title: Evaluation of hands-on training in colonoscopy: is a computer-based simulator useful?
abstract: OBJECTIVE
  The advantages of using a computer-based simulator during colonoscopy training are debated. We aimed to explore its usefulness in objectively measuring trainees' competence in colonoscopy.
  
  
  METHODS
  Twelve colonoscopy trainees (fully trained in upper GI endoscopy) were evaluated using a computer-based simulator (GI-Mentor, Symbionix) before and during hands-on training (i.e. after 60 colonoscopies); the controls were 15 experts (>90% of caecal intubation). Both trainees and experts performed two "screening" simulations (easy and difficult) in a randomised order, and the time to reach the caecum and withdrawal time was assessed.
  
  
  RESULTS
  The percentage of caecal intubation progressively increased during hands-on training. All of the trainees intubated the caecum during the easy and difficult simulations, both before and during hands-on training. The median time (interquartile range) to reach the caecum upon easy simulation was the only variable influenced by hands-on training: 2.7 min (2.1-3.2) before and 1.9 min (1.6-2) during training (p<0.01). Withdrawal time was ≥6 min in the case of five trainees before training, and three during hands-on training. Computer-based simulator performance did not correlate with hands-on training performance.
  
  
  CONCLUSIONS
  The computer-based simulator was not found to be useful in evaluating competence during hands-on training in colonoscopy.
authors.affiliation: Chair of Gastroenterology, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Elvevi
authors.forename: Paolo
authors.initials: P
authors.lastname: Cantù
authors.forename: Giovanni
authors.initials: G
authors.lastname: Maconi
authors.forename: Dario
authors.initials: D
authors.lastname: Conte
authors.forename: Roberto
authors.initials: R
authors.lastname: Penagini
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D002432:Cecum; D002983:Clinical Competence; D003113:Colonoscopy / Q000193:education*; D003198:Computer Simulation; D004503:Education, Medical, Graduate / Q000379:methods*; D004521:Educational Measurement; D005260:Female; D006801:Humans; D007441:Intubation, Gastrointestinal; D008297:Male; D018709:Statistics, Nonparametric; D013997:Time Factors