Role of simulation in training the next generation of endoscopists.

The use of simulation based training in endoscopy has been increasingly described, simulation has the potential reduce the harm caused to patients by novices performing procedures, increase efficiency by reducing the time needed to train in the clinical environment and increase the opportunity to repeatedly practice rare procedures as well as allowing the assessment of performance. Simulators can consist of mechanical devices, employ cadaveric animal tissue or use virtual reality technology. Simulators have been used to teach upper and lower gastrointestinal endoscopy as well as interventional procedures. This review reviews the currently available endoscopic simulators, and the evidence for their efficacy, demonstrating that the ability of simulators to differentiate between novice and expert endoscopists is well established. There is limited evidence for improved patient outcome as a result of simulation training. We also consider how the environment within which a simulation is placed can be manipulated to alter the learning achieved, broadening the scope of simulation to develop communication as well as technical skills. Finally the implications for future practice are considered; technology is likely improve the fidelity of simulators, increasing the potential for simulation to improve patient outcomes. The impact of the simulation environment, and the correct place of simulation within the training curriculum are both issues which need addressing.