A Pilot Randomized Cross-Over Trial Focused on Colonoscopy Skill Acquisition Using High Fidelity Versus Low Fidelity Simulators in Nigeria.

OBJECTIVE

Colorectal cancer (CRC) is the second leading cause of cancer-related deaths worldwide, with incidence and mortality rising in low- and middle-income (LMICs) countries. Expanding the number of healthcare professionals trained in colonoscopy is crucial to addressing the increasing cancer burden. We developed a colonoscopy simulation-based training course and assessed whether training on locally developed low-fidelity (LF) simulation models resulted in skill acquisition and confidence comparable to training on high-fidelity (HF) models.

DESIGN

A randomized crossover trial was conducted as part of a colonoscopy training program, which consisted of a 9-week online lecture series and a 4-day in-person colonoscopy training workshop, using HF and LF simulators. Performance was assessed using the Mayo Colonoscopy Skills Assessment Tool (MCSAT) and the Global Assessment of Gastrointestinal Endoscopic Skills (GAGES) tool. The primary outcome was the difference in median exam scores.

SETTING

The study was conducted at the Obafemi Awolowo University Teaching Hospital in Ile-Ife, Nigeria, from January 4th, 2024, to May 3rd, 2024.

PARTICIPANTS

Participants were surgeons, surgical residents, and gastroenterologists of varying levels of experience from Nigeria.

RESULTS

A total of twenty-one trainees enrolled in the online Zoom lectures, and 18 participants were randomized in the simulation course. Median MCSAT and GAGES scores improved over time in both HF and LF groups. For GAGES scores, only Exam 2 (after lectures and training on a simulation model) showed statistically significant differences for scope navigation (p = 0.046), use of strategies (p = 0.019), and the overall GAGES score (p = 0.041). No significant differences were observed at Exam 4 (the final exam of the course), suggesting that skills had converged by the end of training. Both HF and LF groups demonstrated significant increases in confidence.

CONCLUSIONS

This pilot trial suggests training on LF colonoscopy models results in similar colonoscopy skill acquisition and confidence compared to HF colonoscopy. LF colonoscopy training models can be used as cost-effective teaching tools in LMICs with limited resources and financial investments.