Cross-Over Validation of an Endoscopic Training Box Task

Author(s): Sanjay M. Salgado, Blake A. Niccum, Michael L. Kochman

Background & Aims: Gastroenterology training programs have increasingly incorporated endoscopic simulation into their curricula to augment competency assessment and clinical training. One mechanical simulator model that has demonstrated significant promise is the Thompson Endoscopic Skills Trainer Box (TEST Box). When administering the TEST Box, we have noted that trainees differ in their approach to the tip deflection module, raising concerns pertaining to construct validity.

Methods: Five attending gastroenterologists with at least three years of independent practice participated in a randomized crossover study designed to provide validity data on the endoscopic tip-deflection task of the TEST Box, using two alternative approaches: the “grasping” method, in which a participant grasps the target object with a forceps in order to move the object into the intended location, and the “pass-through” method, in which a participant passes the closed forceps through the central hole in the object and subsequently opens the forceps in order to pick up and move the object into the intended location.

Results: The average scores of “grasping” and “pass-through” methods were 36.0 and 88.2, respectively. The use of the “grasping” method resulted in significantly lower scores compared to the “pass-through” method (p = 0.027; CI -94.5 to -9.9) when performing the tip deflection module of the TEST Box.

Conclusions: As we have historically observed that a cohort of trainee participants routinely utilize the “pass-through” method to complete the tip deflection module of the TEST Box during competency assessments, these observations reveal limitations in the validity of the tip deflection module of the TEST Box.