Virtual Endoscopy Simulator: Can the Unexperienced Be Trained for Real Endoscopy?

Abstract

Introduction: Virtual Endoscopy (GI-Mentor, Symbionix, Israel) is a new tool for preparation and skill training. The aim of the present study was to determine whether standardized virtual training can facilitate the first steps in clinical endoscopy. Methods: A total of 7 beginners (medical students) with no previous experience in GI endoscopy and 3 experts were included. All participants performed a psychomotoric skill test and a baseline test at the GI-Mentor including 2 therapeutic (treatment of ulcer bleeding) and 1 diagnostic (including tumor biopsies) EGD. The beginners were further trained (40 hours) and then re-evaluated. After finishing the virtual training the beginners performed a real EGD in patients. In both settings (live and virtual endoscopy) the parameters total time, time to reach the lower part of the duodenum, examined mucosal surface and efficiency were determined. Results: The beginners showed a significant improvement in Virtual Endoscopy after the training period (total time: 9 versus 4 minutes; time to reach second part of the duodenum: 3.39 versus 0.43 minutes; efficacy 64/96%). The results at the re-evaluation were comparable with the parameters of the experienced endoscopists and no significant differences were detected between the trained students and expert gastroenterologists. Furthermore, all beginners could finish the real endoscopy by themselves without significant help upon training with the Virtual Endoscopy Simulator. However, the endoscopic performance decreased compared to the Virtual training setting (total time 8 minutes; time to reach second part of the duodenum 3.25 minutes; efficacy 82%) probably due to differences between training situation and clinical setup. Discussion: Virtual training in GI Endoscopy is a valid tool for improving skill technique. The learning curve is rapid and after 40 hours training the performance of beginners and experienced endoscopists is comparable. Virtual endoscopy training prepares for live endoscopy and all beginners could perform their first endoscopic examination without significant help. However, due to disturbing factors in the clinical situation (patient and bowel movement; unfamiliar monitor noises) the live performance decreased, but is still better as compared to unexperienced endoscopists. Therefore, training with an endoscopy simulator might represent a new standard for gastroenterologists at the beginning of their endoscopic training in the near future.