Skip to main content
Top
Published in: Surgical Endoscopy 11/2012

01-11-2012 | Review

Systematic review of validity testing in colonoscopy simulation

Authors: James Ansell, John Mason, Neil Warren, Peter Donnelly, Neil Hawkes, Sunil Dolwani, Jared Torkington

Published in: Surgical Endoscopy | Issue 11/2012

Login to get access

Abstract

Background

Simulation is a useful adjunct to skills-based training. It potentially avoids risk to patients during training and development of basic interventional techniques. This may be of particular relevance in colonoscopy where the learning curve can be long. Several endoscopic devices exist that simulate colonoscopy for training purposes. This study was designed to review the evidence for the validity of these simulators.

Methods

MEDLINE (1947 to present), PubMed, Embase classic + Embase, the metaRegister of Controlled Trials, and the Education Resources Information Center (ERIC) were searched for studies validating colonoscopy simulators. For each study, we recorded the type of simulator used, the tasks assessed, the endpoints reported, and the type of validity measured. Common endpoints between studies were compared, and the evidence was graded.

Results

Thirteen studies met the inclusion criteria. Construct validity was reported in five (41.7 %) studies for the Accutouch HT Immersion (cases 1, 3, and 4), four studies (33.3 %) for the GI mentor II (Simbionix) (Modules 1.1, 1.3, 1.7, 2.1, and 5), two studies (16.7 %) for the Olympus Endo Ts-1 2nd Generation, and one study for the Endo X bovine model. Face validity was reported for the Accutouch HT Immersion, the Olympus 2nd Generation, and the KAIST-Ewha. Content validity was reported for the all simulators, excluding the KAIST-Ewha. The only report of criterion validity was for the Endo X bovine model.

Conclusion

Evidence exists to support the face, content, and construct validity of several virtual reality colonoscopy simulators for specific diagnostic and therapeutic modules with selected endpoints. One study demonstrates content, construct, and criterion validity for an ex vivo animal platform. Further work is needed to demonstrate the criterion validity of all devices.
Literature
1.
go back to reference Chesser S, Bowman K, Phillips H (2002) The European Working Time Directive and the training of surgeons. BMJ 325(7362):S69PubMedCrossRef Chesser S, Bowman K, Phillips H (2002) The European Working Time Directive and the training of surgeons. BMJ 325(7362):S69PubMedCrossRef
2.
go back to reference Donohoe CL, Sayana MK, Kennedy MT, Niall DM (2010) European Working Time Directive: implications for surgical training. Ir Med J 103(2):57–59PubMed Donohoe CL, Sayana MK, Kennedy MT, Niall DM (2010) European Working Time Directive: implications for surgical training. Ir Med J 103(2):57–59PubMed
3.
go back to reference Morris-Stiff GJ, Sarasin S, Edwards P, Lewis WG, Lewis MH (2005) The European Working Time Directive: one for all and all for one? Surgery 137(3):293–297PubMedCrossRef Morris-Stiff GJ, Sarasin S, Edwards P, Lewis WG, Lewis MH (2005) The European Working Time Directive: one for all and all for one? Surgery 137(3):293–297PubMedCrossRef
4.
go back to reference Waurick R, Weber T, Bröking K, Van Aken H (2007) The European Working Time Directive: effect on education and clinical care. Curr Opin Anaesthesiol 20(6):576–579PubMedCrossRef Waurick R, Weber T, Bröking K, Van Aken H (2007) The European Working Time Directive: effect on education and clinical care. Curr Opin Anaesthesiol 20(6):576–579PubMedCrossRef
5.
go back to reference Jiang G, Chen H, Wang S, Zhou Q, Li X, Chen K, Sui X (2011) Learning curves and long-term outcome of simulation-based thoracentesis training for medical students. BMC Med Educ 11:39PubMedCrossRef Jiang G, Chen H, Wang S, Zhou Q, Li X, Chen K, Sui X (2011) Learning curves and long-term outcome of simulation-based thoracentesis training for medical students. BMC Med Educ 11:39PubMedCrossRef
7.
go back to reference Stather DR, Maceachern P, Rimmer K, Hergott CA, Tremblay A (2011) Assessment and learning curve evaluation of endobronchial ultrasound skills following simulation and clinical training. Respirology 16(4):698–704PubMedCrossRef Stather DR, Maceachern P, Rimmer K, Hergott CA, Tremblay A (2011) Assessment and learning curve evaluation of endobronchial ultrasound skills following simulation and clinical training. Respirology 16(4):698–704PubMedCrossRef
8.
go back to reference Koch AD, Buzink SN, Heemskerk J, Botden SM, Veenendaal R, Jakimowicz JJ, Schoon EJ (2008) Expert and construct validity of the Simbionix GI Mentor II endoscopy simulator for colonoscopy. Surg Endosc 22(1):158–162PubMedCrossRef Koch AD, Buzink SN, Heemskerk J, Botden SM, Veenendaal R, Jakimowicz JJ, Schoon EJ (2008) Expert and construct validity of the Simbionix GI Mentor II endoscopy simulator for colonoscopy. Surg Endosc 22(1):158–162PubMedCrossRef
10.
go back to reference Desilets DJ, Banerjee S, Barth BA, Kaul V, Kethu SR, Pedrosa MC, Pfau PR, Tokar JL, Varadarajulu S, Wang A, Wong Kee Song LM, Rodriguez SA, ASGE Technology Committee (2011) Endoscopic simulators. Gastrointest Endosc 73(5):861–867PubMedCrossRef Desilets DJ, Banerjee S, Barth BA, Kaul V, Kethu SR, Pedrosa MC, Pfau PR, Tokar JL, Varadarajulu S, Wang A, Wong Kee Song LM, Rodriguez SA, ASGE Technology Committee (2011) Endoscopic simulators. Gastrointest Endosc 73(5):861–867PubMedCrossRef
11.
go back to reference Feldman LS, Sherman V, Fried GM (2004) Using simulators to assess laparoscopic competence: ready for widespread use? Surgery 135(1):28–42PubMedCrossRef Feldman LS, Sherman V, Fried GM (2004) Using simulators to assess laparoscopic competence: ready for widespread use? Surgery 135(1):28–42PubMedCrossRef
13.
go back to reference Sedlack RE (2011) Validation process for new endoscopy teaching tools. Tech Gastrointest Endosc 13:151–154CrossRef Sedlack RE (2011) Validation process for new endoscopy teaching tools. Tech Gastrointest Endosc 13:151–154CrossRef
14.
go back to reference Meeker WQ, Escobar LU (1998) Statistical methods for reliability data. Wiley, Hoboken Meeker WQ, Escobar LU (1998) Statistical methods for reliability data. Wiley, Hoboken
15.
go back to reference Cortina JM (1993) What is coefficient alpha? An examination of theory and applications. J Appl Psychol 78(1):98–104CrossRef Cortina JM (1993) What is coefficient alpha? An examination of theory and applications. J Appl Psychol 78(1):98–104CrossRef
19.
go back to reference Fayez R, Feldman LS, Kaneva P, Fried GM (2010) Testing the construct validity of the Simbionix GI Mentor II virtual reality colonoscopy simulator metrics: module matters. Surg Endosc 24(5):1060–1065PubMedCrossRef Fayez R, Feldman LS, Kaneva P, Fried GM (2010) Testing the construct validity of the Simbionix GI Mentor II virtual reality colonoscopy simulator metrics: module matters. Surg Endosc 24(5):1060–1065PubMedCrossRef
20.
go back to reference Felsher JJ, Olesevich M, Farres H, Rosen M, Fanning A, Dunkin BJ, Marks JM (2005) Validation of a flexible endoscopy simulator. Am J Surg 189(4):497–500PubMedCrossRef Felsher JJ, Olesevich M, Farres H, Rosen M, Fanning A, Dunkin BJ, Marks JM (2005) Validation of a flexible endoscopy simulator. Am J Surg 189(4):497–500PubMedCrossRef
21.
go back to reference Grantcharov TP, Carstensen L, Schulze S (2005) Objective assessment of gastrointestinal endoscopy skills using a virtual reality simulator. JSLS 9(2):130–133PubMed Grantcharov TP, Carstensen L, Schulze S (2005) Objective assessment of gastrointestinal endoscopy skills using a virtual reality simulator. JSLS 9(2):130–133PubMed
22.
go back to reference Haycock AV, Bassett P, Bladen J, Thomas-Gibson S (2009) Validation of the second-generation Olympus colonoscopy simulator for skills assessment. Endoscopy 41(11):952–958PubMedCrossRef Haycock AV, Bassett P, Bladen J, Thomas-Gibson S (2009) Validation of the second-generation Olympus colonoscopy simulator for skills assessment. Endoscopy 41(11):952–958PubMedCrossRef
23.
go back to reference Koch AD, Haringsma J, Schoon EJ, de Man RA, Kuipers EJ (2008) A second-generation virtual reality simulator for colonoscopy: validation and initial experience. Endoscopy 40(9):735–738PubMedCrossRef Koch AD, Haringsma J, Schoon EJ, de Man RA, Kuipers EJ (2008) A second-generation virtual reality simulator for colonoscopy: validation and initial experience. Endoscopy 40(9):735–738PubMedCrossRef
24.
go back to reference Datta V, Mandalia M, Mackay S, Darzi A (2002) The PreOp flexible sigmoidoscopy trainer. Validation and early evaluation of a virtual reality based system. Surg Endosc 16(10):1459–1463PubMedCrossRef Datta V, Mandalia M, Mackay S, Darzi A (2002) The PreOp flexible sigmoidoscopy trainer. Validation and early evaluation of a virtual reality based system. Surg Endosc 16(10):1459–1463PubMedCrossRef
25.
go back to reference MacDonald J, Ketchum J, Williams RG, Rogers LQ (2003) A lay person versus a trained endoscopist: Can the preop endoscopy simulator detect a difference? Surg Endosc 17(6):896–898PubMedCrossRef MacDonald J, Ketchum J, Williams RG, Rogers LQ (2003) A lay person versus a trained endoscopist: Can the preop endoscopy simulator detect a difference? Surg Endosc 17(6):896–898PubMedCrossRef
26.
go back to reference Mahmood T, Darzi A (2003) A study to validate the colonoscopy simulator. Surg Endosc 17(10):1583–1589PubMedCrossRef Mahmood T, Darzi A (2003) A study to validate the colonoscopy simulator. Surg Endosc 17(10):1583–1589PubMedCrossRef
27.
go back to reference Sedlack RE, Kolars JC (2003) Validation of a computer-based colonoscopy simulator. Gastrointest Endosc 57(2):214–218PubMedCrossRef Sedlack RE, Kolars JC (2003) Validation of a computer-based colonoscopy simulator. Gastrointest Endosc 57(2):214–218PubMedCrossRef
28.
go back to reference Moorthy K, Munz Y, Orchard TR, Gould S, Rockall T, Darzi A (2004) An innovative method for the assessment of skills in lower gastrointestinal endoscopy. Surg Endosc 18(11):1613–1619PubMed Moorthy K, Munz Y, Orchard TR, Gould S, Rockall T, Darzi A (2004) An innovative method for the assessment of skills in lower gastrointestinal endoscopy. Surg Endosc 18(11):1613–1619PubMed
29.
go back to reference Woo HS, Kim WS, Ahn W, Lee DY, Yi SY (2008) Haptic interface of the KAIST-Ewha colonoscopy simulator II. IEEE Trans Inf Technol Biomed 12(6):746–753PubMedCrossRef Woo HS, Kim WS, Ahn W, Lee DY, Yi SY (2008) Haptic interface of the KAIST-Ewha colonoscopy simulator II. IEEE Trans Inf Technol Biomed 12(6):746–753PubMedCrossRef
30.
go back to reference Sedlack RE, Baron TH, Downing SM, Schwartz AJ (2007) Validation of a colonoscopy simulation model for skills assessment. Am J Gastroenterol 102(1):64–74PubMedCrossRef Sedlack RE, Baron TH, Downing SM, Schwartz AJ (2007) Validation of a colonoscopy simulation model for skills assessment. Am J Gastroenterol 102(1):64–74PubMedCrossRef
31.
go back to reference Carter FJ, Schijven MP, Aggarwal R, Grantcharov T, Francis NK, Hanna GB, Jakimowicz JJ (2005) Work Group for Evaluation and Implementation of Simulators and Skills Training Programmes. Consensus guidelines for validation of virtual reality surgical simulators. Surg Endosc 19(12):1523–1532PubMedCrossRef Carter FJ, Schijven MP, Aggarwal R, Grantcharov T, Francis NK, Hanna GB, Jakimowicz JJ (2005) Work Group for Evaluation and Implementation of Simulators and Skills Training Programmes. Consensus guidelines for validation of virtual reality surgical simulators. Surg Endosc 19(12):1523–1532PubMedCrossRef
32.
go back to reference Satava RM, Gallagher AG, Pellegrini CA (2003) Surgical competence and surgical proficiency: definitions, taxonomy, and metrics. J Am Coll Surg 196:933–937PubMedCrossRef Satava RM, Gallagher AG, Pellegrini CA (2003) Surgical competence and surgical proficiency: definitions, taxonomy, and metrics. J Am Coll Surg 196:933–937PubMedCrossRef
33.
go back to reference Williams CB (1998) Endoscopy teaching: time to get serious. Gastrointest Endosc 47(5):429–430PubMed Williams CB (1998) Endoscopy teaching: time to get serious. Gastrointest Endosc 47(5):429–430PubMed
34.
go back to reference Hammoud MM, Nuthalapaty FS, Goepfert AR, Casey PM, Emmons S, Espey EL, Kaczmarczyk JM, Katz NT, Neutens JJ, Peskin EG, Association of Professors of Gynecology and Obstetrics Undergraduate Medical Education Committee (2008) To the point: medical education review the role of simulators in surgical training. Am J Obstet Gynaecol 199(4):338–343CrossRef Hammoud MM, Nuthalapaty FS, Goepfert AR, Casey PM, Emmons S, Espey EL, Kaczmarczyk JM, Katz NT, Neutens JJ, Peskin EG, Association of Professors of Gynecology and Obstetrics Undergraduate Medical Education Committee (2008) To the point: medical education review the role of simulators in surgical training. Am J Obstet Gynaecol 199(4):338–343CrossRef
35.
go back to reference Miskovic D, Wyles SM, Ni M, Darzi AW, Hanna GB (2010) Systematic review on mentoring and simulation in laparoscopic colorectal surgery. Ann Surg 252(6):943–951PubMedCrossRef Miskovic D, Wyles SM, Ni M, Darzi AW, Hanna GB (2010) Systematic review on mentoring and simulation in laparoscopic colorectal surgery. Ann Surg 252(6):943–951PubMedCrossRef
36.
go back to reference McGaghie WC, Issenberg SB, Petrusa ER, Scalese RJ (2010) A critical review of simulation based medical education. Med Educ 44:50–63PubMedCrossRef McGaghie WC, Issenberg SB, Petrusa ER, Scalese RJ (2010) A critical review of simulation based medical education. Med Educ 44:50–63PubMedCrossRef
37.
go back to reference Gurusamy K, Aggarwal R, Palanivelu L, Davidson BR (2008) Systematic review of randomized controlled trials on the effectiveness of virtual reality training for laparoscopic surgery. Br J Surg 95(9):1088–1097PubMedCrossRef Gurusamy K, Aggarwal R, Palanivelu L, Davidson BR (2008) Systematic review of randomized controlled trials on the effectiveness of virtual reality training for laparoscopic surgery. Br J Surg 95(9):1088–1097PubMedCrossRef
38.
go back to reference Fisher L, Ormonde DG, Riley RH, Laurence BH (2010) Endoscopic skills training in a simulated clinical setting. Simul Healthc 5(4):232–237PubMedCrossRef Fisher L, Ormonde DG, Riley RH, Laurence BH (2010) Endoscopic skills training in a simulated clinical setting. Simul Healthc 5(4):232–237PubMedCrossRef
39.
go back to reference Haycock AV, East JE, Swain D, Thomas-Gibson S (2010) Development of a novel esophageal stricture simulation. Dig Dis Sci 55(2):321–327PubMedCrossRef Haycock AV, East JE, Swain D, Thomas-Gibson S (2010) Development of a novel esophageal stricture simulation. Dig Dis Sci 55(2):321–327PubMedCrossRef
40.
go back to reference Haycock AV, Youd P, Bassett P, Saunders BP, Tekkis P, Thomas-Gibson S (2009) Simulator training improves practical skills in therapeutic GI endoscopy: results from a randomized, blinded, controlled study. Gastrointest Endosc 70(5):835–845PubMedCrossRef Haycock AV, Youd P, Bassett P, Saunders BP, Tekkis P, Thomas-Gibson S (2009) Simulator training improves practical skills in therapeutic GI endoscopy: results from a randomized, blinded, controlled study. Gastrointest Endosc 70(5):835–845PubMedCrossRef
41.
go back to reference Hassan I, Osei-Agymang T, Radu D, Gerdes B, Rothmund M, Fernández ED (2008) Simulation of laparoscopic surgery—four years’ experience at the Department of Surgery of the University Hospital Marburg. Wien Klin Wochenschr 120(3–4):70–76PubMedCrossRef Hassan I, Osei-Agymang T, Radu D, Gerdes B, Rothmund M, Fernández ED (2008) Simulation of laparoscopic surgery—four years’ experience at the Department of Surgery of the University Hospital Marburg. Wien Klin Wochenschr 120(3–4):70–76PubMedCrossRef
42.
go back to reference Maschuw K, Hassan I, Bartsch DK (2010) Surgical training using simulator Virtual Reality. Chirurg 81(1):19–24PubMedCrossRef Maschuw K, Hassan I, Bartsch DK (2010) Surgical training using simulator Virtual Reality. Chirurg 81(1):19–24PubMedCrossRef
43.
go back to reference Maagaard M, Sorensen JL, Oestergaard J, Dalsgaard T, Grantcharov TP, Ottesen BS, Larsen CR (2011) Retention of laparoscopic procedural skills acquired on a virtual-reality surgical trainer. Surg Endosc 25(3):722–727PubMedCrossRef Maagaard M, Sorensen JL, Oestergaard J, Dalsgaard T, Grantcharov TP, Ottesen BS, Larsen CR (2011) Retention of laparoscopic procedural skills acquired on a virtual-reality surgical trainer. Surg Endosc 25(3):722–727PubMedCrossRef
44.
go back to reference Sturm LP, Windsor JA, Cosman PH, Cregan P, Hewett PJ, Maddern GJ (2008) A systematic review of skills transfer after surgical simulation training. Ann Surg 248(2):166–179PubMedCrossRef Sturm LP, Windsor JA, Cosman PH, Cregan P, Hewett PJ, Maddern GJ (2008) A systematic review of skills transfer after surgical simulation training. Ann Surg 248(2):166–179PubMedCrossRef
45.
go back to reference Ahlberg G, Hultcrantz R, Jaramillo E, Lindblom A, Arvidsson D (2005) Virtual reality colonoscopy simulation: a compulsory practice for the future colonoscopist? Endoscopy 37:1198–1204PubMedCrossRef Ahlberg G, Hultcrantz R, Jaramillo E, Lindblom A, Arvidsson D (2005) Virtual reality colonoscopy simulation: a compulsory practice for the future colonoscopist? Endoscopy 37:1198–1204PubMedCrossRef
46.
go back to reference Sedlack RE, Kolars JC, Alexander JA (2004) Computer simulation training enhances patient comfort during endoscopy. Clin Gastroenterol Hepatol 2:348–352PubMedCrossRef Sedlack RE, Kolars JC, Alexander JA (2004) Computer simulation training enhances patient comfort during endoscopy. Clin Gastroenterol Hepatol 2:348–352PubMedCrossRef
47.
go back to reference Sedlack RE, Kolars JC (2004) Computer simulator training enhances the competency of gastroenterology fellows at colonoscopy: results of a pilot study. Am J Gastroenterol 99:33–37PubMedCrossRef Sedlack RE, Kolars JC (2004) Computer simulator training enhances the competency of gastroenterology fellows at colonoscopy: results of a pilot study. Am J Gastroenterol 99:33–37PubMedCrossRef
48.
go back to reference Cohen J, Cohen SA, Vora KC, Xue X, Burdick JS, Bank S, Bini EJ, Bodenheimer H, Cerulli M, Gerdes H, Greenwald D, Gress F, Grosman I, Hawes R, Mullin G, Schnoll-Sussman F, Starpoli A, Stevens P, Tenner S, Villanueva G (2000) Multicentre, randomised, controlled trial of virtual-reality simulator training in acquisition of competency in colonoscopy. Gastrointest Endosc 64:361–368CrossRef Cohen J, Cohen SA, Vora KC, Xue X, Burdick JS, Bank S, Bini EJ, Bodenheimer H, Cerulli M, Gerdes H, Greenwald D, Gress F, Grosman I, Hawes R, Mullin G, Schnoll-Sussman F, Starpoli A, Stevens P, Tenner S, Villanueva G (2000) Multicentre, randomised, controlled trial of virtual-reality simulator training in acquisition of competency in colonoscopy. Gastrointest Endosc 64:361–368CrossRef
49.
go back to reference Aabakken L, Adamsen S, Kruse A (2000) Performance of a colonoscopy simulator: experience from a hands on course. Endoscopy 32:911–913PubMedCrossRef Aabakken L, Adamsen S, Kruse A (2000) Performance of a colonoscopy simulator: experience from a hands on course. Endoscopy 32:911–913PubMedCrossRef
Metadata
Title
Systematic review of validity testing in colonoscopy simulation
Authors
James Ansell
John Mason
Neil Warren
Peter Donnelly
Neil Hawkes
Sunil Dolwani
Jared Torkington
Publication date
01-11-2012
Publisher
Springer-Verlag
Published in
Surgical Endoscopy / Issue 11/2012
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-012-2332-2

Other articles of this Issue 11/2012

Surgical Endoscopy 11/2012 Go to the issue