Working on a colonoscopy simulator without a structured feedback does not change performance; hence, any effects shown after structured feedback would amount to useful learning of the procedure.
Researchers from Middlesex, England investigated the learning curve for the HT Immersion Medical Colonoscopy Simulator without any structured feedback.
The researchers hoped that this could then be potentially applied to validate the learning curve on the simulator when structured feedback is provided.
|There was no improvement in performance on the simulator from 1st attempt to the 5th in the absence of feedback|
The research group asked candidates to perform colonoscopy on the HT Immersion Medical Colonoscopy Simulator using Modules 3 and 4 at random.
In total, the researchers asked each candidate to perform 5 consecutive virtual colonoscopies on the same module.
The 5 episodes were collectively referred to as 1 trial.
The group used a time result of 3,600 sec (1 h) to denote perforation.
The researchers gave the candidates no guidance or feedback before, during, or after each procedure.
The research team recruited a total of 26 postgraduate doctors, including 9 research fellows, 5 preregistration house officers, 6 specialist registrars, and 6 consultants.
14 candidates had 5 attempts each (i.e., one trial each) on the same module of the colonoscopy simulator (14 trials over 70 episodes).
Another 12 candidates recorded 5 attempts (i.e., one trial each) on 2 modules of the colonoscopy simulator (24 trials over 120 episodes).
In total, the researchers had recorded 190 episodes, representing 38 trials.
The research group found that there was no improvement in performance on the simulator from 1st attempt to the 5th in the absence of feedback.
If the researchers noted any initial gain in any measurable outcome, this was lost in subsequent attempts indicating lack of learning.
The outcomes that the researchers measured included time taken to complete the test, percentage of the mucosa visualized, depth of the instrument inserted, and the path length used.
Dr Mahmood, speaking on behalf of the research team concluded, "This study demonstrates that in the absence of feedback, it is not possible to improve performance on the HT Immersion Medical Colonoscopy Simulator."
"Thus, there is no learning curve for the machine."
He added, "The information from this study is vital for using the simulators in training and assessment because any improvement in learning curves shown after training on simulators can be presumed to be due to learning the procedure and not the simulator."