Training and transfer of colonoscopy skills: a multinational, randomized, blinded, controlled trial of simulator versus bedside training

Background: The Olympus colonoscopy simulator provides I high-fidelity training platform designed to develop knowledge and skills in colonoscopy it has the potential to shorten the learning process to competency. Objective: To investigate the efficacy of the simulator in training novices in colonoscopy by comparing training outcomes from simulator training with those of standard patient-based training. Design: Multinational, multicenter, single-blind, randomized, controlled trial. Setting: Four academic endoscopy centers in the United Kingdom, Italy, and The Netherlands. Participants and Intervention: This study included 36 novice colonoscopists who were randomized to 16 hours of simulator training (subjects) or patient-based training (controls). Participants completed 3 simulator cases before and after training. Three live cases were assessed after training by blinded experts. Main Outcome Measurements: Automatically recorded performance metrics for the simulator cases and blinded expert assessment of live cases using Direct Observation of Procedural Skills and Global Score sheets. Results: Simulator training significantly improved performance on simulated cases compared with patient-based training. Subjects had higher completion rates (P = .001) and shorter completion times (P < .001) and demonstrated superior technical skill (reduced simulated pain scores, correct use of abdominal pressure, and loop management). On live colonoscopy, there were no significant differences between the 2 groups. Limitations: Assessment tools for live colonoscopies may lack sensitivity to discriminate between the skills of relative novices. Conclusion: Performance of novices trained on the colonoscopy simulator matched the performance of those with standard patient-based colonoscopy training, and novices in the simulator group demonstrated Superior technical skills on Simulated cases. The simulator should be considered as a tool for developing knowledge and skills prior to clinical practice. (Gastrointest Endosc 2010;71:298-307.