Didactic teaching and simulator practice improve trainees' understanding and performance of biliary papillotomy.

BACKGROUND: Opportunities for trainees to learn the basics of papillotomy prior to performance on patients is desirable. A papillotomy scoring scale provides objective assessment of papillotomy performance.

AIM: To determine the effects of teaching and simulation practice on papillotomy performance using disposable papillae and the endoscopic retrograde cholangio-pancreatography (ERCP ) mechanical simulator (EMS).

METHOD: Trainees attended workshops with didactic talks on how to perform the "perfect" biliary papillotomy. They performed artificial papillotomy on a series of blank (baseline cut) and lined (learning cut) papillae marked with the perfect biliary axis using the EMS. An exit evaluation involved a papillotomy on a second blank (test cut) papilla. Video recording of the simulation practices were reviewed and scored blindly using the published papillotomy scoring scale modified for EMS practice. The scores for baseline and test blank cuts were compared. Trainees also responded to preand post-practice questionnaire surveys on their understanding and confidence in performing a biliary papillotomy and the credibility of simulator papillotomy practice.

RESULTS: The papillotomy performance of 32 trainees at 7 workshops was analyzed. There was a significant improvement in papillotomy score from 7.0 (6.0-8.0) to 8.5 (8.0-9.0) [Median (25%-75% interquartile range), Wilcoxon signed-rank test, p<0.05] when the baseline and test cuts were compared. There were significant improvements in post-practice score on understanding, confidence and credibility.

CONCLUSION: Didactic teaching and simulation practice demonstrates improvement in trainees' papillotomy performance using artificial papillae with the EMS. The impact of simulation practice as a valid education adjunct on clinical performance deserves further evaluation.