title: Effects of simulation-based training in gastrointestinal endoscopy: a systematic review and meta-analysis.
abstract: OBJECTIVE
  Simulation-based training (SBT) in gastrointestinal endoscopy has been increasingly adopted by gastroenterology fellowship programs. However, the effectiveness of SBT in enhancing trainee skills remains unclear. We performed a systematic review with a meta-analysis of published literature on SBT in gastrointestinal endoscopy.
  
  
  METHODS
  We performed a systematic search of multiple electronic databases for all original studies that evaluated SBT in gastrointestinal endoscopy in comparison with no intervention or alternative instructional approaches. Outcomes included skills (in a test setting), behaviors (in clinical practice), and effects on patients. We pooled effect size (ES) using random-effects meta-analysis.
  
  
  RESULTS
  From 10,903 articles, we identified 39 articles, including 21 randomized trials of SBT, enrolling 1181 participants. Compared with no intervention (n = 32 studies), SBT significantly improved endoscopic process skills in a test setting (ES, 0.79; n = 22), process behaviors in clinical practice (ES, 0.49; n = 8), time to procedure completion in both a test setting (ES, 0.79; n = 16) and clinical practice (ES, 0.75; n = 5), and patient outcomes (procedural completion and risk of major complications; ES, 0.45; n = 10). Only 5 studies evaluated the comparative effectiveness of different SBT approaches; which provided inconclusive evidence regarding feedback and simulation modalities.
  
  
  CONCLUSIONS
  Simulation-based education in gastrointestinal endoscopy is associated with improved performance in a test setting and in clinical practice, and improved patient outcomes compared with no intervention. Comparative effectiveness studies of different simulation modalities are limited.
authors: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
authors: Siddharth
authors: S
authors: Singh
authors: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
authors: Robert E
authors: RE
authors: Sedlack
authors: Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota; Office of Education Research, Mayo Medical School, Rochester, Minnesota. Electronic address: cook.david33@mayo.edu.
authors: David A
authors: DA
authors: Cook
mesh_terms: D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003198:Computer Simulation; D016099:Endoscopy, Gastrointestinal / Q000193:education*; D006302:Health Services Research; D006801:Humans; D008953:Models, Anatomic
keywords: Education; Gastrointestinal Endoscopy; Outcomes; Simulation