title: Virtual reality colonoscopy simulation: a compulsory practice for the future colonoscopist?
abstract: OBJECTIVE
  As for any manual procedure, the learning curves for medical interventions can have undesirable phases, occurring mostly in the early experience of applying a technique. There have been impressive advances in endoscopic procedures during recent years, and there is an emerging trend that the number of procedures is increasing in parallel with these. In addition, the introduction of screening programs for colorectal cancer will also increase the numbers of procedures needed. Recent developments in medical simulation seem promising with regard to the possibility of "training out" undesirable parts of the learning curve outside the operating room. The aim of this study was to investigate whether the use of the AccuTouch flexible endoscopy simulator improves the early part of the learning curve in colonoscopy training.
  
  
  METHODS
  12 endoscopy trainees, 10 surgeons and two medical gastroenterologists, all with experience in gastroscopy but with no specific colonoscopy experience, were randomly assigned to either simulator training or to a control group. They all received the same theoretical study package and the training group practiced with the AccuTouch colonoscopy simulator until a predefined expert level of performance was reached. All trainees performed their first ten individual colonoscopies described in detail in a separate protocol.
  
  
  RESULTS
  Trainees in the simulator-trained group performed significantly better (P=0.0011) and managed to reach the cecum in 52% of their cases (vs. 19% in the control group), and were 4.53 times more likely to succeed compared with the controls. Additionally, there was a significantly shorter procedure time and less patient discomfort in the hands of the simulator-trained group.
  
  
  CONCLUSIONS
  Skills acquired using the AccuTouch simulator transfer well into the clinical colonoscopy environment. The results of this trial clearly support the plan to integrate simulator training into endoscopic education curricula.
authors.affiliation: Department of Surgery, and Center for Advanced Medical Simulation, Karolinska Hospital, Stockholm, Sweden. gunnar.ahlberg@karolinska.se
authors.forename: G
authors.initials: G
authors.lastname: Ahlberg
authors.forename: R
authors.initials: R
authors.lastname: Hultcrantz
authors.forename: E
authors.initials: E
authors.lastname: Jaramillo
authors.forename: A
authors.initials: A
authors.lastname: Lindblom
authors.forename: D
authors.initials: D
authors.lastname: Arvidsson
mesh_terms: D000328:Adult; D002983:Clinical Competence; D003108:Colonic Diseases / Q000000981:diagnostic imaging; D023881:Colonography, Computed Tomographic / Q000379:methods*; D004503:Education, Medical, Graduate / Q000379:methods; D005260:Female; D005544:Forecasting; D005762:Gastroenterology / Q000193:education; D006801:Humans; D007396:Internship and Residency; D008297:Male; D016544:Patient Simulation; D018570:Risk Assessment; D012680:Sensitivity and Specificity