Training with a computer-based simulator achieves basic manual skills required for upper endoscopy: a randomized controlled trial.
BACKGROUND
Changes in medical practice have constrained the time available for education and the availability of patients for training. Computer-based simulators have been devised that can be used to achieve manual skills without patient contact. This study prospectively compared, in a clinical setting, the efficacy of a computer-based simulator for training in upper endoscopy.


METHODS
Twenty-two fellows with no experience in endoscopy were randomly assigned to two groups: one group underwent 10 hours of preclinical training with a computer-based simulator, and the other did not. Each trainee performed upper endoscopy in 19 or 20 patients. Performance parameters evaluated included the following: esophageal intubation, procedure duration and completeness, and request for assistance. The performance of the trainees also was evaluated by the endoscopy instructor.


RESULTS
A total of 420 upper endoscopies were performed; the computer pretrained group performed 212 and the non-pretrained group, 208. The pretrained group performed more complete procedures (87.8% vs. 70.0%; p < 0.0001), required less assistance (41.3% vs. 97.9%; p < 0.0001), and the instructor assessed performance as "positive" more often for this group (86.8% vs. 56.7%; p < 0.0001). The length of procedures was comparable for the two groups.


CONCLUSIONS
The computer-based simulator is effective in providing novice trainees with the skills needed for identification of anatomical landmarks and basic endoscopic maneuvers, and in reducing the need for assistance by instructors.
Di Giulio
Emilio
E
Divisione di Malattie Digestive e del Fegato, Ospedale Sant'Andrea, Universitá di Roma La Sapienza, Via della Balduina 80, 00136 Rome, Italy.
Fregonese
Diego
D
Casetti
Tino
T
Cestari
Renzo
R
Chilovi
Fausto
F
D'Ambra
Giancarlo
G
Di Matteo
Giovanni
G
Ficano
Leonardo
L
Delle Fave
Gianfranco
G
D000328:Adult; D002983:Clinical Competence; D003198:Computer Simulation; D016099:Endoscopy, Gastrointestinal; D004947:Esophagus; D005260:Female; D005762:Gastroenterology / Q000193:education*; D006801:Humans; D007440:Intubation; D008297:Male; D008875:Middle Aged