A Prospective Randomized Trial Comparing a Virtual Reality Simulator to Bedside Teaching for Training in Sigmoidoscopy
Submitted 17 December 2002
Accepted after Revision 24 February 2003
24 June 2003 (online)
Background and Study Aims: Clinical investigation using endoscopy simulators is now possible due to recent advances in virtual reality technology. A prospective randomized trial was conducted to compare the exclusive use of a virtual reality endoscopy simulator with bedside teaching for training in sigmoidoscopy.
Materials and Methods: Internal medicine residents were randomly assigned to training exclusively using a virtual reality simulator (group 1) or via bedside teaching (group 2). Residents were then observed performing five sigmoidoscopic procedures in asymptomatic patients referred for colorectal cancer screening. Endoscopic examinations were evaluated for procedure duration, completion, ability to perform retroflexion, and level of patient comfort/discomfort. Each examination was scored from 1 (inability to insert the endoscope beyond the rectum) to 5 (able to complete the entire examination independently in less than 20 min).
Results: Sixty-six sigmoidoscopic examinations were completed by nine residents in group 1 (simulator-trained group) and seven residents in group 2 (traditional teaching group). Participants in group 1 had more difficulty with initial endoscope insertion and negotiation of the rectosigmoid junction (mean score ± SEM 2.9 ± 0.2) than those in group 2 (3.8 ± 0.2) (P < 0.001). The splenic flexure was reached independently in 10 of 34 examinations (29 %) in group 1, compared with 23 of 32 examinations (72 %) in group 2 (P = 0.001). Retroflexion was successfully performed by 19 of 34 (56 %) in group 1 compared to 27 of 32 (84 %) in group 2 (P = 0.02). The average procedure time, patient satisfaction, and discomfort associated with the procedure did not differ statistically between the two groups.
Conclusions: The use of a state-of-the-art virtual reality-based endoscopy simulator is inferior to traditional bedside teaching techniques when used exclusively for training medical residents to perform sigmoidoscopy.
- 1 Kohn L T, Corrigan J M, Donaldson M S, eds. To err is human: building a safer health system. Washington, DC; National Academy Press 1999
- 2 Hayward R A, Hofer T P. Estimating hospital deaths due to medical errors: preventability is in the eye of the reviewer. JAMA. 2001; 286 415-420
- 3 McCashland T, Brand R, Lyden E, de Garmo P. The time and financial impact of training fellows in endoscopy. Am J Gastroenterol. 2000; 95 3129-3132
- 4 Hochberger J, Maiss J, Magdeburg B, Cohen J, Hahn E G. Training simulators and education in gastrointestinal endoscopy: current status and perspectives in 2001. Endoscopy. 2001; 33 541-549
- 5 Jackson J L, Osgard E, Fincher R K. Resident participation in flexible sigmoidoscopy does not affect patient satisfaction. Am J Gastroenterol. 2000; 95 1563-1566
- 6 Schoen R E, Weissfeld J L, Bowen N J. et al . Patient satisfaction with screening flexible sigmoidoscopy. Arch Intern Med. 2000; 160 1790-1796
- 7 Aabakken L, Adamsen S, Kruse A. Performance of a colonoscopy simulator: experience from a hands-on endoscopy course. Endoscopy. 2000; 32 911-913
- 8 Tuggy M L. Virtual reality flexible sigmoidoscopy simulator training: impact on resident performance. J Am Board Fam Pract. 1998; 11 426-433
- 9 Guidelines for training non-specialists in screening flexible sigmoidoscopy . Gastrointest Endosc. 2000; 51 783-785
- 10 Hawes R, Lehman G A, Hast J. et al . Training resident physicians in fiberoptic sigmoidoscopy: how many supervised examinations are required to achieve competence?. Am J Med. 1986; 80 465-470
L. B. Gerson, M. D., M. Sc.
Division of Gastroenterology and Hepatology, Room A149 ·
Stanford University Medical Center · Stanford, CA 94305-5202 · USA
Fax: + 1-650-723-8305 ·