Endoscopic tip-control measured by a snare tip soft coagulation training model correlates with endoscopist profile and therapeutic expertise (The HAM Study)

ObjectiveOperator technical skill is recognised as a critical determinant of surgical outcomes. However, no equivalent recognition for quality of endoscope tip manipulation (tip-control) exists. We aimed to create an ex-vivo snare tip soft coagulation (STSC) model to objectively quantify endoscopist tip-control.MethodThis prospective interventional study was conducted at Ghent University Hospital. Participants applied STSC to a training model simulating four endoscopic mucosal resection (EMR) defects on a slice of ham. Accuracy (correct/total-hits) and speed (correct-hits/s) were assessed from a video by a single-blinded rater using a web-based scoring system.Results22 endoscopists participated. Interventional endoscopists demonstrated significantly higher accuracy (87.0%) and speed (0.184 correct-hits/s) compared with trainees (74.5%, 0.106 correct-hits/s; both p<0.001) and non-interventional consultants (77%, 0.141 correct-hits/s; p<0.001). The tip-control of trainees and non-interventional consultants was not significantly different. Endoscopists having performed ≥1000 colonoscopies, performing SMSA-4 polypectomies or ≥50 EMRs/year showed superior tip-control. Endoscopists with >5 years of endoscopic experience did not have better tip-control (accuracy 88.0%(p=0.07), speed 0.132 hits/s (p=0.36)) when compared with those with ≤4 years of experience.ConclusionThis inexpensive ex vivo STSC simulation model effectively quantified endoscopic tip-control, correlating with endoscopist expertise and clinical profiles. The model could support the shift towards competency-based education, potentially improving patient outcomes.Trial registration numberNCT05660317.