To tell or not to tell: an examination of the effectiveness of instruction in colonoscopy looping management

The traditional, patient-based method of teaching colonoscopy is being increasingly supplanted by surgical simulation. At present, however, there is no well-established simulation-based training curriculum for colonoscopy, and little is known about what variables best facilitate skill acquisition in this context. The primary aim of the present research was to investigate the effect of instruction in the acquisition of a complex psychomotor skill involved in colonoscopy: looping management. A secondary aim was to examine the association between innate abilities (specifically, hand-eye coordination and visual-spatial ability) and overall looping management skill. Participants (n = 47) were tested under a mixed experimental design, completing 10 trials on a physical model colonoscopy simulator after being assigned to either receive or not receive instruction on looping management. In addition to the surgical simulations, participants completed the Gibson Spiral Maze test of hand-eye coordination and the MRT-A test of visual-spatial ability. Three indices of looping management skill were assessed: loops solved, segment completion rate, and time in sigmoid. Contrary to hypotheses, non-instructed participants did not evidence better performance over time on the three dependent measures compared to instructed participants. Overall, however, and against predictions, instructed participants solved a greater percentage of loops than their non-instructed counterparts. Against hypotheses, no association was found between either hand-eye coordination or visual spatial ability and overall performance scores for the three dependent measures. Findings are discussed in relation to a framework based on discovery-based learning. Potential avenues for extending research on skill acquisition in simulated colonoscopy are also provided