title: Simulated colonoscopy training leads to improved performance during patient-based assessment.
abstract: BACKGROUND
  Virtual reality (VR) endoscopy simulators are increasingly being used in the training of novice endoscopists. There are, however, insufficient data regarding the effect of simulator training on the early learning curve of novice endoscopists.
  
  
  OBJECTIVE
  The aim of this study was to assess the clinical performance of novice endoscopists during colonoscopy after intensive and prolonged training on a VR endoscopy simulator.
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  Single university medical center.
  
  
  METHODS
  Patient-based assessment (PBA) of performance was carried out on patients routinely scheduled for colonoscopy.
  
  
  METHODS
  Eighteen trainees without any endoscopic experience were included in the study. They were divided into 2 groups. The simulator-training program consisted of either 50 (group I) or 100 (group II) VR colonoscopies. After 10, 30, and 50 (group I) and after 20, 60, and 100 (group II) VR colonoscopies, trainees underwent both simulator-based assessment and PBA.
  
  
  METHODS
  Cecal intubation time, colonic insertion depth, and cecal intubation rate.
  
  
  RESULTS
  Eighteen novices participated in the study. All completed VR training and assessments. The mean cecal intubation time on the SBA decreased from a baseline of 9.50 minutes to 2.20 minutes at completion of the training (P = .002). Colonic insertion depth during PBA improved from 29.4 cm to 63.7 cm (P < .001). The learning effect of simulator training ceased after 60 colonoscopies.
  
  
  CONCLUSIONS
  Single-center study, no formal sample size calculation.
  
  
  CONCLUSIONS
  VR training by using a colonoscopy simulator leads to a significant improvement in performance with the simulator itself and, more importantly, to significantly improved performances during patient-based colonoscopy. This study demonstrates the rationale for intensive simulator training in the early learning curve of novices performing colonoscopy.
authors.affiliation: Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands.
authors.forename: Arjun D
authors.initials: AD
authors.lastname: Koch
authors.affiliation: Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands.
authors.forename: Vivian E
authors.initials: VE
authors.lastname: Ekkelenkamp
authors.affiliation: Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands.
authors.forename: Jelle
authors.initials: J
authors.lastname: Haringsma
authors.affiliation: Department of Gastroenterology and Hepatology, Catharina Hospital, Eindhoven, the Netherlands.
authors.forename: Erik J
authors.initials: EJ
authors.lastname: Schoon
authors.affiliation: Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands.
authors.forename: Robert A
authors.initials: RA
authors.lastname: de Man
authors.affiliation: Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands.
authors.forename: Ernst J
authors.initials: EJ
authors.lastname: Kuipers
mesh_terms: D000328:Adult; D002983:Clinical Competence; D003113:Colonoscopy / Q000193:education*; D003198:Computer Simulation; D005260:Female; D006801:Humans; D008297:Male; D017145:Models, Educational; D009426:Netherlands; D011446:Prospective Studies; D014584:User-Computer Interface