title: Evaluation of two flexible colonoscopy simulators and transfer of skills into clinical practice.
abstract: BACKGROUND
  Surgical residents have learned flexible endoscopy by practicing on patients in hospital settings under the strict guidance of experienced surgeons. Simulation is often used to "pretrain" novices on endoscopic skills before real clinical practice; nonetheless, the optimal method of training remains unknown. The purpose of this study was to compare endoscopic virtual reality and physical model simulators and their respective roles in transferring skills to the clinical environment.
  
  
  METHODS
  At the beginning of a skills development rotation, 27 surgical postgraduate year 1 residents performed a baseline screening colonoscopy on a real patient under faculty supervision. Their performances were scored using the Global Assessment of Gastrointestinal Endoscopic Skills (GAGES). Subsequently, interns completed a 3-week flexible endoscopy curriculum developed at our institution. One-third of the residents were assigned to train with the GI Mentor simulator, one-third trained with the Kyoto simulator, and one-third of the residents trained using both simulators. At the end of their rotations, each postgraduate year 1 resident performed one posttest colonoscopy on a different patient and was again scored using GAGES by an experienced faculty.
  
  
  RESULTS
  A statistically significant improvement in the GAGES total score (p < 0.001) and on each of its subcomponents (p = 0.001) was observed from pretest to posttest for all groups combined. Subgroup analysis indicated that trainees in the GI Mentor or both simulators conditions showed significant improvement from pretest to posttest in terms of GAGES total score (p = 0.017 vs 0.024, respectively). This was not observed for those exclusively using the Kyoto platform (p = 0.072). Nonetheless, no single training condition was shown to be a better training modality when compared to others in terms of total GAGES score or in any of its subcomponents.
  
  
  CONCLUSIONS
  Colonoscopy simulator training with the GI Mentor platform exclusively or in combination with a physical model simulator improves skill performance in real colonoscopy cases when measured with the GAGES tool.
authors.affiliation: Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas. Electronic address: gomezpp@uthscsa.edu.
authors.forename: Pedro Pablo
authors.initials: PP
authors.lastname: Gomez
authors.affiliation: Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
authors.forename: Ross E
authors.initials: RE
authors.lastname: Willis
authors.affiliation: Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
authors.forename: Kent
authors.initials: K
authors.lastname: Van Sickle
mesh_terms: D000328:Adult; D002983:Clinical Competence; D020685:Colonoscopes; D003113:Colonoscopy / Q000193:education*; D003198:Computer Simulation; D004503:Education, Medical, Graduate / Q000379:methods*; D005260:Female; D005336:Fiber Optic Technology; D006801:Humans; D007396:Internship and Residency / Q000379:methods; D008297:Male; D008611:Mentors; D018583:Pliability; D018794:Problem-Based Learning / Q000379:methods; D012494:Sampling Studies; D013781:Texas
keywords: GAGES; Patient Care; Practice-Based Learning and Improvement; Systems-Based Practice; flexible endoscopy; simulation; skills assessment