title: Lack of a discriminatory function for endoscopy skills on a computer-based simulator.
abstract: BACKGROUND
  Computer-based endoscopy simulators have been developed to enable trainees to learn and gain technical endoscopic skills before operating on patients. However, these simulators have not been validated as models of patient-based endoscopy. This study aimed to determine whether a computer-based simulator can accurately represent an actual esophagogastroduodenoscopy (EGD) and colonoscopy and to evaluate its ability to discriminate between varying levels of expertise in performing endoscopic procedures based on objective parameters.
  
  
  METHODS
  In a prospective, observational trial, five first-year gastroenterology fellows and six gastroenterology attendings from a single academic center completed six endoscopy cases on the Simbionix GI Mentor II endoscopy simulator. The cases were selected to represent common clinical scenarios. The performance parameters were collected by the simulator. The 13 performance parameters measured by the endoscopy simulator were compared between the two study groups. After the simulator cases, the participants completed a survey evaluating the realism of the simulator.
  
  
  RESULTS
  Novices and experts were able to complete the tasks in the simulated cases with no significant overall differences between the two groups. The computer-based simulator was able to discriminate levels of expertise only for parameters related to the time spent on the procedure (total time, time to reach the second duodenum, time to reach the cecum, and efficiency of screening). No statistically significant differences were found for the other nine performance parameters measured by the simulator. Based on the survey data, expert opinion concluded that the simulator does not offer a realistic simulation of human endoscopy.
  
  
  CONCLUSIONS
  The computer-based endoscopy simulator displays a lack of ability to discriminate between novices and experts in terms of endoscopic skills based on measured objective performance parameters. The findings of this study suggest that the computer-based simulator lacks fidelity and that upgrades are necessary to increase the simulator's ability to reproduce human endoscopy more accurately.
authors.affiliation: Internal Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA. stephen.kim@uphs.upenn.edu
authors.forename: Stephen
authors.initials: S
authors.lastname: Kim
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Spencer
authors.forename: George A
authors.initials: GA
authors.lastname: Makar
authors.forename: Nuzhat A
authors.initials: NA
authors.lastname: Ahmad
authors.forename: David L
authors.initials: DL
authors.lastname: Jaffe
authors.forename: Gregory G
authors.initials: GG
authors.lastname: Ginsberg
authors.forename: Katherine J
authors.initials: KJ
authors.lastname: Kuchenbecker
authors.forename: Michael L
authors.initials: ML
authors.lastname: Kochman
mesh_terms: D002983:Clinical Competence; D003113:Colonoscopy / Q000592:standards*; D003198:Computer Simulation; D004384:Duodenoscopy / Q000592:standards*; D004945:Esophagoscopy / Q000592:standards*; D005773:Gastroscopy / Q000592:standards*; D006801:Humans; D011446:Prospective Studies
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