Endoscopic skills training in a simulated clinical setting

We describe a simulation and scenario-based model of training in gastrointestinal endoscopic hemostasis, which combines acquisition of procedural and problem-solving skills in a close to reality simulated clinical setting.

Two day courses in endoscopic hemostasis were conducted at the Clinical Training and Education Centre, the University of Western Australia, Perth, Australia. In total, 23 trainees were enrolled. The Erlangen Endo-Trainer simulator, porcine specimens of esophagus, stomach, and duodenum with a range of simulated bleeding sources, a separate catheter and a pump to simulate massive bleeding, and a full arm model with injectable veins were used. The SimMan monitor and software package were used to simulate hemodynamic parameters and electrocardiogram. Faculty members adjusted the rate of bleeding and vital parameters. The exercise was video recorded. On the first day, the group underwent simulator training in techniques of endoscopic hemostasis. On the second day, participants were scenario-based trained in full management of a "bleeding patient," which included resuscitation, sedation, endoscopy, and hemostasis, acting as leaders in teams of three. The course was evaluated by participants using a standardized questionnaire.

A complex clinical setting of acute gastrointestinal bleeding was recreated with a high degree of realism. All participants reported that the simulated clinical scenario was a positive learning experience, helpful in managing complications and performing complex problem-solving tasks in a dynamic environment.

Scenario and simulation-based training in endoscopic hemostasis may provide an opportunity to improve procedural skills and acquire practical experience in managing this medical emergency, which requires the ability to process, integrate, and adequately and quickly respond to complex information in unexpected conditions working as a team leader.