Troubleshooting common endoscopic malfunctions: a study integrating a preoperative checklist and troubleshooting guide into surgical resident training

Introduction: This study assessed the utility of a checklist in troubleshooting endoscopic equipment. Prior studies have demonstrated that performance in simulated tasks translates into completion of similar tasks in the operating room. Checklists have been shown to decrease error and improve patient safety. There is currently limited experience with the use of simulation and checklists to improve troubleshooting of endoscopic equipment. We propose the use of a checklist during a simulated colonoscopy to improve performance during endoscopic troubleshooting.

Methods: This study randomized 20 surgical residents (PGY1-3) who were blinded to the purpose of the simulation. Participants were asked to complete two consecutive colonoscopies in a mock endoscopy suite. Prior to each trial, a standard set of equipment malfunctions were created; the equipment was returned to working order if the subjects were unable to successfully troubleshoot the equipment within the first 3 min of the simulation. Between trials, the intervention group was provided a troubleshooting checklist, which they were permitted to utilize during the second trial. The control group had no intervention. Scores were calculated for each task by subtracting time to completion from total time allowed (180 s), with 0 indicating the task was not completed. Groups were compared utilizing unpaired Student's t-test with p < 0.05 threshold for significance.

Results: Average scores were compared for 5 tasks in the first trial and 6 tasks in the second trial. During the first trial, there were no significant differences. However, during the second trial, there was a significant improvement with the checklist for 5/6 tasks.

Conclusion: Use of a checklist, with no further intervention, significantly improves the ability of novice endoscopists to identify and remedy common equipment malfunctions. Introduction of a troubleshooting checklist may represent a simple and low-cost way to improve both efficiency and safety in the endoscopy suite.