Transfer of virtual reality endoscopy training to live animal colonoscopy: a randomized control trial of proficiency vs. repetition-based training.

BACKGROUND: Low first-time pass rates of the Fundamentals of Endoscopic Surgery (FES) exam stimulated development of virtual reality (VR) simulation curricula for test preparation. This study evaluates the transfer of VR endoscopy training to live porcine endoscopy performance and compares the relative effectiveness of a proficiency-based vs repetition-based VR training curriculum. METHODS: Novice endoscopists completed pretesting including the FES manual skills examination and Global Assessment of GI Endoscopic Skills (GAGES) assessment of porcine upper and lower endoscopy. Participants were randomly assigned one of two curricula: proficiency-based or repetition-based. Following curriculum completion, participants post-tested via repeat FES examination and GAGES porcine endoscopy assessments. The two cohorts pre-to-post-test differences were compared using ANCOVA. RESULTS: Twenty-two residents completed the curricula. There were no differences in demographics or clinical endoscopy experience between the groups. The repetition group spent significantly more time on the simulator (repetition: 242.2 min, SD 48.6) compared to the proficiency group (proficiency: 170.0 min, SD 66.3; p = 0.013). There was a significant improvement in porcine endoscopy (pre: 10.6, SD 2.8, post: 16.6, SD 3.4; p < 0.001) and colonoscopy (pre: 10.4, SD 2.7, post: 16.4, SD 4.2; p < 0.001) GAGES scores as well as FES manual skills performance (pre: 270.9, SD 105.5, post: 477.4, SD 68.9; p < 0.001) for the total cohort. There was no difference in post-test GAGES performance or FES manual skills exam performance between the two groups. Both the proficiency and repetition group had a 100% pass rate on the FES skills exam following VR curriculum completion. CONCLUSION: A VR endoscopy curriculum translates to improved performance in upper and lower endoscopy in a live animal model. VR curricula type did not affect FES manual skills examination or live colonoscopy outcomes; however, a proficiency curriculum is less time-consuming and can provide a structured approach to prepare for both the FES exam and clinical endoscopy.

The Effects of Differential Learning on the Standing Broad Jump.

In this investigation, we examined the influence of two approaches of motor skill learning (differential learning and repetition-based) for an explosive motor skill. Twenty-seven individuals completed four training sessions of a standing broad jump task, presented with either differential training or a repetition-based approach. We collected pre-and post-training assessments that included maximal jump distances used to index performance and the recording of ground reaction forces to determine potential biomechanical changes (normalized vertical ground reaction force - GRFvert, rate of force development - RFD, and horizontal take-off velocity - Vhor). Results showed that differential training exhibited greater jump distances than repetition-based training (p < .001) but no training effect was found for jump distances between pre- and post-assessments for either training approach (p = .15). However, a significant increase occurred for Vhor with greater velocities achieved following training (p = .03). Overall, differential training failed to show the expected performance enhancements for a discrete, explosive motor task; this may be related to limited exposure and task specific demands of the movement. Further research is needed to better understand the task factors influencing skill acquisition from differential training.