The next generation of endoscopic simulation.

Over the past decade, the capabilities and use of endoscopic simulators have steadily expanded. Nevertheless, simulator use has yet to become fully integrated into standard endoscopic training programs. There are two obstacles. First, we lack adequate knowledge about how competency should be defined and how people become proficient in various specific techniques. Second, there has not been an affordable and convenient model to effectively assist in training and assessment. This paper explores the barriers to incorporation of simulators in training programs, and discusses currently available mechanical, computer, and ex vivo tissue models for assessment.