title: Validation of a flexible endoscopy simulator.
abstract: BACKGROUND
  Virtual reality (VR) simulation is a rapidly proliferating adjunct of surgical training. Numerous devices have evolved as educational tools in a variety of fields. Whether these tools can be used for validation of physicians' skills has yet to be determined. The objective of this study was to determine whether the GI Mentor (Simbionix, Lod, Israel) flexible endoscopy simulator construct could distinguish experienced endoscopists from beginners.
  
  
  METHODS
  Seventy-five surgical attendings, fellows, and residents were recruited for participation in the study. Two cohorts were used and these groups were selected from 2 separate scientific sessions. Participants completed a standardized questionnaire documenting their endoscopic training and experience. Physicians subsequently were designated as experienced or beginner after their endoscopic training and experience were evaluated. All participants completed 1 of 2 colonoscopic simulations. The GI Mentor objectively evaluated performance on the basis of programmed data points, including the time to reach the cecum, the percentage of mucosa visualized, the completed polypectomy rate, the percentage of time spent in clear view through the lumen, the percentage of time that the patient was in pain, and overall efficiency.
  
  
  RESULTS
  In both simulations, experienced endoscopists were more efficient than beginners (.32%/s vs. .26%/s, P=.02; and .53%/s vs. .37%/s, P=.03) and achieved a greater polypectomy rate (78% vs. 43%, P=.03; and 87% vs. 48%, P=.01). Furthermore, experienced endoscopists visualized more of the colonic surface (86% vs. 82%, P=.02) and spent a greater proportion of the time in clear view of the lumen (55% vs. 47%, P=.05) than beginners completing the first simulation. In the second simulation, experienced participants reached the cecum more rapidly than beginners (175 vs. 262 s, P=.01).
  
  
  CONCLUSIONS
  The G1 Mentor VR colonoscopy construct appears valid. Significant performance differences were shown between the experienced and beginner cohorts. The beginner participants in this study were all physicians with some degree of endoscopic experience. Therefore, the G1 Mentor distinguished endoscopists of varying experience and exposure. Further validation studies are needed to evaluate the breadth of programs inherent to this simulator and to determine whether it may be used in the future for qualification and certification purposes.
authors.affiliation: Minimally Invasive Surgery Center, Cleveland Clinic Foundation, Cleveland, OH, USA.
authors.forename: Joshua J
authors.initials: JJ
authors.lastname: Felsher
authors.forename: Max
authors.initials: M
authors.lastname: Olesevich
authors.forename: Houssam
authors.initials: H
authors.lastname: Farres
authors.forename: Michael
authors.initials: M
authors.lastname: Rosen
authors.forename: Alicia
authors.initials: A
authors.lastname: Fanning
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Dunkin
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Marks
mesh_terms: D002983:Clinical Competence; D015331:Cohort Studies; D020685:Colonoscopes; D003113:Colonoscopy / Q000379:methods*; D003198:Computer Simulation; D005257:Fellowships and Scholarships; D005260:Female; D005336:Fiber Optic Technology; D005762:Gastroenterology / Q000193:education; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008505:Medical Staff, Hospital; D011336:Probability; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires; D014481:United States; D014584:User-Computer Interface