title: Computer-based virtual reality colonoscopy simulation improves patient-based colonoscopy performance.
abstract: BACKGROUND
  Colonoscopy simulators that enable one to perform computer-based virtual colonoscopy now exist. However, data regarding the effectiveness of this virtual training are limited.
  
  
  OBJECTIVE
  To determine whether virtual reality simulator training translates into improved patient-based colonoscopy performance.
  
  
  METHODS
  The present study was a prospective controlled trial involving 18 residents between postgraduate years 2 and 4 with no previous colonoscopy experience. These residents were assigned to receive 16 h of virtual reality simulator training or no training. Both groups were evaluated on their first five patient-based colonoscopies. The primary outcome was the number of proctor 'assists' required per colonoscopy. Secondary outcomes included insertion time, depth of insertion, cecal intubation rate, proctor- and nurse-rated competence, and patient-rated pain.
  
  
  RESULTS
  The simulator group required significantly fewer proctor assists than the control group (1.94 versus 3.43; P ≤ 0.001), inserted the colonoscope further unassisted (43 cm versus 24 cm; P=0.003) and there was a trend to intubate the cecum more often (26% versus 10%; P=0.06). The simulator group received higher ratings of competence from both the proctors (2.28 versus 1.88 of 5; P=0.02) and the endoscopy nurses (2.56 versus 2.05 of 5; P=0.001). There were no significant differences in proctor-, nurse- or patient-rated pain, or attention to discomfort.
  
  
  CONCLUSIONS
  Computer-based colonoscopy simulation in the initial stages of training improved novice trainees' patient-based colonoscopy performance.
authors.forename: Keith S
authors.initials: KS
authors.lastname: McIntosh
authors.forename: James C
authors.initials: JC
authors.lastname: Gregor
authors.forename: Nitin V
authors.initials: NV
authors.lastname: Khanna
mesh_terms: D000328:Adult; D002432:Cecum; D002983:Clinical Competence; D003113:Colonoscopy / Q000009:adverse effects / Q000193:education* / Q000592:standards*; D003198:Computer Simulation; D004503:Education, Medical, Graduate / Q000379:methods*; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000379:methods*; D007441:Intubation, Gastrointestinal; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology; D010147:Pain Measurement; D017060:Patient Satisfaction; D011446:Prospective Studies; D013997:Time Factors; D014584:User-Computer Interface
references.citation: Am J Surg. 2005 Apr;189(4):497-500
references.pmid: 15820469
references.citation: Surg Endosc. 2004 Oct;18(10):1514-8
references.pmid: 15791380
references.citation: Gastrointest Endosc. 2006 Sep;64(3):361-8
references.pmid: 16923483
references.citation: Am J Gastroenterol. 2000 Nov;95(11):3129-32
references.pmid: 11095329
references.citation: Gastrointest Endosc. 2013 Apr;77(4):558-65
references.pmid: 23260317
references.citation: Clin Gastroenterol Hepatol. 2004 Apr;2(4):348-52
references.pmid: 15067632
references.citation: Gastrointest Endosc. 2003 Jan;57(1):8-16
references.pmid: 12518123
references.citation: Gastrointest Endosc. 2003 Feb;57(2):214-8
references.pmid: 12556787
references.citation: JSLS. 2005 Apr-Jun;9(2):130-3
references.pmid: 15984697
references.citation: J Surg Educ. 2007 Nov-Dec;64(6):399-409
references.pmid: 18063277
references.citation: Surg Endosc. 2008 Jan;22(1):158-62
references.pmid: 17516114
references.citation: Gastrointest Endosc. 2010 Feb;71(2):298-307
references.pmid: 19889408