Development of a novel ERCP mechanical simulator

BACKGROUND: There is a paucity of objective methods for evaluating trainee performance and comparing ERCP accessories. OBJECTIVE: Use of a mechanical ERCP simulator to evaluate trainee performance and to compare ERCP accessories via procedure time. DESIGN: Pilot study using a mechanical simulator. SETTING: Hands-on ERCP practice workshops. SUBJECTS: Endoscopists at various levels of ERCP experience. METHOD: Validation studies are described to show that the simulator permits participants with varying ERCP experience to demonstrate their skill levels and offers novel training applications in ERCP courses. The time required for completing a simulated stent placement procedure, simulated fluoroscopy time, and participant expectations were recorded in different settings. Participants' expectations were compared before and after training to determine whether the simulator was a credible adjunct to ERCP training. RESULTS: Significantly shorter procedure times were recorded for the same accessories used by participants with more ERCP experience than those with less experience and for the same group of participants when using accessories with 1 design compared with another. The mean total credibility score showed a significant increase after simulator practice. LIMITATIONS: In vitro practice by using a mechanical simulator; results may not translate directly to the clinical setting. How the objective procedure times measured during practice can complement assessment of trainee competence or define usefulness of different accessories is unknown but deserves to be explored in future studies. CONCLUSIONS: The procedure times can categorize participants according to their ERCP experience and separate accessories according to their ease of use. An increase in credibility score validates participants' endorsement of such practice as a credible adjunct to ERCP training.