The British Society of Gastroenterology (BSG) and the Bangladesh Gastroenterology Society (BGS) have collaborated on an endoscopy training programme, which has grown up over the past decade from a small scheme borne out of the ideas of consultant gastroenterologists in Swansea, South Wales (United Kingdom) to improve gastroenterology services in Bangladesh to become a formalised training programme with broad reach. In this article, we document the socioeconomic and historical problems that beset Bangladesh, the current training needs of doctors and how the BSG-BGS collaboration has made inroads into changing outcomes both for gastroenterologists in Bangladesh, but also for the populations they serve.

Background and study aims Video-colonoscopy, despite being the gold-standard for diagnosis of colorectal lesions, has limitations including patient discomfort and risk of complications. This study assessed training characteristics and acceptability in operators of a new robotic colonoscope (RC). Materials and methods Participants (n = 9) with varying degrees of skill and background knowledge in colonoscopy performed colonoscopies with a RC on a simulation-based training model. Quantitative procedure-related and qualitative operator-related parameters were recorded. Results Polyp detection rate was highest in the novice group (91.67 %) followed by experts (86.11 %), then equally, trainees and video gamers (79.17 %). Four participants repeated the procedure at a follow-up session. Each participant improved cecal intubation time and had the same or higher polyp detection rate. The potential role for RC was identified for an out-of-hospital environment and as a novel diagnostic tool. Conclusions Results from this pilot suggest that operators at all skill levels found the RC acceptable and potentially useful as a diagnostic tool. Acquisition of skills with RC seems to improve rapidly to a clinically relevant level with simulation-based training

Emergency laparotomy is one of six index operations for which all higher general surgery trainees (HST) are required to demonstrate both a minimum indicative number and competence level, prior to the award of a certificate of completion of training. It is a high-risk procedure associated with significant morbidity and mortality and has been subject to several contemporary, high profile national initiatives not least the National Emergency Laparotomy Audit (NELA),1 aimed at improving the quality of care for patients. Compounded by out of hours presentations and the high risks associated with the procedure, training opportunities for emergency …

Introduction Several methods of securing a tracheostomy tube have been described in the literature including using ties or tapes around the neck and suturing the plastic flange to the neck in various ways. However, there are no wet lab-based studies to objectively determine the force required to displace the tracheostomy tube using different securing techniques. Ours is the first animal tissue simulation study published in the literature. Methods A simulated tracheostomy stoma was created on a sheep neck model. A tracheostomy tube was inserted into the stoma and secured using various methods. Tension tests were conducted to significantly displace the tube from the stoma. Each technique was repeated six times on different sheep necks. All results were analysed using SPSS®. Results Repeat measurements indicated that the largest displacement forces come from an oblique direction while the lowest force values were found at the lateral angle. Averages of displacement showed that medially placed sutures required the largest forces in comparison with other securing methods. Wilcoxon signed-rank testing indicated that medial and continuous suture security resists displacement at forces that otherwise displace flange and interrupted sutures. Conclusions This study has shown that any type of securing suture requires a greater displacement force than the strap of the tracheostomy tube holder alone. Medially placed sutures require a greater displacement force than those placed laterally. Displacement in the lateral direction requires the least force in comparison with movement at perpendicular or oblique angles.

Early diagnosis of colorectal cancer results in better patient outcomes. Reported barriers to screening amongst non-responders, delays in diagnostic pathways, and current constraints in colonoscopy capacity contribute to delays in diagnosis. We hypothesise that changing the diagnostic paradigm through primary care based semi-automated robotic colonoscopy may improve access and engagement. This project involved development of a training programme with a simulation training model to understand the specific training needs and methods of fulfilling these for the potential ultimate users of primary care based robotic colonoscopy.

Introducing the UK’s first thyroid FNA training course.

Background: The Welsh Institute for Minimal Access Therapy (WIMAT) colonoscopy suitcase is an ex vivo porcine simulator for polypectomy training.Objective: To establish whether this model has construct and concurrent validity.Design: Prospective, cross-sectional study.Setting: Endoscopic training center.Participants: Twenty novice (N), 20 intermediate (I), 20 advanced (Ad), and 20 expert (E) colonoscopists.Intervention: A simulated polypectomy task aimed at removing 2 polyps; A (simple), B (complex).Main Outcome Measurements: Two accredited colonoscopists, blinded to group allocation, scored performances according to Direct Observation of Polypectomy Skills (DOPyS) assessment parameters. Group performances were compared. Real-life DOPyS scores were correlated to simulator DOPyS results.Results: Median overall DOPyS scores for novices were 1.00 (1.00-1.87) for A and 0.50 (0.00-1.00) for B (A vs B; P < .01). Intermediates scored 2.50 (2.00-2.88) for A and 2.00 (1.13-2.50) for B (A vs B; P = .03). The advanced group scored 3.00 (2.50-3.50) for A and 2.50 (2.00-3.00) for B (A vs B; P = .01). Experts scored 3.00 (3.00-3.88) for A and 3.00 (2.50-3.50) for B (A vs B; P = .47). Intergroup comparisons for A were, N vs I; P < .01, N vs Ad; P < .01, N vs E; P < .01, I vs Ad; P < .01, I vs E; P < .01, and Ad vs E; P = .46. Intergroup comparisons for B were, N vs I; P < .01, N vs Ad; P < .01, N vs E; P < . 01, I vs Ad; P < .03, I vs E; P < .01, and Ad vs E; P = .06. There was no difference between real-life DOPyS scores and simulator scores (0.07).Limitations: The model does not have inbuilt assessment parameters.Conclusion: This simulator demonstrates construct and concurrent validity for colon polypectomy training.

BACKGROUND: The aim of this study was to establish if endoscopists can reliably self-assess their ability to perform simulated colonic polypectomy.METHODS: Novices, intermediates, advanced, and experts performed a video-recorded polypectomy task using the Welsh Institute for Minimal Access Therapy (WIMAT) colonoscopy suitcase simulator. This involved removal of a simple polyp (A) and a complex polyp (B). Participants self-assessed themselves using a Direct Observation of Polypectomy Skills (DOPyS) assessment form. Two blinded, independent, Joint Advisory Group on Gastrointestinal Endoscopy (JAG) accredited assessors graded each performance using the same DOPyS scoring. The Spearman coefficient was used to determine the correlation between self and assessors' scores.RESULTS: Eighty participants completed the task. There was a weak correlation between assessors' scores and self-assessment scores for all groups (novices: rho = -.44, P = .85; intermediates: rho = -.16, P = .51; advanced: rho = .16, P = .50; and experts: rho = .07, P = .76). There was a strong correlation between scores from assessor 1 and 2 for polyp A (rho = .80, P <= .01) and polyp B (rho = .80, P <= .01).CONCLUSIONS: The correlation between self-assessment and assessors' scores is weak. Novices and intermediates underestimate performance, whereas advanced and experts overestimate performance. Regular feedback may improve accuracy. (C) 2014 Elsevier Inc. All rights reserved.

The opportunity for using simulation in medical training has expanded in recent years. 1–3 Laparoscopic surgery is an area that is ideally suited to the use of simulators for the acquisition of clinical skills. 4 Simulation allows educators to have control over pre-selected scenarios, without distressing patients or encountering complications. 5

BACKGROUND Transanal endoscopic microsurgery (TEM) and transanal endoscopic operation (TEO) have been widely adopted since first being described by Buess et al in 1985. A specially designed rectoscope is used with laparoscopic imaging and angulated instrumentation to allow precise dissection of rectal lesions under a magnified view. We describe a novel ex vivo simulator for TEO/TEM training. TECHNIQUE A porcine rectal specimen was used to simulate the human rectum. A standardised liquid polyp mix is injected into the submucosal layer of the bowel. This solidifies at room temperature, allowing it to remain in situ, providing a realistic rectal lesion when visualised through the transanal endoscopic equipment (Fig 1). The stages of polyp removal can be practised including circumferential excision margin marking, polyp excision and suturing of the rectal defect. This simulation has been trialled by delegates on a laboratory-based TEO course (Fig 2).

Ultravision™ is a new device that utilizes electrostatic precipitation to clear surgical smoke. The aim was to evaluate its performance during laparoscopic cholecystectomy.

AIM:Simulation allows the acquisition of complex skills within a safe environment. Endoscopic polypectomy has a long learning curve. Our novel polypectomy simulator may be a useful adjunct for training. The aim of this study was to assess its content validity. METHOD:The Welsh Institute for Minimal Access Therapy (WIMAT) endoscopy suitcase was designed to simulate colonic polypectomy. Participants from regional and national courses were recruited into the study. Each undertook a standardized simulated polypectomy and completed a seven-point Likert scale questionnaire examining its realism. RESULTS:In all, 17 participants completed the questionnaire: 15 (88.2%) gastroenterologists, one (5.9%) colorectal surgeon and one (5.9%) experienced endoscopic nurse specialist. Of the gastroenterologists, seven (46.7%) were consultants and eight (53.3%) were senior trainees or Post CCT (Certificate of Completion of Training) fellows. The mean number of real-life polypectomies performed by the cohort was 156 (95% CI 35-355). The highest scores were for 'mucosal realism' (median score 6.0, P=0.001), 'endoscopic snare control' (median score 6.0, P=0.001), 'handling the polyp' (median score 6.0, P=0.001) and 'raising mucosa' (median score 6.0, P<0.001). Of the 15 parameters examined only three were not statistically significant in favour of the simulator. These were 'anatomical realism of sessile polyps', 'resistance of scope movement' and 'paradoxical motion'. The overall score for the simulation was 6.0 (P < 0.001). There was no significant difference between the level of difficulty of the simulator compared with real life (median score 4.0, P = 0.559). CONCLUSION:The WIMAT colonoscopy suitcase model has excellent content validity for several parameters. This may have potential applications in medical training and assessment.

The evidence for using surgical simulators in training and assessment is growing rapidly. A systematic review has demonstrated the validity of different simulators for a range of procedures. Research suggests that skills developed on simulators can be transferred to the operating theatre. The increased interest in simulation comes as a result of the need to streamline surgical training. This is reflected by the numerous simulation-based courses that have become an essential part of modern surgical training.