Abstract
Objective
Manipulation of the colonoscope is a technical challenge for novice clinicians which is best learned in a simulated environment. It involves the coordination of scope tip steering with scope insertion, using a rotated image as reference. The purpose of this work is to develop and validate a system which objectively assesses colonoscopy technical skills proficiency in an arbitrary training environment, allowing novices to assess their technical proficiency prior to real patient encounters.
Methods
We implemented a motion tracking setup to objectively analyze and assess the way operators perform colonoscopies, including an analysis of wrist and elbow joint motions. Subsequently, we conducted a validation study to verify whether our motion analysis could discriminate novice colonoscopists from experts. Participants navigated a wooden bench-top model using a standard colonoscope while their motions were tracked.
Results
The developed motion tracking setup allowed colonoscopists of varying levels of proficiency to have their colonoscope manipulation assessed, and was able to be operated by a trained non-technical operator. Novice operators had significantly greater median times (101.5 vs. 31.5 s) and number of hand movements (62.0 vs. 21.5) than experts. Experts, however, spent a significantly greater proportion of time in extreme ranges of wrist and elbow joint motion than novices.
Conclusion
We have developed and implemented a hand and joint motion analysis system that is able to discriminate novices from experts based on objective measures of motion. These metrics could, thus, serve as proxies for technical proficiency during training.
Similar content being viewed by others
References
Marshall JB (1995) Technical proficiency of trainees performing colonoscopy: a learning curve. Gastrointest Endosc 42:287–291
Anderson ML, Pasha TM, Leighton JA (2000) Endoscopic perforation of the colon: lessons from a 10-year study. Am J Gastroenterol 95:3418–3422
Hill A, Horswill MS, Plooy AM, Watson MO, Karamatic R, Basit TA, Wallis GM, Riek S, Burgess-Limerick R, Hewett DG (2012) Assessing the realism of colonoscopy simulation: the development of an instrument and systematic comparison of 4 simulators. Gastrointest Endosc 75:631–640
Preisler L, Svendsen MB, Nerup N, Svendsen LB, Konge L (2015) Simulation-based training for colonoscopy: establishing criteria for competency. Medicine (Baltimore) 94:e440
Chak A, Cooper GS, Blades EW, Canto M, Sivak MV (1996) Prospective assessment of colonoscopic intubation skills in trainees. Gastrointest Endosc 44:54–57
Vassiliou MC, Kaneva PA, Poulose BK, Dunkin BJ, Marks JM, Sadik R, Sroka G, Anvari M, Thaler K, Adrales GL, Hazey JW, Lightdale JR, Velanovich V, Swanstrom LL, Mellinger JD, Fried GM (2010) Global assessment of gastrointestinal endoscopic skills (GAGES): a valid measurement tool for technical skills in flexible endoscopy. Surg Endosc 24:1834–1841
Ritter EM, Cox TC, Trinca KD, Pearl JP (2013) Simulated colonoscopy objective performance evaluation (SCOPE): a non-computer-based tool for assessment of endoscopic skills. Surg Endosc 27:4073–4080
Sedlack RE, Coyle WJ, Obstein KL, Al-Haddad MA, Bakis G, Christie JA, Davila RE, DeGregorio B, DiMaio CJ, Enestvedt BK, Jorgensen J, Mullady DK, Rajan L (2014) ASGEś assessment of competency in endoscopy evaluation tools for colonoscopy and EGD. Gastrointest Endosc 79:1–7
Walsh CM, Ling SC, Khanna N, Cooper MA, Grover SC, May G, Walters TD, Rabeneck L, Reznick R, Carnahan H (2014) Gastrointestinal endoscopy competency assessment tool: development of a procedure-specific assessment tool for colonoscopy. Gastrointest Endosc 79:798–807
Walsh CM, Ling SC, Khanna N, Grover SC, Yu JJ, Cooper MA, Yong E, Nguyen GC, May G, Walters TD, Reznick R, Rabeneck L, Carnahan H (2015) Gastrointestinal endoscopy competency assessment tool: reliability and validity evidence. Gastrointest Endosc 81:1417–1424
Aggarwal R, Grantcharov TP, Darzi A (2007) Framework for systematic training and assessment of technical skills. J Am Coll Surg 204:697–705
Reiley CE, Lin HC, Yuh DD, Hager GD (2011) Review of methods for objective surgical skill evaluation. Surg Endosc 25:356–366
Ansell J, Mason J, Warren N, Donnelly P, Hawkes N, Dolwani S, Torkington J (2012) Systematic review of validity testing in colonoscopy simulation. Surg Endosc 26:3040–3052
Triantafyllou K, Lazaridis LD, Dimitriadis GD (2014) Virtual reality simulators for gastrointestinal endoscopy training. World J Gastrointest Endosc 6:6–12
Ekkelenkamp VE, Koch AD, de Man RA, Kuipers EJ (2016) Training and competence assessment in GI endoscopy: a systematic review. Gut 65:607–615
Koch AD, Buzink SN, Heemskerk J, Botden SM, Veenendaal R, Jakimowicz JJ, Schoon EJ (2008) Expert and construct validity of the Simbionix GI Mentor II endoscopy simulator for colonoscopy. Surg Endosc 22:158–162
Fayez R, Feldman LS, Kaneva P, Fried GM (2010) Testing the construct validity of the Simbionix GI Mentor II virtual reality colonoscopy simulator metrics: module matters. Surg Endosc 24:1060–1065
MacDonald J, Ketchum J, Williams RG, Rogers LQ (2003) A lay person versus a trained endoscopist: can the preop endoscopy simulator detect a difference? Surg Endosc 17:896–898
Haycock AV, Bassett P, Bladen J, Thomas-Gibson S (2009) Validation of the second-generation Olympus colonoscopy simulator for skills assessment. Endoscopy 41:952–958
Plooy AM, Hill A, Horswill MS, Cresp AS, Watson MO, Ooi SY, Riek S, Wallis GM, Burgess-Limerick R, Hewett DG (2012) Construct validation of a physical model colonoscopy simulator. Gastrointest Endosc 76:144–150
Svendsen MB, Preisler L, Hillingsoe JG, Svendsen LB, Konge L (2014) Using motion capture to assess colonoscopy experience level. World J Gastrointest Endosc 6:193–199
Telem DA, Rattner DW, Gee DW (2014) Endoscopic simulator curriculum improves colonoscopy performance in novice surgical interns as demonstrated in a swine model. Surg Endosc 28:1494–1499
MacNeil K, Wang CN, Holden MS, Ungi T, Fichtinger G, Hookey L (2016) System for objectively evaluating colonoscopy procedural skills using motion analysis. In: 14th annual imaging network Ontario symposium
Lasso A, Heffter T, Rankin A, Pinter C, Ungi T, Fichtinger G (2014) PLUS: open-source toolkit for ultrasound-guided intervention systems. IEEE Trans Biomed Eng 61:2527–2537
Ungi T, Sargent D, Moult E, Lasso A, Pinter C, McGraw RC, Fichtinger G (2012) Perk Tutor: an open-source training platform for ultrasound-guided needle insertions. IEEE Trans Biomed Eng 59:3475–3481
McGraw R, Chaplin T, McKaigney C, Rang L, Jaeger M, Redfearn D, Davison C, Ungi T, Holden M, Yeo C, Keri Z, Fichtinger G (2016) Development and evaluation of a simulation-based curriculum for ultrasound-guided central venous catheterization. In: CJEM, pp 1–9
Mohankumar D, Garner H, Ruff K, Ramirez FC, Fleischer D, Wu Q, Santello M (2014) Characterization of right wrist posture during simulated colonoscopy: an application of kinematic analysis to the study of endoscopic maneuvers. Gastrointest Endosc 79:480–489
Walsh CM, Ling SC, Wang CS, Carnahan H (2009) Concurrent versus terminal feedback: it may be better to wait. Acad Med 84:S54–S57
Romano J, Kromrey JD, Coraggio J, Skowronek J (2006) Appropriate statistics for ordinal level data: should we really be using t-test and Cohen’s d for evaluating group differences on the NSSE and other surveys. In: Annual meeting of the Florida Association of Institutional Research
Bond CF, Titus LJ (1983) Social facilitation: a meta-analysis of 241 studies. Psychol Bull 94:265–292
Nerup N, Preisler L, Svendsen MBS, Svendsen LB, Konge L (2015) Assessment of colonoscopy by use of magnetic endoscopic imaging: design and validation of an automated tool. Gastrointest Endosc 81:548–554
Preisler L, Svendsen SMB, Søndergaard B, Brink L, Nordentoft T, Svendsen LB, Konge L (2016) Automatic and unbiased assessment of competence in colonoscopy: exploring validity of the Colonoscopy Progression Score CoPS. Endosc Int Open 4:E1238–E1243
Konge L, Svendsen MBS, Preisler L, Svendsen LB, Park YS (2017) Combining different methods improves assessment of competence in colonoscopy. Scand J Gastroenterol 52:601–605
Acknowledgements
Matthew S. Holden is supported by the Canada Graduate Scholarship from the Natural Sciences and Engineering Research Council of Canada and by the Walter C. Sumner Foundation Fellowship. Gabor Fichtinger is supported as a Cancer Care Ontario Research Chair in Cancer Imaging. Financial support was received from the SEAMO Educational Innovation and Research Fund. This work was financially supported as a Collaborative Health Research Project (CHRP #127797), a joint initiative between the Natural Sciences and Engineering Research Council of Canada (NSERC) and the Canadian Institutes of Health Research (CIHR). Funding was provided by Walter C. Sumner Foundation.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
All authors declare that they have no conflict of interest.
Ethical approval
All procedures in this study involving human participants were performed in accordance with the ethical standards of the institution, and were approved by the research ethics board at Queen’s University. This study does not contain any procedures involving animals.
Informed consent
All participation was voluntary, and written informed consent was obtained from all participants.
Rights and permissions
About this article
Cite this article
Holden, M.S., Wang, C.N., MacNeil, K. et al. Objective assessment of colonoscope manipulation skills in colonoscopy training. Int J CARS 13, 105–114 (2018). https://doi.org/10.1007/s11548-017-1676-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11548-017-1676-4