Colonoscopy requires an examiner to inspect the colonic mucosal surface by applying push/pull forces and torque to a colonoscope to maneuver through the colon. Skilled endoscopists reach the cecum quickly, minimize pain and have high rates of polyp detection. Training programs are designed to impart and assess these skills. The CFM™ was designed to be a cost-effective tool for quantifying manipulation technique, examining maneuvers, and improving skills by using real-time force monitoring and post-procedure force pattern analysis. Design: The CFM™ system consists of a handheld colonoscope shaft attachment, a recharging station, and a laptop computer. The ergonomic asymmetrical plastic body provides a secure grip for the gloved hand when pushing, pulling, or rotating the instrument. The components are housed in the handle and include a load cell sensor system, a custom electronic board with Bluetooth® radio and rechargeable batteries. The wireless connection reports force and torque at 7.5 measurements/s for distances up to 10 meters. The batteries provide power for more than 90 min of use. The CFM™ uses an electronically controlled miniature motor to tighten and loosen the CFM™ grip in less than 2 secs. The inner diameter of the CFM™ grip is designed not to restrict advance and withdraw movement. Custom software calibrates the device, collects and displays the measurements, processes the data, and replays stored data for review. Testing: CFM™ pre-clinical bench testing was conducted to verify performance. Absolute system accuracy for the device was determined to be +/- 2.2% of the full scale. This was a function of several sources of error including error in calibration, digital measurement, reproducibility, and system noise. Because a secure grip along a lubricated instrument is required, another critical parameter was the maximum force and torque that can be applied before CFM™ slippage occured. The maximum push/pull force that can be applied before CFM™ slippage was 50N and the maximum torque before sliding was 1.3Nm These values exceed the corresponding peak values previously reported. The CFM™ underwent high level disinfection without alteration in function and clinical testing confirmed its capability to provide highly detailed force data. Conclusion: The CFM™ is a new device designed to measure the forces used by an endoscopist to perform colonoscopy. Laboratory and clinical tests demonstrated CFM™ potential as a new and practical tool for teaching, performance assessment and enhancement and quality assurance.(Grant Support NIH/NIDDK SBIR 5R44DK068936-03)