Teaching peroral endoscopic myotomy (POEM) to surgeons in practice: an "into the fire" pre/post-test curriculum

Introduction With the increasing adoption of peroral endoscopic myotomy (POEM) as a first-line therapy for achalasia as well as a growing list of other indications, it is apparent that there is a need for effective training methods for both endoscopists in training and those already in practice. We present a hands-on-focused with pre-and post-testing methodology to teach these skills. Methods Six POEM courses were taught by 11 experienced POEM endoscopists at two independent simulation laboratories. The training curriculum included a pre-training test, lectures and discussion, mentored hands-on instruction using live porcine and ex-plant models, and a post-training test. The scoring sheet for the pre-and post-tests assessed the POEM performance with a Likert-like scale measuring equipment setup, mucosotomy creation, endoscope navigation, visualization, myotomy, and closure. Participants were stratified by their experience with upper-GI endoscopy (Novices < 100 cases vs. Experts >= 100 cases), and their data were analyzed and compared. Results Sixty-five participants with varying degrees of experience in upper-GI endoscopy and laparoscopic achalasia cases completed the training curriculum. Participants improved knowledge scores from 69.7 +/- 17.1 (pre-test) to 87.7 +/- 10.8 (post-test) (p< 0.01). POEM performance increased from 15.1 +/- 5.1 to 25.0 +/- 5.5 (out of 30) (p< 0.01) with the greatest gains in mucosotomy [1.7-4.4 (out of 5), p< 0.01] and equipment (3.4-4.7, p< 0.01). Novices had significantly lower pre-test scores compared with Experts in upper-GI endoscopy (overall pre-score: 11.9 +/- 5.6 vs. 16.3 +/- 4.6, p< 0.01). Both groups improved significantly after the course, and there were no differences in post-test scores (overall post-score: 23.9 +/- 6.6 vs. 25.4 +/- 5.1, p = 0.34) between Novices and Experts. Conclusions A multimodal curriculum with procedural practice was an effective curricular design for teaching POEM to practitioners. The curriculum was specifically helpful for training surgeons with less upper-GI endoscopy experience.