Simulator training in gastrointestinal endoscopy from basic training to advanced endoscopic procedures (pdf download available)

Simulator-based gastrointestinal endoscopy training has gained acceptance over the last decades and has been extensively studied. Colonoscopy aftercare Several types of simulators have been validated and it has been demonstrated that the use of simulators in the early training setting accelerates the learning curve in acquiring basic skills. Colonoscopy findings Current GI endoscopy simulators lack the degree of realism that would be necessary to provide training to achieve full competency or to be applicable in certification.


Colonoscopy definition Virtual Reality and mechanical simulators are commonly used in basic flexible endoscopy training, whereas ex vivo and in vivo models are used in training the most advanced endoscopic procedures. Bronchoscopy definition Validated models for the training of more routine therapeutic interventions like polypectomy, EMR, stenting and haemostasis are lacking or scarce and developments in these areas should be encouraged.

[Show abstract] [Hide abstract] ABSTRACT: Changes in medical practice have constrained the time available for education and the availability of patients for training. Colonoscopy perforation Computer-based simulators have been devised that can be used to achieve manual skills without patient contact. Bronchoscopy results This study prospectively compared, in a clinical setting, the efficacy of a computer-based simulator for training in upper endoscopy.

Twenty-two fellows with no experience in endoscopy were randomly assigned to two groups: one group underwent 10 hours of preclinical training with a computer-based simulator, and the other did not. Colonoscopy complications symptoms Each trainee performed upper endoscopy in 19 or 20 patients. Post colonoscopy side effects Performance parameters evaluated included the following: esophageal intubation, procedure duration and completeness, and request for assistance. Endoscopy medical definition The performance of the trainees also was evaluated by the endoscopy instructor.

A total of 420 upper endoscopies were performed; the computer pretrained group performed 212 and the non-pretrained group, 208. Bronchoscopy risks The pretrained group performed more complete procedures (87.8% vs. Colonoscopy preparation tips 70.0%; p < 0.0001), required less assistance (41.3% vs. Colonoscopy polyps found 97.9%; p < 0.0001), and the instructor assessed performance as "positive" more often for this group (86.8% vs. Endoscopy biopsy 56.7%; p < 0.0001). Colonoscopy complications The length of procedures was comparable for the two groups.

The computer-based simulator is effective in providing novice trainees with the skills needed for identification of anatomical landmarks and basic endoscopic maneuvers, and in reducing the need for assistance by instructors.

[Show abstract] [Hide abstract] ABSTRACT: Considerable advances have been made in the field of endoscopic simulation since the development of the first endoscopic mannequin simulator in the late 1960s.(1) Computer-based simulators have been developed for training in EGD, flexible sigmoldoscopy, colonoscopy, ERCP, and EUS. Bronchoscopy with biopsy The purpose of this technical review is to present the current status of endoscopic simulation and to examine its role for training and assessing operator competence in both academic and community gastroenterology practices. Endoscopy biopsy results The use of simulators for endoscopic training has several potentially attractive features. Bronchoscopy procedure Physicians practicing in academic institutions face increasing demands to perform more patient care. Bronchoscopy with bal Finding the time to train medical residents and gastroenterology fellows in endoscopic procedures has become a challenge. Ebus bronchoscopy The use of endoscopic simulators, particularly early in the learning curve, is proposed as an alternative method for educating trainees about the technical aspects of endoscopic procedures. What is bronchoscopy Patients have indicated dissatisfaction with procedures performed by trainees, particularly early in the training period. Fibre optic bronchoscopy In addition, an increased frequency of minor adverse events associated with such procedures has been described.(2) The impact of endoscopic training on procedural time and financial revenues was previously studied by using 1997 to 1999 data from the Clinical Outcomes Research Initiative project, a large national endoscopy database.(3) Fellow involvement prolonged procedure time by 10% to 37%, with an estimated loss of reimbursement to the academic institution of $500,000 to $1,000,000 per year. Colonoscopy video youtube The implementation of endoscopic simulators in the training process could partially reduce the adverse financial impact associated with training and theoretically could decrease adverse events and discomfort for patients.

Questionnaires were mailed to 1000 consecutive patients 30 days after endoscopy to evaluate procedure-related negative outcomes (serious and minor adverse events) and patient satisfaction. What is a bronchoscopy Serious adverse events were defined as follows: oversedation requiring administration of a reversal agent, and those that resulted in a physician visit, emergency department visit, admission to the hospital, or death. Colonoscopy deaths per year Minor adverse events were defined as all problems other than serious adverse events that patients related to their endoscopic procedure.

The 30-day frequency of negative outcomes in the 869 patients who responded was 14.3%, of which 0.6% were serious and 13.7% were minor adverse events. Bronchoscopy test The frequency of negative outcomes was 17.1% for EGD, 15.0% for colonoscopy, 24.4% for combined EGD and colonoscopy, and 7.8% for flexible sigmoidoscopy. Bronchoscopy biopsy One hundred percent of the serious adverse events were known to us, but only 16.0% of minor adverse events (p < 0.001). Bronchoscopy complications Multiple logistic regression identified midazolam dose (OR for each 1 mg increase in dose 4.5; 95% CI [2.7, 7.3]; p < 0.001), treatment with warfarin (OR 3.0; 95% CI [1.4, 6.2]; p = 0.003), comorbid disease (OR 2.1; 95% CI [1.3, 3.4]; p = 0.001), endoscopy performed in July or August (OR 2.0; 95% CI [1.1,3.7]; p = 0.02), and age (OR for each 1 year increase in age 1.03; 95% CI [1.01, 1.05]; p = 0.01) as independent predictors of negative outcomes. Post colonoscopy instructions There was a significant association between negative outcomes and decreased patient satisfaction, and patients who reported negative outcomes were less likely to agree to endoscopy in the future.

Serious adverse events were rare after endoscopy performed by gastroenterology fellows. Bronchoscopy images Contacting patients 30 days after outpatient endoscopy significantly improved the detection of negative outcomes. Post colonoscopy care Although the majority of negative outcomes were minor, these adverse events were associated with decreased patient satisfaction.