Adam J Goodman1, Joshua Melson2, Harry R Aslanian3, Manoop S Bhutani4, Kumar Krishnan5, David R Lichtenstein6, Udayakumar Navaneethan7, Rahul Pannala8, Mansour A Parsi9, Allison R Schulman10, Amrita Sethi11, Shelby A Sullivan12, Nirav Thosani13, Guru Trikudanathan14, Arvind J Trindade15, Rabindra R Watson16, John T Maple17. 1. Division of Gastroenterology and Hepatology, NYU Langone Medical Center, New York University School of Medicine, New York, New York, USA. 2. Division of Digestive Diseases, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA. 3. Section of Digestive Diseases, Department of Internal Medicine, Yale University, New Haven, Connecticut, USA. 4. Department of Gastroenterology, Hepatology and Nutrition, MD Anderson Cancer Center, The University of Texas, Houston, Texas, USA. 5. Division of Gastroenterology, Department of Internal Medicine, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts, USA. 6. Division of Gastroenterology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA. 7. Center for Interventional Endoscopy, Florida Hospital, Orlando, Florida, USA. 8. Division of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Arizona, USA. 9. Department of Gastroenterology & Hepatology, Tulane University, New Orleans, Louisiana, USA. 10. Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA. 11. Division of Digestive and Liver Diseases, New York-Presbyterian/Columbia University Medical Center, New York, New York, USA. 12. Division of Gastroenterology and Hepatology, University of Colorado School of Medicine, Aurora, Colorado, USA. 13. Division of Gastroenterology, Hepatology and Nutrition, McGovern Medical School, UTHealth, Houston, Texas, USA. 14. Division of Gastroenterology, University of Minnesota, Minneapolis, Minnesota, USA. 15. Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, New Hyde Park, New York, USA. 16. Interventional Endoscopy Services, California Pacific Medical Center, San Francisco, California, USA. 17. Division of Digestive Diseases and Nutrition, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA. Electronic address: John-Maple@ouhsc.edu.
Abstract
BACKGROUND AND AIMS: Simulation refers to educational tools that allow for repetitive instruction in a nonpatient care environment that is risk-free. In GI endoscopy, simulators include ex vivo animal tissue models, live animal models, mechanical models, and virtual reality (VR) computer simulators. METHODS: After a structured search of the peer-reviewed medical literature, this document reviews commercially available GI endoscopy simulation systems and clinical outcomes of simulation in endoscopy. RESULTS: Mechanical simulators and VR simulators are frequently used early in training, whereas ex vivo and in vivo animal models are more commonly used for advanced endoscopy training. Multiple studies and systematic reviews show that simulation-based training appears to provide novice endoscopists with some advantage over untrained peers with regard to endpoints such as independent procedure completion and performance time, among others. Data also suggest that simulation training may accelerate the acquisition of specific technical skills in colonoscopy and upper endoscopy early in training. However, the available literature suggests that the benefits of simulator training appear to attenuate and cease after a finite period. Further studies are needed to determine if meeting competency metrics using simulation will predict actual clinical competency. CONCLUSIONS: Simulation training is a promising modality that may aid in endoscopic education. However, for widespread incorporation of simulators into gastroenterology training programs to occur, simulators must show a sustained advantage over traditional mentored teaching in a cost-effective manner. Because most studies evaluating simulation have focused on novice learners, the role of simulation training in helping practicing endoscopists gain proficiency using new techniques and devices should be further explored.
BACKGROUND AND AIMS: Simulation refers to educational tools that allow for repetitive instruction in a nonpatient care environment that is risk-free. In GI endoscopy, simulators include ex vivo animal tissue models, live animal models, mechanical models, and virtual reality (VR) computer simulators. METHODS: After a structured search of the peer-reviewed medical literature, this document reviews commercially available GI endoscopy simulation systems and clinical outcomes of simulation in endoscopy. RESULTS: Mechanical simulators and VR simulators are frequently used early in training, whereas ex vivo and in vivo animal models are more commonly used for advanced endoscopy training. Multiple studies and systematic reviews show that simulation-based training appears to provide novice endoscopists with some advantage over untrained peers with regard to endpoints such as independent procedure completion and performance time, among others. Data also suggest that simulation training may accelerate the acquisition of specific technical skills in colonoscopy and upper endoscopy early in training. However, the available literature suggests that the benefits of simulator training appear to attenuate and cease after a finite period. Further studies are needed to determine if meeting competency metrics using simulation will predict actual clinical competency. CONCLUSIONS: Simulation training is a promising modality that may aid in endoscopic education. However, for widespread incorporation of simulators into gastroenterology training programs to occur, simulators must show a sustained advantage over traditional mentored teaching in a cost-effective manner. Because most studies evaluating simulation have focused on novice learners, the role of simulation training in helping practicing endoscopists gain proficiency using new techniques and devices should be further explored.
Authors: Rajesh N Keswani; Amrita Sethi; Alessandro Repici; Helmut Messmann; Philip W Chiu Journal: Gastroenterology Date: 2020-05-07 Impact factor: 22.682