title: Impact of a simulation training curriculum on technical and nontechnical skills in colonoscopy: a randomized trial.
abstract: BACKGROUND
  GI endoscopy simulation-based training augments early clinical performance; however, the optimal manner by which to deliver training is unknown.
  
  
  OBJECTIVE
  We aimed to validate a simulation-based structured comprehensive curriculum (SCC) designed to teach technical, cognitive, and integrative competencies in colonoscopy.
  
  
  METHODS
  Single-blinded, randomized, controlled trial.
  
  
  METHODS
  Endoscopic simulation course at an academic hospital.
  
  
  METHODS
  Thirty-three novice endoscopists were allocated to an SCC group or self-regulated learning (SRL) group. The SCC group received a curriculum consisting of 6 hours of didactic lectures and 8 hours of virtual reality simulation-based training with expert feedback. The SRL group was provided a list of desired objectives and was instructed to practice on the simulator for an equivalent time (8 hours).
  
  
  METHODS
  Clinical transfer was assessed during 2 patient colonoscopies using the Joint Advisory Group Direct Observation of Procedural Skills (JAG DOPS) scale. Secondary outcome measures included differences in procedural knowledge, immediate post-training simulation performance, and delayed post-training (4-6 weeks) performance during an integrated scenario test on the JAG DOPS communication and integrated scenario global rating scales.
  
  
  RESULTS
  There was no significant difference in baseline or post-training performance on the simulator task. The SCC group performed superiorly during their first and second clinical colonoscopies. Additionally, the SCC group demonstrated significantly better knowledge and colonoscopy-specific performance, communication, and global performance during the integrated scenario.
  
  
  CONCLUSIONS
  We were unable to measure SRL participants' effort outside of mandatory training. In addition, feedback metrics and number of available simulation cases are limited.
  
  
  CONCLUSIONS
  These results support integration of endoscopy simulation into a structured curriculum incorporating instructional feedback and complementary didactic knowledge as a means to augment technical, cognitive, and integrative skills acquisition, as compared with SRL on virtual reality simulators. (
  
  
  BACKGROUND
  NCT01991522.)
authors.affiliation: Division of Gastroenterology, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Samir C
authors.initials: SC
authors.lastname: Grover
authors.affiliation: Division of Gastroenterology, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Ankit
authors.initials: A
authors.lastname: Garg
authors.affiliation: Division of Gastroenterology, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Scaffidi
authors.affiliation: Wilson Centre, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Yu
authors.affiliation: Division of Gastroenterology, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Ian S
authors.initials: IS
authors.lastname: Plener
authors.affiliation: Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Gastroenterology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors.forename: Elaine
authors.initials: E
authors.lastname: Yong
authors.affiliation: Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Gastroenterology, University Health Network, Toronto, Ontario, Canada.
authors.forename: Maria
authors.initials: M
authors.lastname: Cino
authors.affiliation: Department of Surgery, St. Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Teodor P
authors.initials: TP
authors.lastname: Grantcharov
authors.affiliation: Wilson Centre, University of Toronto, Toronto, Ontario, Canada; Division of Gastroenterology, Hepatology and Nutrition, and the Learning Institute, Hospital for Sick Children, Toronto, Ontario, Canada; Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Catharine M
authors.initials: CM
authors.lastname: Walsh
mesh_terms: D000328:Adult; D002983:Clinical Competence; D003113:Colonoscopy / Q000193:education*; D003479:Curriculum; D005260:Female; D006801:Humans; D008297:Male; D009864:Ontario; D011446:Prospective Studies; D000066908:Simulation Training / Q000379:methods*; D016037:Single-Blind Method