Virtual reality simulation training for health professions trainees in gastrointestinal endoscopy
Abstract
Background
Traditionally, training in gastrointestinal endoscopy has been based upon an apprenticeship model, with novice endoscopists learning basic skills under the supervision of experienced preceptors in the clinical setting. Over the last two decades, however, the growing awareness of the need for patient safety has brought the issue of simulation‐based training to the forefront. While the use of simulation‐based training may have important educational and societal advantages, the effectiveness of virtual reality gastrointestinal endoscopy simulators has yet to be clearly demonstrated.
Objectives
To determine whether virtual reality simulation training can supplement and/or replace early conventional endoscopy training (apprenticeship model) in diagnostic oesophagogastroduodenoscopy, colonoscopy and/or sigmoidoscopy for health professions trainees with limited or no prior endoscopic experience.
Search methods
Health professions, educational and computer databases were searched until November 2011 including The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, Scopus, Web of Science, Biosis Previews, CINAHL, Allied and Complementary Medicine Database, ERIC, Education Full Text, CBCA Education, Career and Technical Education @ Scholars Portal, Education Abstracts @ Scholars Portal, Expanded Academic ASAP @ Scholars Portal, ACM Digital Library, IEEE Xplore, Abstracts in New Technologies and Engineering and Computer & Information Systems Abstracts. The grey literature until November 2011 was also searched.
Selection criteria
Randomised and quasi‐randomised clinical trials comparing virtual reality endoscopy (oesophagogastroduodenoscopy, colonoscopy and sigmoidoscopy) simulation training versus any other method of endoscopy training including conventional patient‐based training, in‐job training, training using another form of endoscopy simulation (e.g. low‐fidelity simulator), or no training (however defined by authors) were included. Trials comparing one method of virtual reality training versus another method of virtual reality training (e.g. comparison of two different virtual reality simulators) were also included. Only trials measuring outcomes on humans in the clinical setting (as opposed to animals or simulators) were included.
Data collection and analysis
Two authors (CMS, MES) independently assessed the eligibility and methodological quality of trials, and extracted data on the trial characteristics and outcomes. Due to significant clinical and methodological heterogeneity it was not possible to pool study data in order to perform a meta‐analysis. Where data were available for each continuous outcome we calculated standardized mean difference with 95% confidence intervals based on intention‐to‐treat analysis. Where data were available for dichotomous outcomes we calculated relative risk with 95% confidence intervals based on intention‐to‐treat‐analysis.
Main results
Thirteen trials, with 278 participants, met the inclusion criteria. Four trials compared simulation‐based training with conventional patient‐based endoscopy training (apprenticeship model) whereas nine trials compared simulation‐based training with no training. Only three trials were at low risk of bias. Simulation‐based training, as compared with no training, generally appears to provide participants with some advantage over their untrained peers as measured by composite score of competency, independent procedure completion, performance time, independent insertion depth, overall rating of performance or competency error rate and mucosal visualization. Alternatively, there was no conclusive evidence that simulation‐based training was superior to conventional patient‐based training, although data were limited.
Authors' conclusions
The results of this systematic review indicate that virtual reality endoscopy training can be used to effectively supplement early conventional endoscopy training (apprenticeship model) in diagnostic oesophagogastroduodenoscopy, colonoscopy and/or sigmoidoscopy for health professions trainees with limited or no prior endoscopic experience. However, there remains insufficient evidence to advise for or against the use of virtual reality simulation‐based training as a replacement for early conventional endoscopy training (apprenticeship model) for health professions trainees with limited or no prior endoscopic experience. There is a great need for the development of a reliable and valid measure of endoscopic performance prior to the completion of further randomised clinical trials with high methodological quality.
PICOs
Plain language summary
Virtual Reality Simulators for Training Gastrointestinal Endoscopy
Traditionally trainees have learned to perform endoscopy in the clinical setting under the supervision of a trained endoscopist. Virtual reality computer simulators are becoming popular as a way of providing trainees with an opportunity to practice skills in a risk‐free environment. This review was undertaken to determine whether virtual reality simulation training can supplement and/or replace early patient‐based endoscopy training. We included randomised trials comparing virtual reality endoscopy simulation training with any other form of endoscopy training (patient‐based training, no training, training using another form of endoscopy simulation) for trainees with little or no prior endoscopic experience. Thirteen trials involving 278 participants were included. All trials except one were at high risk of bias. Simulation‐based endoscopy training, as compared with no training, generally appears to provide trainees with an advantage as measured by a composite score of competency, ability to complete procedures independently, time taken to complete a task, depth of endoscope insertion, overall rating of performance, number of errors and mucosal visualization. There was no conclusive evidence that simulation‐based training, as compared with traditional patient‐based training, provided benefit, although data were limited. The results of this review have shown that virtual reality endoscopy training can be used to supplement early traditional endoscopy training for trainees with little or no endoscopic experience.
