Teaching peroral endoscopic pyloromyotomy (POP) to practicing endoscopists: An into-the-fire approach to simulation

Background: Peroral endoscopic pyloromyotomy, or gastric peroral endoscopic myotomy, is a novel endoscopic procedure for the treatment of refractory gastroparesis. We present a simulation-based curriculum using an into-the-fire approach with hands-on preand post-tests to teach this procedure. Methods: Six, 1-day peroral endoscopic pyloromyotomy courses were taught by an expert surgical endoscopist in 2018 to 2019. The curriculum is composed of a series of pretraining tests, lectures, mentored hands-on instruction, and post-training tests using porcine models. Both preand post-testing included a confidence survey, a knowledge-based written test, and a specific assessment form for the peroral endoscopic pyloromyotomy procedure. Participants' scores were analyzed using paired t tests. Results: Twenty-eight practicing physicians participated. After completing the curriculum, participants had improved confidence scores (10.5 +/- 5.2 vs 19.4 +/- 3.6; P < .001), written test scores (6.8 +/- 1.6 vs 8.0 +/- 1.1; P < .001), and hands-on performance scores (23.6 +/- 3.4 vs 29.3 +/- 1.4; P < .001) with marked improvement in all components of the peroral endoscopic pyloromyotomy procedure. Postcourse surveys showed 93% of participants had performed or intended to perform the peroral endoscopic pyloromyotomy procedure within the next year. Conclusion: Our simulation curriculum with an into-the-fire approach to teach peroral endoscopic pyloromyotomy is effective in improving practitioner knowledge, confidence, and technical skills, leading to an increase in the adoption of this procedure. (c) 2020 Elsevier Inc. All rights reserved.

Automated summary

The simulation-based curriculum for peroral endoscopic pyloromyotomy proved effective in improving practitioner knowledge, confidence, and technical skills. Participants showed significant improvements in all aspects of the procedure, leading to a high adoption rate among the practitioners.