title: Training and transfer of colonoscopy skills: a multinational, randomized, blinded, controlled trial of simulator versus bedside training.
abstract: BACKGROUND
  The Olympus colonoscopy simulator provides a high-fidelity training platform designed to develop knowledge and skills in colonoscopy. It has the potential to shorten the learning process to competency.
  
  
  OBJECTIVE
  To investigate the efficacy of the simulator in training novices in colonoscopy by comparing training outcomes from simulator training with those of standard patient-based training.
  
  
  METHODS
  Multinational, multicenter, single-blind, randomized, controlled trial.
  
  
  METHODS
  Four academic endoscopy centers in the United Kingdom, Italy, and The Netherlands.
  
  
  METHODS
  This study included 36 novice colonoscopists who were randomized to 16 hours of simulator training (subjects) or patient-based training (controls). Participants completed 3 simulator cases before and after training. Three live cases were assessed after training by blinded experts.
  
  
  METHODS
  Automatically recorded performance metrics for the simulator cases and blinded expert assessment of live cases using Direct Observation of Procedural Skills and Global Score sheets.
  
  
  RESULTS
  Simulator training significantly improved performance on simulated cases compared with patient-based training. Subjects had higher completion rates (P=.001) and shorter completion times (P < .001) and demonstrated superior technical skill (reduced simulated pain scores, correct use of abdominal pressure, and loop management). On live colonoscopy, there were no significant differences between the 2 groups.
  
  
  CONCLUSIONS
  Assessment tools for live colonoscopies may lack sensitivity to discriminate between the skills of relative novices.
  
  
  CONCLUSIONS
  Performance of novices trained on the colonoscopy simulator matched the performance of those with standard patient-based colonoscopy training, and novices in the simulator group demonstrated superior technical skills on simulated cases. The simulator should be considered as a tool for developing knowledge and skills prior to clinical practice.
authors.affiliation: Wolfson Unit for Endoscopy, St. Mark's Hospital, Imperial College London, London, UK. ahaycock@imperial.ac.uk.
authors.forename: Adam
authors.initials: A
authors.lastname: Haycock
authors.forename: Arjun D
authors.initials: AD
authors.lastname: Koch
authors.forename: Pietro
authors.initials: P
authors.lastname: Familiari
authors.forename: Foke
authors.initials: F
authors.lastname: van Delft
authors.forename: Evelien
authors.initials: E
authors.lastname: Dekker
authors.forename: Lucio
authors.initials: L
authors.lastname: Petruzziello
authors.forename: Jelle
authors.initials: J
authors.lastname: Haringsma
authors.forename: Siwan
authors.initials: S
authors.lastname: Thomas-Gibson
mesh_terms: D000328:Adult; D002983:Clinical Competence; D003113:Colonoscopy / Q000379:methods*; D003198:Computer Simulation; D004503:Education, Medical, Graduate / Q000379:methods; D004521:Educational Measurement; D005260:Female; D005762:Gastroenterology / Q000193:education; D006801:Humans; D007318:Inservice Training / Q000379:methods*; D007391:International Cooperation; D007396:Internship and Residency; D008297:Male; D019095:Point-of-Care Systems; D011336:Probability; D011446:Prospective Studies; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D018709:Statistics, Nonparametric