Role of virtual reality simulation in endoscopy training

Table 2 Results of studies evaluating the role of simulation in oesophagogastroduodenoscopy training

Ref.	Primary outcome	Secondary outcome
Bloom et al[6]	Mean time to complete procedure was 224 ± 27.65 s for novice, 171.22 ± 25.43 s for intermediate and 106.40 ± 13.08 s for experienced candidates (P = 0.008)	Mean percentage of total surface visualised was 60.56 ± 2.56 for novice, 66.56 ± 2.80 for intermediate and 72.10 ± 0.23 for experienced candidates (P = 0.005)
	The study demonstrated the construct validity of the simulator	Questionnaire responses suggested that novice and intermediate candidates considered VR simulation an important training tool
Clark et al[2]	Efficiency scores (total time to complete procedure divided by percentage of mucosal surface examined) of senior residents were higher than those of junior residents (85% vs 59%) demonstrating improved efficiency with continued use of simulator
Di Giulio et al[4]	The simulator-trained group performed a higher number of complete procedures (87.8% vs 70%, P < 0.0001) and needed less assistance (41.3% vs 97.9%, P < 0.0001) compared to control group. Length of procedure was similar in the two groups	Instructor marked performance as positive more frequently in the simulator-trained group compared to the controls (86.8% vs 56.7%, < 0.0001)
Ferlitsch et al[7]	Performance of expert candidates (compared to novices) was better in performance of J-manoeuvre during oesophagogastroduodenoscopy (P < 0.005), complications at colonoscopy (P < 0.02), insertion time (P < 0.001), identification of abnormal findings in gastroscopy and colonoscopy (P < 0.02) and skill performance (P < 0.01). Amongst novices, the simulation-trained group had a better performance compared to the controls in relation to complication rates at virtual endoscopy (P < 0.04), the insertion time during colonoscopy (P < 0.03) and skill performance (P < 0.01)
Ferlitsch et al[3]	The simulation-trained group performed better than the control group in terms of time needed to reach the duodenum [239 s (range 50-620) vs 310 s (110-720), P < 0.0001] and technical ability (P < 0.02) in the first ten endoscopic examinations on patients. Diagnostic ability was similar in the two groups	There were no significant differences in pain scores between the groups after 10 and after 60 endoscopies
	After 60 endoscopic examinations, investigation time was still less in the simulation-trained group. Technical and diagnostic ability improved during on-patient training in both groups and differences between groups were no longer seen at that stage
Sedlack[9]	The control group performed better than the simulation-trained group in terms of patient discomfort (5; IQR, 4-6 vs 6; IQR, 5-6; P = 0.015), sedation, independence and competence scores
Shirai et al[5]	The simulator-trained group achieved significantly higher scores than the control group in the following skills: oesophageal intubation, passing from the EGJ to the antrum, pyloric intubation, and examination of the duodenum and the fundus
Van Sickle et al[8]	The study group showed an improvement in endoscopic skills (e.g., Global Assessment of Gastrointestinal Endoscopic Skills scores) after 8 wk of VR simulation training

IQR: Interquartile range; EGJ: Esophagogastric junction; VR: Virtual reality.