title: Poor discriminatory function for endoscopic skills on a computer-based simulator.
abstract: BACKGROUND
  Computer-based endoscopy simulators may enable trainees to learn and develop technical skills before performing on patients. Simulators require validation as adequate models of live endoscopy before being used for training or assessment purposes.
  
  
  OBJECTIVE
  To evaluate content and criterion validity of the CAE EndoscopyVR Simulator colonoscopy and EGD modules as predictors of clinical endoscopic skills.
  
  
  METHODS
  Prospective, observational, non-randomized, parallel cohort study.
  
  
  METHODS
  Single academic center with accredited gastroenterology training program.
  
  
  METHODS
  Five novice first-year gastroenterology fellows and 6 expert gastroenterology attending physicians.
  
  
  METHODS
  Participants performed 18 simulated colonoscopies and 6 simulated EGDs. The simulator recorded objective performance parameters. Participants then completed feedback surveys.
  
  
  METHODS
  The 57 objective performance parameters measured by the endoscopy simulator were compared between the two study groups. Novice and expert survey responses were analyzed.
  
  
  RESULTS
  Significant differences between novice and expert performance were detected in only 19 of 57 (33%) performance metrics. Eight of these 19 (42%) were time-related metrics, such as total procedure time, time to anatomic landmarks, and time spent in contact with GI mucosa. Of 49 non-time related measures, the few additional statistically significant differences between novices and experts involved air insufflation, sedation management, endoscope force, and patient comfort. These findings are of uncertain clinical significance. Survey data found multiple aspects of the simulation to be unrealistic compared with human endoscopy.
  
  
  CONCLUSIONS
  Small sample size.
  
  
  CONCLUSIONS
  The CAE EndoscopyVR Simulator displays poor content and criterion validity and is thereby incapable of predicting skill during in vivo endoscopy.
authors.affiliation: Department of Medicine, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA.
authors.forename: Ryan A
authors.initials: RA
authors.lastname: McConnell
authors.forename: Stephen
authors.initials: S
authors.lastname: Kim
authors.forename: Nuzhat A
authors.initials: NA
authors.lastname: Ahmad
authors.forename: Gary W
authors.initials: GW
authors.lastname: Falk
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Forde
authors.forename: Gregory G
authors.initials: GG
authors.lastname: Ginsberg
authors.forename: David L
authors.initials: DL
authors.lastname: Jaffe
authors.forename: George A
authors.initials: GA
authors.lastname: Makar
authors.forename: William B
authors.initials: WB
authors.lastname: Long
authors.forename: Kashyap V
authors.initials: KV
authors.lastname: Panganamamula
authors.forename: Michael L
authors.initials: ML
authors.lastname: Kochman
mesh_terms: D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003113:Colonoscopy / Q000193:education / Q000592:standards; D003198:Computer Simulation; D004503:Education, Medical, Graduate / Q000379:methods*; D016099:Endoscopy, Gastrointestinal / Q000193:education* / Q000592:standards; D005257:Fellowships and Scholarships; D005762:Gastroenterology / Q000193:education*; D006801:Humans; D061646:Operative Time; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D013997:Time Factors