Training and transfer of colonoscopy skills: a multinational, randomized, blinded, controlled trial of simulator versus bedside training

Gastrointest Endosc. 2010 Feb;71(2):298-307. doi: 10.1016/j.gie.2009.07.017. Epub 2009 Nov 3.


Background: The Olympus colonoscopy simulator provides a high-fidelity training platform designed to develop knowledge and skills in colonoscopy. It has the potential to shorten the learning process to competency.

Objective: To investigate the efficacy of the simulator in training novices in colonoscopy by comparing training outcomes from simulator training with those of standard patient-based training.

Design: Multinational, multicenter, single-blind, randomized, controlled trial.

Setting: Four academic endoscopy centers in the United Kingdom, Italy, and The Netherlands.

Participants and intervention: This study included 36 novice colonoscopists who were randomized to 16 hours of simulator training (subjects) or patient-based training (controls). Participants completed 3 simulator cases before and after training. Three live cases were assessed after training by blinded experts.

Main outcome measurements: Automatically recorded performance metrics for the simulator cases and blinded expert assessment of live cases using Direct Observation of Procedural Skills and Global Score sheets.

Results: Simulator training significantly improved performance on simulated cases compared with patient-based training. Subjects had higher completion rates (P=.001) and shorter completion times (P < .001) and demonstrated superior technical skill (reduced simulated pain scores, correct use of abdominal pressure, and loop management). On live colonoscopy, there were no significant differences between the 2 groups.

Limitations: Assessment tools for live colonoscopies may lack sensitivity to discriminate between the skills of relative novices.

Conclusion: Performance of novices trained on the colonoscopy simulator matched the performance of those with standard patient-based colonoscopy training, and novices in the simulator group demonstrated superior technical skills on simulated cases. The simulator should be considered as a tool for developing knowledge and skills prior to clinical practice.

Publication types

  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Clinical Competence*
  • Colonoscopy / methods*
  • Computer Simulation*
  • Education, Medical, Graduate / methods
  • Educational Measurement
  • Female
  • Gastroenterology / education
  • Humans
  • Inservice Training / methods*
  • International Cooperation
  • Internship and Residency
  • Male
  • Point-of-Care Systems*
  • Probability
  • Prospective Studies
  • Reproducibility of Results
  • Risk Factors
  • Sensitivity and Specificity
  • Single-Blind Method
  • Statistics, Nonparametric