KU School of Medicine–Wichita
1010 N. Kansas
Wichita, KS, 67214
November 18, 2020
By Brian Whepley
Guiding a scope for an upper endoscopy or colonoscopy can be counterintuitive, like backing up a trailer. Move left to go right, right to go left, except a digestive tract has more twists and turns than a driveway. And, of course, there's a human involved, one more likely than a trailer to feel discomfort if something goes awry.
Two residency programs sponsored by KU School of Medicine-Wichita, general surgery and family medicine at Ascension Via Christi, recently pooled resources to invest in a simulator, the GI Mentor, to improve training for gastrointestinal procedures. The simulator is housed in the surgical residency's skills lab at Ascension Via Christi St. Francis.
Joining forces for the simulator and other training, "it really is a win-win for both programs," said Marilee McBoyle, M.D., surgery director of the lab, whose education director is John Smith, M.D. Both are KU School of Medicine-Wichita clinical professors.
McBoyle said general surgery residents "get an amazing amount of both upper and lower endoscopies with patients, but the GI Mentor lets them practice specific procedures on the identical machine that they will do the testing" for the Fundamentals of Endoscopic Surgery exam.
"Family medicine residents may not get as much endoscopic exposure as general surgery residents do, so for those residents planning to go to rural communities, the GI Mentor provides an additional benefit," McBoyle said.
The skills lab earned accreditation in mid-2019 from the American College of Surgeons, an extensive process involving a site visit. Part of the lab's mission is reaching out to other residency programs, and family medicine was a natural. Plenty of residents will have opportunities to use the device, as the surgical program has 31 and family medicine 54.
Incorporating actual scopes, the GI Mentor has separate openings for upper endoscopies and colonoscopies. The simulator has a video monitor and provides a realistic journey up and down areas of investigation. It has numerous modules ranging from basic orientation to more involved procedures like polyp removal. Its great advantage is residents can practice a procedure repeatedly, working on technique and developing a feel for the scope.
"It takes care of a lot of the hand-eye coordination and a lot of the understanding of the mechanics of the machine," said Devin Penny, D.O., a family medicine residency faculty member. "Before they do their first actual procedure, they can spend time with the machine. They can do 10 cases over the course of a couple of hours if they want to. The residents can get proficient with the scope and then we can work on nuances."
"In the body, with all the different pressures along the scope, the front of the scope can do something unexpected. That absolutely happens in real life," Penny said. "So left doesn't always move the scope to the left, and you have to adjust. It's just a complicated thing, and to simulate that, you really have to have a higher level of a simulator."
"These devices help the learner establish muscle memory. They help with coordination and speed. They train the brain to be able to function in that capacity comfortably," said Joe Crain, skills lab manager. "It gives immediate feedback on their strengths and weaknesses."
The training occurs, Penny said, without "the pressure of making sure the patient's intubated or that someone has to take over and finish because of time constraints. That's why it's cool."
"They can make mistakes in the sim lab, so they don't in the patient," Crain said.
The number of endoscopic procedures a practicing physician does can depend on their interests and where they practice. Some general surgeons perform them, especially if located where there are few gastroenterologists. The same is true of family doctors practicing in rural areas without ready access to surgeons or gastroenterologists.
The surgical skills lab's work is not limited to the GI Mentor. Its training includes sutures, wound care and REBOA, where residents learn to insert balloon catheters that control hemorrhages until a surgeon can perform repairs. The lab also has a Lap Mentor (laparoscopic simulator) to teach suturing skills and surgical procedures such as colon resection, gallbladder removal and Nissen fundoplication, which combats acid reflux.
The lab uses a 3D printer to make body parts and kits to train residents in surgery, family medicine and possibly other programs in certain tasks. They've produced veins and arteries for a vascular anastomosis lab, which teaches how to connect blood vessels to each other, such as in a coronary bypass. They've produced bowel and intestine sections, from silicon, foam and other materials. They've made wounds and burns - McBoyle's specialty - for training.
The lab's work is just one piece of the training residents receive.
"We know it's going to parallel what they're doing in the operating room, so they can advance to higher-level skills more quickly and learn more in a shorter amount of time," Crain said. "If it helps one doctor learn one skill to save one patient, how can you say it's not worth it?"KU School of Medicine-Wichita