Role of simulation in training the next generation of endoscopists

Abstract

The use of simulation based training in endoscopy has been increasingly described, simulation has the potential reduce the harm caused to patients by novices performing procedures, increase efficiency by reducing the time needed to train in the clinical environment and increase the opportunity to repeatedly practice rare procedures as well as allowing the assessment of performance. Simulators can consist of mechanical devices, employ cadaveric animal tissue or use virtual reality technology. Simulators have been used to teach upper and lower gastrointestinal endoscopy as well as interventional procedures. This review reviews the currently available endoscopic simulators, and the evidence for their efficacy, demonstrating that the ability of simulators to differentiate between novice and expert endoscopists is well established. There is limited evidence for improved patient outcome as a result of simulation training. We also consider how the environment within which a simulation is placed can be manipulated to alter the learning achieved, broadening the scope of simulation to develop communication as well as technical skills. Finally the implications for future practice are considered; technology is likely improve the fidelity of simulators, increasing the potential for simulation to improve patient outcomes. The impact of the simulation environment, and the correct place of simulation within the training curriculum are both issues which need addressing.

Keywords: Gastroenterology; Endoscopy; Simulation; Simulation environment; Interventional endoscopy

Core tip: Evidence is increasing that simulation is an effective means of teaching interventional procedures. We review the current use of simulators and the evidence for their efficacy, before considering the impact of the simulation environment on the learning that can be achieved. We argue that the use of the simulation environment as a tool to broaden the educational scope of simulation to teach skills other than the technical, is important to maximum utilisation of simulation.