Background and Study Aims: Skills in gastrointestinal endoscopy mainly depend on experience and practice. Training
on endoscopy simulators may decrease the time needed to reach competency in endoscopy.
The purpose of the study was to determine whether the GI-Mentor, a virtual reality
endoscopy simulator, can distinguish between beginners and experts in endoscopy and
to assess whether training improves the performance of beginners.
Methods: A total of 13 beginners and 11 experts (more than 1000 procedures) in gastrointestinaI
endoscopy were included. The baseline assessment consisted of virtual endoscopies
and skill tests. The beginners were randomly allocated to receive training (n = 7)
or no training (n = 6). The training group was allowed to practice using the simulator
for 2 hours per day. After 3 weeks participants were re-evaluated with two new virtual
endoscopy cases and one virtual skill test. Insertion time, correctly identified pathologies,
adverse events and skill test performance were recorded.
Results: The baseline assessment revealed significant differences favoring the experts for
virtual endoscopies and skill tests. Significant differences in favor of experts were
found for successful retroflection during esophagogastroduodenoscopy (EGD) (P < 0.005);
adverse events during colonoscopy (P < 0.02); insertion time (P < 0.001); correctly
identified pathologies in gastroscopy and colonoscopy (P < 0.02); and skill test performance
(P < 0.01). The final evaluation showed significant differences between training and
no-training groups, in favor of the training group, for the number of adverse events
during virtual endoscopy (P < 0.04), for the insertion time during colonoscopy (P
< 0.03); and for skill test performance (P < 0.01). The training group improved its
abilities on the simulator significantly. Differences between experts and the training
group were no longer seen.
Conclusion: This virtual endoscopy simulator is capable of identifying differences between beginners
and experts in gastrointestinal endoscopy. A 3-week training improves the performance
of beginners significantly. This quite fast improvement in endoscopic skills certainly
cannot be seen in clinical practice; no conclusions can be made about the impact of
virtual simulator training on real-life endoscopy, and this must be evaluated.
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A. Ferlitsch, M.D.
Department of Internal Medicine IV · Division of Gastroenterology and Hepatology ·
University of Vienna · Waehringer Guertel 18 - 20 · 1090 Vienna · Austria
Fax: + 43-1-40400-4735
Email: arnulf.ferlitsch@akh-wien.ac.at
