title: Learning the skills of flexible sigmoidoscopy - the wider perspective.
abstract: BACKGROUND
  Nurse-led gastrointestinal endoscopy is a priority clinical area in the UK. Endoscopic procedures are challenging to learn, requiring a combination of technical competence (manipulating a flexible endoscope and interpreting the findings) and interpersonal skills (engaging effectively with a conscious patient who is frequently apprehensive). This paper explores the potential of an innovative, scenario-based approach which links a simulated patient with a computer-driven virtual reality (VR) training device for flexible sigmoidoscopy. Within this safe yet realistic quasi-clinical environment, learners carry out the procedure while interacting with the 'patient'. Communication skills are assessed by simulated patients, while quantitative performance data relating to the procedure is generated automatically by the VR simulator.
  
  
  METHODS
  This pilot study took place within a nurse practitioner endoscopy course. A mixed methodology combined qualitative and quantitative data (observation and interview studies, communication rating scales and a range of computer-generated output measures from the VR simulator) in a multifaceted evaluation.
  
  
  RESULTS
  Seven nurses took part in the study. Participants found the scenarios to be a convincing and powerful learning experience. All experienced high levels of anxiety. Simulated patients identified strengths in participants' communication skills, together with areas for development. Simulator-based practice led to an improvement in objective performance measures.
  
  
  CONCLUSIONS
  Scenario-based training provides a powerful learning experience, allowing participants to build their technical expertise and apply it within a holistic clinical context without the risk of causing harm. We used this pilot study as a springboard for discussions over wider implications of procedure-based skills training, locating it within the literature on expertise and situated learning.
authors.affiliation: Imperial College London, UK. r.kneebone@imperial.ac.uk
authors.forename: R L
authors.initials: RL
authors.lastname: Kneebone
authors.forename: D
authors.initials: D
authors.lastname: Nestel
authors.forename: K
authors.initials: K
authors.lastname: Moorthy
authors.forename: P
authors.initials: P
authors.lastname: Taylor
authors.forename: S
authors.initials: S
authors.lastname: Bann
authors.forename: Y
authors.initials: Y
authors.lastname: Munz
authors.forename: A
authors.initials: A
authors.lastname: Darzi
mesh_terms: D002983:Clinical Competence / Q000592:standards*; D003198:Computer Simulation; D004509:Education, Nursing, Continuing / Q000379:methods; D004724:Endoscopy / Q000193:education / Q000379:methods; D006801:Humans; D009722:Nurse Practitioners / Q000193:education*; D024802:Nurse's Role; D016544:Patient Simulation; D010865:Pilot Projects; D012812:Sigmoidoscopy / Q000592:standards*