Colorectal cancer is a major cause of disease and death in Australia. It is second only to breast cancer in prevalence and second only to lung cancer in cancer-related mortality. One of the most effective interventions is screening. If caught early, bowel cancer can be controlled, and the spread contained. In 2008 the Australian Government established the National Bowel Screening Program to facilitate a nationwide effort to raise the amount of screening taking place.
One negative consequence of this initiative is the enormous pressure it placed on gastrointestinal surgeons tasked with performing the colonoscopy scans. For that reason, part of the funding initiative from the government was invested into finding ways to train the next generation of coloscopists more quickly and effectively.
In partnership with the CSIRO, Queensland Health and the Department of Health and Aging, a UQ team was tasked with analysing current training practices to identify areas of potential innovation and improvement.
Solution
The project tackled five major areas of what is called part-task training. The idea was to improve skill in these key areas rather than the typical apprenticeship model in which most of the learning happened “on the job” under expert supervision which served as an inefficient bottle-neck at the time. The team identified five areas in which skills could be improved before this final training:
- Fundamental human factors analysis of the skills and understanding required to perform the task.
- Part-task in which recruits are familiarised with steering the scope tip.
- Part-task on a model torso in which users are familiarised with the forces being applied, identifying scope loops and learning how to get out of loops.
- Familiarisation through video footage sessions, to the types of malignant and benign growths they would encounter during scoping.
- Use of the CSIRO’s advanced simulator, identifying performance criteria and dependent measures.
Research Team
Associate Professor David Hewett, Professor Stephan Riek, Professor Guy Wallis, Dr Annaliese Plooy, Professor Robin Burgess-Limerick, Professor Mark Horswill, Professor Marcus Watson
Funding Source
Department of Health and Aging, and Queensland Health
Outputs
- Training videos.
- Several academic publications.
- Construct validation of a physical model colonoscopy simulator, AM Plooy, A Hill, MS Horswill, ASG Cresp, MO Watson, SY Ooi, S Riek, ...Gastrointestinal Endoscopy 76 (1), 144-150
- Assessing the realism of colonoscopy simulation: the development of an instrument and systematic comparison of 4 simulators, A Hill, MS Horswill, AM Plooy, MO Watson, R Karamatic, TA Basit, ...Gastrointestinal Endoscopy 75 (3), 631-640. e3
- A competency framework for colonoscopy training derived from cognitive task analysis techniques and expert review, CM Zupanc, R Burgess-Limerick, A Hill, S Riek, GM Wallis, AM Plooy, ... BMC Medical Education 15 (1), 1-11
- The efficacy of training insertion skill on a physical model colonoscopy simulator, AM Plooy, A Hill, MS Horswill, ASG Cresp, R Karamatic, S Riek, ... Endoscopy International Open 4 (12), E1252-E1260
- Assessing colonoscopic inspection skill using a virtual withdrawal simulation: a preliminary validation of performance metrics, CM Zupanc, GM Wallis, A Hill, R Burgess-Limerick, S Riek, AM Plooy, ... BMC Medical Education 17 (1), 1-10
- Assessment of colorectal polyp recognition skill: development and validation of an objective test, A Hill, MS Horswill, AM Plooy, MO Watson, LN Rowlands, GM Wallis, ... Surgical Endoscopy 31 (6), 2426-2436
Outcomes
The training videos have been adopted by GESA – the national peak body for training gastrointestinal surgeons. The scope tip training innovation have likewise become a core element of training nationally, and use of the torso part-task training system has likewise been used.
Impact
One of the crucial elements of this project was the close collaboration between UQ and partners in Queensland Health. By validating our measures with trained coloscopists and medical trainees, we were able to make an evidence-based case for the introduction of these elements into the national curriculum with little or no push-back.
Project members
HMNS Researchers
