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Objective: To develop a low-cost simulator model and a colonoscope with materials that are easily accessible to offer training on colonoscopy skills during undergraduate studies. Since this is the procedure of choice for colorectal cancer screening, the general practitioner must be able to recognize its main indications, preparation, and complications. Methods: Using materials such as a mannequin, a vehicle inspection camera, a conduit, polyvinyl chloride (PVC) pipe, acrylic, wood, and red paint, we built a simulator and a 150-cm long and 20-to-25-mm thick colonoscope. The colonoscope's handle and handhold were made of acrylic, the colonoscope's mobile end was made with articulated PVC rings, and the up and down movements were performed according to the traction of the steel cables. The camera attached to its distal end enables connection to a smartphone to view the image. In the simulator, the conduit was inserted into the mannequin to simulate the curvatures of the colon. Red spray paint was used to simulate the staining of the colonic mucosa in the inner region of the mannequin and the adventitial layer in the outer region. Results: We were able to build a simulator and a colonoscope with a total amount of R $ 182.82 (roughly US$ 36.50). Both were tested and proved to be useful in the acquisition of psychomotor and cognitive skills in colonoscopy. Conclusion The simulator and colonoscope developed by us are cost-effective, useful in the acquisition of psychomotor and cognitive skills in colonoscopy, and can facilitate the structuring of a training program for undergraduate students. (AU)

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INTRODUCTION: To practice colonoscopy in a Latin American country it is required to certify the acquisition of specific competence, but there is no consensus regarding the criteria that define it. Lack of training in digestive endoscopy skills is associated with an increased risk of diagnostic and therapeutic error; late diagnosis of cancer, increased risk of complications and incomplete procedures with negative consequences for patients. OBJECTIVE: To establish the performance criteria of the specific competence required by a specialist to perform colonoscopy, in order to impact with better results on the quality of health. MATERIALS AND METHODS: Qualitative study of consensus of experts. With semi-structured personal interviews, the information is documented to carry out the questionnaires that are applied in successive rounds until reaching consensus of more than 70% with the participation of more than 80% of the experts, using the Delphi method. RESULTS: Performance criteria are identified, which determine the specific competence required to perform colonoscopy with quality and safety. With significant findings due to the high percentage of agreement, they are presented grouped into 4 categories: general, before, during and after the procedure. Among the most important criteria that reached 100% agreement, are those related to cognitive, motor and integrative skills; quality, safety, screening, diagnostic and therapeutic techniques of this procedure. CONCLUSION: The criteria standardized by consensus, constitute a very valuable tool in the Latin American countries for the formation and evaluation of competences.

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RESUMEN Introducción: Para ejercer la colonoscopía en un país latinoamericano es requisito certificar la adquisición de la competencia específica, pero no hay consenso respecto a los criterios que la definen. La falta de formación en competencias en endoscopía digestiva, se asocia a mayor riesgo de error diagnóstico y terapéutico; diagnóstico tardío del cáncer, mayor riesgo de complicaciones y la realización de procedimientos incompletos con consecuencias negativas para los pacientes. Objetivo: Establecer los criterios de desempeño de la competencia específica requerida por un especialista para ejercer la colonoscopía, con el fin de impactar con mejores resultados en la calidad de la salud. Materiales y métodos: Estudio cualitativo de consenso de expertos. Con entrevistas personales semiestructuradas se documenta la información para realizar los cuestionarios que se aplican en rondas sucesivas hasta alcanzar consenso mayor al 70% con la participación de más del 80% de los expertos, utilizando el método Delphi. Resultados: Se identifican los criterios de desempeño, que determinan la competencia específica requerida para ejercer con calidad y seguridad la colonoscopía. Con hallazgos significativos por el alto porcentaje de acuerdo, se presentan agrupados en 4 categorías: general, antes, durante y posterior al procedimiento. Dentro de los criterios más importantes que alcanzaron un acuerdo del 100%, están los relacionados con habilidades cognitivas, motoras e integrativas; calidad, seguridad, tamización, técnicas diagnósticas y terapéuticas de este procedimiento. Conclusión: Los criterios estandarizados por consenso, constituyen una herramienta muy valiosa en los países latinoamericanos para la formación y evaluación de competencias.

ABSTRACT Introduction: To practice colonoscopy in a Latin American country it is required to certify the acquisition of specific competence, but there is no consensus regarding the criteria that define it. Lack of training in digestive endoscopy skills is associated with an increased risk of diagnostic and therapeutic error; late diagnosis of cancer, increased risk of complications and incomplete procedures with negative consequences for patients. Objective: To establish the performance criteria of the specific competence required by a specialist to perform colonoscopy, in order to impact with better results on the quality of health. Materials and methods: Qualitative study of consensus of experts. With semi-structured personal interviews, the information is documented to carry out the questionnaires that are applied in successive rounds until reaching consensus of more than 70% with the participation of more than 80% of the experts, using the Delphi method. Results: Performance criteria are identified, which determine the specific competence required to perform colonoscopy with quality and safety. With significant findings due to the high percentage of agreement, they are presented grouped into 4 categories: general, before, during and after the procedure. Among the most important criteria that reached 100% agreement, are those related to cognitive, motor and integrative skills; quality, safety, screening, diagnostic and therapeutic techniques of this procedure. Conclusion: The criteria standardized by consensus, constitute a very valuable tool in the Latin American countries for the formation and evaluation of competences.

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BACKGROUND: Quality of bowel preparation and patient knowledge remains a major barrier for completing colorectal cancer screening. Few studies have tested unique ways to impact patient understanding centering on interactive computer programs, pictures, and brochures. Two studies explored instructional videos but focused on patient compliance and anxiety as endpoints. Furthermore, excessive video length and content may limit their impact on a broad patient population. No study so far has studied a video's impact on preparation quality and patient understanding of the colonoscopy procedure. METHODS: We conducted a single blinded prospective study of inner city patients presenting for a first time screening colonoscopy. During their initial visit patients were randomized to watch an instructional colonoscopy video or a video discussing gastroesophageal reflux disease (GERD). All patients watched a 6 minutes long video with the same spokesperson, completed a demographic questionnaire (Supplemental Digital Content 1, http://links.lww.com/JCG/A352) and were enrolled only if screened within 30 days of their visit. On the day of the colonoscopy, patients completed a 14 question quiz of their knowledge. Blinded endoscopist graded patient preparations based on the Ottawa scale. All authors had access to the study data and reviewed and approved the final manuscript. RESULTS: Among the 104 subjects enrolled in the study, 56 were in the colonoscopy video group, 48 were in GERD video group, and 12 were excluded. Overall, 48% were male and 52% female; 90% of patients had less than a high school education, 76% were African American, and 67% used a 4 L split-dose preparation. There were no differences between either video group with regard to any of the above categories. Comparisons between the 2 groups revealed that the colonoscopy video group had significantly better Ottawa bowel preparation score (4.77 vs. 6.85; P=0.01) than the GERD video group. The colonoscopy video group also had less-inadequate repeat bowel preparations versus the GERD video group (9% vs. 23%; P<0.01). The overall score on the knowledge questionnaire (Supplemental Digital Content 1, http://links.lww.com/JCG/A352) was significantly higher in the colonoscopy video group as compared with the GERD video group (12.77 vs. 11.08; P<0.001. In all patients the overall quiz score positively correlated with preparation quality (odds ratio, 2.31; confidence interval, 1.35-3.94; P<0.001). CONCLUSIONS: Our unique population represented an overwhelmingly under-educated (85% had a high school education or less) and minority group (76% African American). They are one of the most at risk of having multiple barriers such as comprehension and reading difficulties resulting in poor preparation examinations and no shows to procedures. Our instructional video proved to be high yield in this population. The patients assigned to watch the colonoscopy video showed a significant increase in "excellent" grade adequate bowel preparation quality by >23% and a significant decrease in "inadequate" bowel preparations by almost 50%. Our study proves that an educational video can improve both comprehension with regard to all aspects of colonoscopy. ClinicalTrials.gov number, NCT02906969.

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