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Annual Meeting 2019 Presentations

Poster4-09: DISCOVERING CURRICULUM AND SIMULATOR DESIGN INSIGHTS VIA COGNITIVE TASK ANALYSIS FOR A NOVEL VIRTUAL REALITY SIMULATOR FOR ENDOSCOPIC SUBMUCOSAL DISSECTION
Cullen Jackson, PhD1, Sudeep Hegde, PhD2, Zhaohui Xia3, Tansel Halic, PhD4, Daniel B Jones, MD, MS, FACS1, Suvranu De, PhD3; 1Beth Israel Deaconess Medical Center, 2University at Buffalo, 3Rensselaer Polytechnic Institute, 4University of Central Arkansas

 

INTRODUCTION: Endoscopic Submucosal Dissection (ESD) is a minimally-invasive technique that enables complete en-bloc resection and shows low recurrence rates for treating colon cancer. Key challenges to the spread of ESD in Western countries are a lack of adoption and few training opportunities. As part of an ongoing project to develop a virtual reality simulator (the Virtual Endoluminal Surgery Simulator or VESS) for training ESD, we conducted a Cognitive Task Analysis (CTA) to better understand clinicians’ cognitive processes with respect to undertaking the procedure so we could use them as part of the instructional design of the simulator.

METHODS AND PROCEDURES: We conducted CTA-based structured interviews (60-90 mins) with seven endoscopists with varying degrees of experience with ESD (six attendings and one fellow). We also observed ESD procedures with one expert endoscopist (22 total hours of observation), and observed two expert instructors teach an ESD workshop using porcine models (five hours of observation).

RESULTS: Analysis of the data shows that different levels of learner require different simulator designs and interactions. For instance, a novice learner should start with one type of electrosurgical knife to reduce their cognitive burden and allow more focus on the technical aspects of the procedure (maintaining the dissection plane); in addition, they should focus on one procedural phase (marking the lesion) that is low risk (no chance of bleeds or perforations) but requires a high level of precision that will generalize to later phases. Conversely, a more seasoned learner should complete more phases with a complex lesion (spread across a haustral fold) requiring multiple techniques (tunneling, traction) and instruments to successfully dissect.

CONCLUSIONS: Qualitative data were collected through observations and interviews of ESD practitioners. Analysis of the data provides insights into how the training curricula should be designed to appropriately scaffold learners as they progress in ESD expertise. Designing these insights into the VESS will enhance its effectiveness as a trainer, and this technique could be applied to the development of training curricula for any simulation-based trainer.