Does Simulator Training in Colonoscopy Reduce Procedure-Related Complications?

Abstract

Training in colonoscopy occurs in the traditional mentoring method, wherein trainees are exposed to procedures under the guidance of an experienced teacher. This teaching experience is unstructured and dictated by the random admission of patients rather than a consistent exposure to fundamental medical problems in an organized programmatic fashion. Evidence shows that a higher incidence of complications is observed in procedures performed by trainees in comparison to experienced endoscopists. Colonoscopy simulator training is without the involvement of patient risk and might lead to improved quality of patient care without any additional risk. Virtual reality simulators provide the ability of feedback of patient discomfort and could increase the awareness of trainees causing discomfort. This increased vigilance could potentially lead to a decreased rate of colon perforation. Training on ex-vivo simulators may lead to better performance of interventional procedures, such as polypectomy and endoscopic mucosal resection, with the possibility of decreasing the incidence of intraoperative and postoperative bleeding. Data shows that with the use of structured simulator training with ample feedback from tutors, fellows advance faster to more proficient skill levels. Reaching a more advanced level of expertise by simulator training in the early phase of training could potentially lead to increased patient comfort and thus less requirement of sedation, which has been shown to decrease the rate of unexpected cardiopulmonary events. However, clinical evidence of simulator training in colonoscopy in reducing procedure-related complications is currently not available and subject to further investigation. Given the low rate of complications associated with colonoscopy, studies to provide this evidence may be difficult to conduct.