Computer-based virtual reality colonoscopy simulation improves patient-based colonoscopy performance.

BACKGROUND: Colonoscopy simulators that enable one to perform computer-based virtual colonoscopy now exist. However, data regarding the effectiveness of this virtual training are limited.
OBJECTIVE: To determine whether virtual reality simulator training translates into improved patient-based colonoscopy performance.
METHODS: The present study was a prospective controlled trial involving 18 residents between postgraduate years 2 and 4 with no previous colonoscopy experience. These residents were assigned to receive 16 h of virtual reality simulator training or no training. Both groups were evaluated on their first five patient-based colonoscopies. The primary outcome was the number of proctor 'assists' required per colonoscopy. Secondary outcomes included insertion time, depth of insertion, cecal intubation rate, proctor- and nurse-rated competence, and patient-rated pain.
RESULTS: The simulator group required significantly fewer proctor assists than the control group (1.94 versus 3.43; P ≤ 0.001), inserted the colonoscope further unassisted (43 cm versus 24 cm; P=0.003) and there was a trend to intubate the cecum more often (26% versus 10%; P=0.06). The simulator group received higher ratings of competence from both the proctors (2.28 versus 1.88 of 5; P=0.02) and the endoscopy nurses (2.56 versus 2.05 of 5; P=0.001). There were no significant differences in proctor-, nurse- or patient-rated pain, or attention to discomfort. CONCLULSIONS: Computer-based colonoscopy simulation in the initial stages of training improved novice trainees' patient-based colonoscopy performance.