Impact of Virtual Reality Simulator Training on the Acquisition of Competency in Colonoscopy: Final Results of Multi-Center Randomized Controlled Trial

BACKGROUND: The GI Mentor™ is a virtual reality endoscopy simulator which uses force feedback technology to create a realistic training experience. We conducted a randomized blinded comparison of simulator training vs no simulator training to define the benefit of simulator training. METHODS: First year GI fellows were randomized to receive 10 hours of unsupervised training on the GI Mentor™or no simulator experience during the first 8 weeks of fellowship. Fellows performed all procedures except colonoscopy during this time. After this period, both groups began performing real colonoscopy. The first 200 colonoscopies performed by each fellow were graded by proctors to measure technical and cognitive success, subjective competency and patient comfort level. Objective competency for a procedure was defined as unassisted examination to the cecum with correct recognition and identification of abnormalities. RESULTS: 45 fellows were randomized from 16 hospitals over 2 years. Pre-colonoscopy experience in other procedures and the # of failed examinations rated as difficult for the proctor were similar in the 2 groups. Fellows in the simulator group had significantly higher objective competency rates during the first 100 cases. A mixed effects model demonstrated higher objective competence overall in the simulator group (p < 0.0001) with the difference between groups being significantly greater during the first 80 cases performed than during the latter cases. The median # of cases needed to reach 90% competency was 160 in both groups. Patient comfort level was similar in the two groups. CONCLUSION: Fellows who undergo colonoscopy training for 10 hours on the GI Mentor™ perform significantly better during the early phase of real colonoscopy training. Almost all trainees reach full competency by 200 colonoscopies. Study funded by ASGE Outcomes & Effectiveness Award.