people
32 participants
Where
2 sitesGermany
Study dates
3 Aug 2020to 14 Dec 2022
Phase
Observational
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • Healthy volunteers accepted
  • Adult, Older adult

Study population: see above

Who may be able to join

  • Trainees:
  • licensed physicians in internal medicine, surgery or gastroenterology,
  • no endoscopic or laparoscopic experience
  • informed consent
  • Patient's endoscopies:
  • all patients > 18 years of age who are capable of being informed and have a clinical indication for esophagogastroduodenoscopy
  • informed consent
  • simple examination expected

Who cannot join

  • Patient's endoscopies:
  • difficult examination expected

Trial locations and contacts

2 sites in 1 country.

Germany2 sites
  • University Hospital Eppendorf

    Hamburg, 20246

  • Albertinen Krankenhaus

    Hamburg, 22457

Other trials in Germany

About this study

The aim of the study is to clarify whether physicians training for gastroscopies benefit from a modified training course. The duration and type of optimized use of training simulators as part of a basic gastroscopy course can lead to a higher level of competence in patient examinations (main target parameters) than conventional use. Further goals are the comparison of the theoretical knowledge gained through the modified versus conventional course, as well as the self-assessment of the participants.

Read the detailed description

Training in interventional medicine, including surgery and endoscopy, is usually still done on the patient, under more or less qualified supervision. Previous exercises on models or simulators are still the exception and only reach around 40% of colleagues in countries with defined curricula and guidelines.The simulator-based training, however, offers a protected area in which, without risk to the patient, initial learning successes in flexible endoscopy can be achieved according to the "trial and error" principle. Various studies have shown that initial training on the simulator is beneficial: Physicians trained on the simulator require less support during the first examinations on the patient, less examination time, can reach and identify anatomical landmarks better and have better hand-eye coordination.If the simulator training is embedded in a structured curriculum, greater successes seem to be achieved in comparison to unstructured training. The feedback during the training is also a positive influencing factor; this should ideally take place at the end of each unit. It is also possible to use a simulator to train defined partial performances and to repeat these in the required amount. A step-by-step structure with defined intermediate goals, in the sense of mastery learning, also increases effectiveness.There is little data on the optimal duration or the saturation of the learning curve in simulator training. In one study the learning curve flattened after 60 simulated colonoscopies. Another study showed a gradual improvement up to 6 hours on the simulator. It also used threshold values for the performance score to define the optimal point in time for transition to patient-based training.

The current certification for the standardization of the nationwide endoscopy training courses by the German Gastroenterological Society (DGVS), provides for 4 hours of training on the simulator, including one hour of introduction. With an also recommended maximum group size of 4 participants per simulator, this corresponds to a duration of only 1 hour of effective simulator training per trainee. There are no recommendations for structuring simulator trainings or the type of simulators used.

The main aim of the present study is to find out whether it is possible to improve this situation without unrealistically extending the training and course times.

Trainees will randomly attend either a conventional training or an extended simulator training. Immediately after the course, in accordance with the DGVS guidelines, an examination of the same content for both groups to inquire the theoretical knowledge is done.1-5 weeks after completion of the training course, an evaluation of the endoscopic skills of the participants takes place. It is done on the patient, under supervision, as is currently customary in everyday clinical training. After a one-day introduction through observation of routine gastroscopies, two gastroscopies are then carried out. Two endoscopists independently assess the performance based on a Video record of the examination. All endoscopists involved in supervision or assessment are blinded to the trainee's group membership..

Being tested
conventional DGVS training, extended simulator training
Keywords
simulator training, gastroscopy training, physicians training

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • conventional DGVS trainingOther

    see above

  • extended simulator trainingOther

    see above

Study groups in NCT04898803
Study groupRoleWhat they receive
conventional gastroscopy training coursephysicians receive the DGVS-recommended training, consisting of a 2-day course with 1 hour of simulator training
Receives: Other: conventional DGVS training
extended simulator coursephysicians receive a two-day simulator course with a minimum of 6 hours of simulator training per trainee, structured in stages in the sense of progressive or mastery learning. The initial part of the training will be part-task training.
Receives: Other: extended simulator training

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Global Assessment of Gastrointestinal Endoscopic Skills (GAGES) competence score competence score

    Comparison of the GAGES competence score of the video-based observations of the first two patient examinations, each assessed by two endoscopists. To be valuated: intubation of esophagus, scope navigation, ability to keep a clear endoscope field, instrumentation, quality of examination. Best score each question 5 pts, worst 1 pt.

    Measured: one to five weeks after training course

  2. Non-inferiority of the new training procedure

    Non-inferiority of the new training procedure in the final exams according to DGVS criteria

    Measured: through study completion, approximately 1 year

Secondary outcomes (3)
  1. competence assessment Direct Observation of Procedural Skills (DOPS) by Joint Advisory Group on Gastrointestinal Endoscopy (JAG)

    Comparison of the JAG DOPS competence level of the video-based observations of the first two patient examinations, each assessed by two endoscopists. Assession of trainee's needed level of supervision at pre- and post procedure, insertion and withdrawal, visualisation, management of findings, and non-technical skills. Each has 4 values, best is "Competent for independent practice", worst is "maximal supervision"

    Measured: one to five weeks after training course

  2. Assessment of Competency in Endoscopy (ACE)

    Comparison of the ACE competence evaluation of the video-based observations of the first two patient examinations, each assessed by two endoscopists.

    Measured: one to five weeks after training course

  3. mean self-assessment by Visual Analog Scale (VAS)

    VAS after the first two patient examinations. This enables an assessment of the stress level and ultimately a measurement of the cognitive load of the subject. To be evaluated on a non-scaled line from "do not agree at all" to "totally agree".

    Measured: one to five weeks after training course

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted24 May 2021
  2. Study start3 Aug 2020
  3. Primary completion14 Dec 2022
  4. Study completion14 Dec 2022

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Observational
Observational model
Cohort
Time perspective
Prospective
Enrolment
32 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04898803
Sponsor's protocol ID
PV7217
Acronym
EFFEKTRA
Status last verified
Jun 2023
First submitted
25 Jan 2021
Last updated
28 Jun 2023
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Amiot A, Conroy G, Le Baleur Y, Winkler J, Palazzo M, Treton X. Endoscopic training: A nationwide survey of French fellows in gastroenterology. Clin Res Hepatol Gastroenterol. 2018 Apr;42(2):160-167. doi: 10.1016/j.clinre.2017.08.005. Epub 2017 Sep 18.

    PubMed 28927657
  • Jirapinyo P, Thompson CC. Current status of endoscopic simulation in gastroenterology fellowship training programs. Surg Endosc. 2015 Jul;29(7):1913-9. doi: 10.1007/s00464-014-3884-0. Epub 2014 Oct 11.

    PubMed 25303910
  • Ende A, Zopf Y, Konturek P, Naegel A, Hahn EG, Matthes K, Maiss J. Strategies for training in diagnostic upper endoscopy: a prospective, randomized trial. Gastrointest Endosc. 2012 Feb;75(2):254-60. doi: 10.1016/j.gie.2011.07.063. Epub 2011 Dec 7.

    PubMed 22153875
  • Haycock A, Koch AD, Familiari P, van Delft F, Dekker E, Petruzziello L, Haringsma J, Thomas-Gibson S. Training and transfer of colonoscopy skills: a multinational, randomized, blinded, controlled trial of simulator versus bedside training. Gastrointest Endosc. 2010 Feb;71(2):298-307. doi: 10.1016/j.gie.2009.07.017. Epub 2009 Nov 3.

    PubMed 19889408
  • Sedlack RE, Kolars JC, Alexander JA. Computer simulation training enhances patient comfort during endoscopy. Clin Gastroenterol Hepatol. 2004 Apr;2(4):348-52. doi: 10.1016/s1542-3565(04)00067-9.

    PubMed 15067632
  • Shirai Y, Yoshida T, Shiraishi R, Okamoto T, Nakamura H, Harada T, Nishikawa J, Sakaida I. Prospective randomized study on the use of a computer-based endoscopic simulator for training in esophagogastroduodenoscopy. J Gastroenterol Hepatol. 2008 Jul;23(7 Pt 1):1046-50. doi: 10.1111/j.1440-1746.2008.05457.x. Epub 2008 Jun 28.

    PubMed 18554236
  • Ahlberg G, Hultcrantz R, Jaramillo E, Lindblom A, Arvidsson D. Virtual reality colonoscopy simulation: a compulsory practice for the future colonoscopist? Endoscopy. 2005 Dec;37(12):1198-204. doi: 10.1055/s-2005-921049.

    PubMed 16329017
  • Cohen J, Cohen SA, Vora KC, Xue X, Burdick JS, Bank S, Bini EJ, Bodenheimer H, Cerulli M, Gerdes H, Greenwald D, Gress F, Grosman I, Hawes R, Mullin G, Schnoll-Sussman F, Starpoli A, Stevens P, Tenner S, Villanueva G. Multicenter, randomized, controlled trial of virtual-reality simulator training in acquisition of competency in colonoscopy. Gastrointest Endosc. 2006 Sep;64(3):361-8. doi: 10.1016/j.gie.2005.11.062.

    PubMed 16923483
  • Di Giulio E, Fregonese D, Casetti T, Cestari R, Chilovi F, D'Ambra G, Di Matteo G, Ficano L, Delle Fave G. Training with a computer-based simulator achieves basic manual skills required for upper endoscopy: a randomized controlled trial. Gastrointest Endosc. 2004 Aug;60(2):196-200. doi: 10.1016/s0016-5107(04)01566-4.

    PubMed 15278044
  • Ferlitsch A, Schoefl R, Puespoek A, Miehsler W, Schoeniger-Hekele M, Hofer H, Gangl A, Homoncik M. Effect of virtual endoscopy simulator training on performance of upper gastrointestinal endoscopy in patients: a randomized controlled trial. Endoscopy. 2010 Dec;42(12):1049-56. doi: 10.1055/s-0030-1255818. Epub 2010 Oct 22.

    PubMed 20972956
  • Maiss J, Millermann L, Heinemann K, Naegel A, Peters A, Matthes K, Hahn EG, Hochberger J. The compactEASIE is a feasible training model for endoscopic novices: a prospective randomised trial. Dig Liver Dis. 2007 Jan;39(1):70-8; discussion 79-80. doi: 10.1016/j.dld.2006.07.007. Epub 2006 Aug 30.

    PubMed 16942923
  • McIntosh KS, Gregor JC, Khanna NV. Computer-based virtual reality colonoscopy simulation improves patient-based colonoscopy performance. Can J Gastroenterol Hepatol. 2014 Apr;28(4):203-6. doi: 10.1155/2014/804367.

    PubMed 24729994
  • Park J, MacRae H, Musselman LJ, Rossos P, Hamstra SJ, Wolman S, Reznick RK. Randomized controlled trial of virtual reality simulator training: transfer to live patients. Am J Surg. 2007 Aug;194(2):205-11. doi: 10.1016/j.amjsurg.2006.11.032.

    PubMed 17618805
  • Sedlack RE, Kolars JC. Computer simulator training enhances the competency of gastroenterology fellows at colonoscopy: results of a pilot study. Am J Gastroenterol. 2004 Jan;99(1):33-7. doi: 10.1111/j.1572-0241.2004.04007.x.

    PubMed 14687137
  • Tuggy ML. Virtual reality flexible sigmoidoscopy simulator training: impact on resident performance. J Am Board Fam Pract. 1998 Nov-Dec;11(6):426-33. doi: 10.3122/jabfm.11.6.426.

    PubMed 9875997

Questions about this trial

What is this clinical trial studying?

An observational study of Physicians Gastroscopy Training, run by Universitätsklinikum Hamburg-Eppendorf at 2 sites in Germany.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 8 inclusion and 2 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 28 Jun 2023. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 2 sites in Germany. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Global Assessment of Gastrointestinal Endoscopic Skills (GAGES) competence score competence score (time frame: one to five weeks after training course). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT04898803, which also lists 42 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 28 Jun 2023.

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