仿真结肠镜运用系统反馈独立训练与教师指导训练的比较研究

目的本研究拟开展仿真内镜不同训练模式对结肠镜技能建立的作用研究,以期发现最优化的训练模式。方法将学员分为2组,A组采用自学法,B组教师指导法。训练完成后根据成绩判断哪种训练方法最适合结肠镜受训学员。结果两组总体评分无显著性差异,各环节比较包括安全性、准确度、残气量、肠袢形成及操作时间方面均无显著性差异。结论本研究表明应推荐自学法为仿真结肠镜的训练方法。     

低剂量聚乙二醇联合硫酸镁用于肠道准备的效果评价

背景：聚乙二醇（PEG）为临床常用肠道准备清洁剂,但仍存在一些缺点。笔者等设计了一种低剂量PEG联合低剂量硫酸镁的肠道准备方案,以期能减少PEG溶液摄入量,提高肠腔清洁程度,减少气泡,缩短结肠镜检查时间。目的：以标准剂量PEG方案为对照,评价新方案在结肠镜检查前肠道准备中的有效性、耐受性、安全性以及合适的给药时机。方法：连续收集拟行结肠镜检查者180例,随机分为三组。A组服用标准剂量PEG（68.56 g/包×2包）、B组连续服用低剂量PEG（1包）和硫酸镁（25%,60 ml）、C组间断服用低剂量PEG和硫酸镁行肠道准备。内镜医师单盲行Boston肠道准备量表（BBPS）和肠腔内气泡评分,记录结肠镜检查时间。问卷调查患者对药物的耐受性,记录服药后不良反应。监测用药前后心率、血压和实验室指标。结果：所有患者均完成肠道准备和全结肠镜检查。B、C两组BBPS总分显著高于A组（P〈0.05）,结肠镜检查时间显著短于A组（P〈0.05）,B组肠腔内气泡评分显著低于A、C两组（P〈0.05）。B、C两组药物口感评分、完全服用率和愿意再服率均高于A组。三组间总体不良反应评分无明显差异。结论：与标准剂量PEG方案相比,连续服用低剂量PEG和低剂量硫酸镁用于结肠镜检查前肠道准备更为有效,耐受性更高;两种方案安全性相似。     

结肠镜检查前肠道准备清洁效果的临床对比研究

目的：观察不同方法对结肠镜检查前肠道准备的清洁效果及其副作用。方法：312例结肠镜检查者肠道清洁前随机分为口服甘露醇组（A组）、口服番泻叶组（B组）、结肠循环冲洗组（C组）及联合B方法与C方法（D组）。据结肠镜检查中肠道清洁程度（I－Ⅲ级）和清洁范围（0－4度）评价肠道清洁效果。结果：D组肠道清洁程度和清洁范围最理想，其肠道清洁程度满意－比较满意率（I＋Ⅱ：96．2％）显著高于A组（82．1％；P＜0．01）、B组（85．7％；P＜0．05）和C组（69．3％，P＜0．01）。C组降结肠以下清洁率（65．4％）显著高于A组（37．1％，P＜0．01）和B组37．7％，P＜0．01），同时其肠道清洁失败率（30．8％）也显著高于B组（14．3％，P＜0．01）。此外，C组副作用发生率（3．8％）显著低于其他三组（A组43．6％，B组54．5％和D组58．2％，P均＜0．01）。结论：口服水泻剂联合结肠途径治疗机循环冲洗法是比较理想的全结肠清洁方法，单纯结肠循环冲洗法适合于乙状结肠镜检查前肠道准备。     

以二氧化碳为媒介的老年人结肠镜检查的安全性和舒适性

目的分析评价二氧化碳（C02）为媒介的结肠镜检查应用于老年患者的安全性和舒适性。方法这是一项随机双盲对照研究。选取110例老年人,随机分为以空气为媒介的结肠镜组（n=55）和以CO2为媒介的结肠镜组（n=55）。通过腹痛和腹胀的问卷调查、腹部平片肠管积气程度、经皮CO2分压连续测定等结果,分析比较两组间的差异性。结果CO2组平均插入时间短,且成功率高,与空气组比较差异有统计学意义[（7．0±4．9）vs（9．0±3．7）min;P〈0．05];结肠镜检查后5,10,15,20min不同时间点进行的腹痛、腹胀的问卷调查评分中,C02组的评分明显低于空气组,差异有统计学意义[5min：（15．4±2．1）VS（63．5±13．5）,10min：（5．1±1．3）vs（60．3±10．9）,15min：（0．5±0．7）vs（58．6±11．6）,20min：（0．0±O．7）vs（50．4±8．2）;P〈0．01];C02组的肠管扩张程度评分明显低于空气组,差异有统计学意义[（1．2±0．5）vs（3．6±0．9）;P〈0．05];结肠镜检查前、到达回盲部、退回至直肠、检查结束后10min4个时间点记录经皮呼气末CO2分压,差异均无统计学意义。结论与以空气为媒介的结肠镜比较,以CO2为媒介的结肠镜检查应用于老年人,安全可靠,并且具有痛苦小、操作时间短、耐受性好的显著优势。     

不同时间点服用西甲硅油在结肠镜检查前肠道准备中的作用

【】目的 探讨不同时间点服用西甲硅油在结肠镜检查前肠道准备中的作用。方法 将270例拟行结肠镜检查的患者随机分为3组,所有患者均在结肠镜检查前4小时服用聚乙二醇电解质清洁肠道。A组：结肠镜检查前2小时口服西甲硅油30ml;B组：结肠镜检查前1小时服用西甲硅油30ml。C组：结肠镜检查前0.5小时服用西甲硅油30ml。观察3组患者的肠道清洁程度、肠腔内气泡情况、息肉检出率及操作时间。结果 三组患者之间的肠道清洁程度差异无统计学意义(P>0.05)。与A组和C组相比,B组的肠腔内气泡明显减少(P<0.05),息肉检出率明显升高(P<0.05),操作时间明显降低(P<0.05)。A组和C组相比,肠腔内气泡情况、息肉检出率及操作时间无明显差异(P>0.05)。结论 结肠镜检查前1小时口服西甲硅油30ml可减少肠腔内气泡、提高息肉检出率,并缩短操作时间。     

不同有氧运动模式对原发性高血压患者心肌肥厚、自主神经功能及运动耐力的影响

目的 研究不同有氧运动模式对原发性高血压患者心肌肥厚、自主神经功能及运动耐力的影响。 方法 选取2018年6月～2020年3月在南京医科大学附属淮安第一医院就诊的原发性高血压患者123例,随机分为A、B、C组。A组为安静对照组,不进行运动训练;B组进行中低强度持续有氧运动训练;C组进行高强度间歇有氧运动训练,运动训练持续12周。对比三组训练前后血压、体质量、左心室质量指数（LVMI）、左心室舒张末期内径（LVDd）、左心室后壁厚度（LVPWT）、室间隔厚度（IVST）水平变化,自主神经功能及运动耐力变化。 结果 与训练前比较,三组患者训练4、8与12周后收缩压与舒张压均降低（均P<0.01）;与训练4周后本组比较,训练8与12周后收缩压与舒张压均降低（均P<0.01）。与训练8周后本组比较,训练12周后收缩压与舒张压均降低（均P<0.01）。与A组训练后同时段比较,B组、C组收缩压与舒张压均降低（均P<0.01）;与B组训练后同时段比较,C组收缩压与舒张压均降低（均P<0.01）;训练后与训练前比较,A组LVMI与LVDd降低（均P<0.01）,LVPWT与IVST降低（均P<0.05）,B组与C组体质量、LVMI、LVDd、LVPWT与IVST均降低（均P<0.01）;与训练后A组比较,B组体质量、LVMI、LVDd、LVPWT、IVST均降低（均P<0.05）,C组体质量、LVMI、LVDd、LVPWT、IVST均降低（均P<0.01）;与训练后B组比较,C组体质量、LVMI、LVDd、LVPWT、IVST均降低（均P<0.01）。训练后与训练前比较,三组VO₂与METs水平均升高（均P<0.01）;训练后与A组比较,B组VO₂与METs水平均升高（均P<0.05）,C组VO₂与METs水平均升高（均P<0.01）;训练后与B组比较,C组VO₂与METs水平均升高（均P<0.01）。 结论 高强度间歇有氧运动、中低强度持续有氧运动均能有效降低原发性高血压患者的血压,减轻体质量,改善患者心肌肥厚和自主神经功能,提高运动耐力,且高强度间歇有氧运动的效果更佳。     

“简化拉玛泽减痛法”在结肠镜检查中的应用效果评价

目的评价结肠镜检查过程中应用＂简化拉玛泽减痛法＂进行干预的效果。方法 225例结肠镜检查病人,分为简化拉玛泽减痛法组（拉玛泽组）、麻醉剂组和对照组。拉玛泽组70例在结肠镜检查过程中辅助使用＂简化拉玛泽减痛法＂,麻醉剂组85例在检查过程中使用芬太尼及丙泊酚麻醉,对照组70例则不进行其它干预措施,进行肠镜检查过程中记录肠道清洁度、肠道病变情况、肠镜到达回盲部的时间、成功率、疼痛程度以及并发症,病例资料进行统计学分析。结果三组病人肠道清洁度、肠道病变情况、成功率比较均无统计学差异（P〉0.05）;拉玛泽在肠镜到达回盲部的时间方面不及麻醉组（P〈0.05）,与对照组相比亦无明显优势（P〉0.05）;但拉玛泽组相对于对照组可有效减轻肠镜检查疼痛程度（P〈0.05）;在并发症比较方面,三组的差异有统计学意义（P〈0.05）,麻醉剂组并发症的发生率较高。结论 ＂简化拉玛泽减痛法＂在肠镜检查过程中的应用,可以有效减轻病人的疼痛程度且并发症少,有临床应用价值。     

HIV感染者肠黏膜MUC1及MUC2分析

目的 对比健康者、无症状HIV感染者及AIDS期患者肠黏膜黏蛋白1(MUC1)、黏蛋白2(MUC2)表达水平的差异。方法 结肠镜下采集三组人群结肠黏膜组织标本,分别采用HE染色及PAS染色观察肠黏膜组织基本情况及杯状细胞表达情况,采用实时荧光定量反转录聚合酶链反应（RT-qPCR）、免疫组化及蛋白印迹评估MUC1、MUC2表达情况。结果 与A组（n=15）(1.200±0.414)相比,B组（n=15）(3.600±0.910)与C组（n=15）(5.000±0.655)结肠黏膜病理评分明显升高（P<0.001）,且C组升高比B组更明显（P<0.05）;B组（80.533±14.752）及C组（61.601±11.561）杯状细胞数量均低于A组（96.210±17.334）,且C组低于B组（P<0.05）。RT-qPCR、免疫组化、蛋白印迹检测显示：与A组（1.026±0.071,0.210±0.085,0.356±0.146）相比,MUC1在B组（0.865±0.015,0.149±0.034,0.195±0.113）及C组（0.803±0.080,0.121±0....     

不同剂量西甲硅油行结肠镜检查术前肠道准备的效果分析

目的探讨结肠镜检查术前使用不同剂量西甲硅油的肠道准备效果。方法150例结肠镜检查患者随机分成3组,各组50例,A．组使用复方聚乙二醇电解质散＋西甲硅油5ml进行肠道准备,A：组使用复方聚乙二醇电解质散＋西甲硅油10ml进行肠道准备,B组（对照组）单纯使用复方聚乙二醇电解质散进行肠道准备,比较各组在肠道清洁程度、祛泡效果、结肠镜检查操作时间、操作者对结肠镜检查的满意度以及患者对结肠镜检查的耐受程度方面存在的差异。结果A,组、A：组和B组祛泡满意率分别为98．0％（49／50）、100．0％（50／50）和80．0％（40／50）,各组比较差异有统计学意义（x^2=17．855,P=0．000）。而各组在肠道清洁满意率（x^2=1．500,P=0．472）、结肠镜检查平均操作时间（Z=-0．333,P=0．765）、操作者对结肠镜检查的满意度（x^2=6．303,P=0．178）以及患者对结肠镜检查的耐受程度（x^2=8．238,P=0．083）方面差异无统计学意义。结论结肠镜检查术前肠道准备中常规使用复方聚乙二醇电解质散的同时联合使用西甲硅油,在不明显影响肠道清洁程度和患者术中耐受程度的前提下,可显著提高祛泡效果,5ml西甲硅油的剂量基本可以满足临床祛泡需要,而10ml剂量的祛泡效果更好。     

复方聚乙二醇电解质散不同给药方式对上午行结肠镜检查患者肠道准备效果的临床观察及分析

目的观察复方聚乙二醇电解质散(polyethylene glycol electrolytes powder,PEG-EP)不同给药方式对上午行结肠镜检查患者的肠道准备效果及耐受性。方法将我院消化内科收治的拟行结肠镜检查的144例患者随机分为A、B、C三组,A组患者于结肠镜检查前1 d晚上一次性给予2 L复方聚乙二醇电解质溶液,B组患者于结肠镜检查当日早上一次性给予2 L复方聚乙二醇电解质溶液,C组患者分别于结肠镜检查前一晚及结肠镜检查当日早上各给予1 L复方聚乙二醇电解质溶液进行肠道准备。对比分析三组患者肠道准备清洁度、不良反应发生率、睡眠干扰情况、重复检查意愿及回盲部插镜率。结果 A、B、C三组患者的肠道准备有效率比较,差异无统计学意义(P 0. 05),但三组患者肠道准备效果的I级率比较,C组明显高于A、B组(P 0. 05); C组患者不良反应发生率低于A、B两组(P 0. 05),且C组患者睡眠干扰较A、B两组低(P 0. 05),患者依从性好,其中A、C两组患者重复检查意愿高于B组(P 0. 05)。结论复方聚乙二醇电解质散小剂量分次给药法用于结肠镜前肠道准备,相较于单次大剂量给药法,可获得相当的肠道准备有效率及回盲部插镜率,但肠道准备质量I级率较高,且患者不良反应发生率低,睡眠干扰小,患者重复检查意愿高。     

Computer-based virtual reality colonoscopy simulation improves patient-based colonoscopy performance

BACKGROUND:

Colonoscopy simulators that enable one to perform computer-based virtual colonoscopy now exist. However, data regarding the effectiveness of this virtual training are limited.

OBJECTIVE:

To determine whether virtual reality simulator training translates into improved patient-based colonoscopy performance.

METHODS:

The present study was a prospective controlled trial involving 18 residents between postgraduate years 2 and 4 with no previous colonoscopy experience. These residents were assigned to receive 16 h of virtual reality simulator training or no training. Both groups were evaluated on their first five patient-based colonoscopies. The primary outcome was the number of proctor ‘assists’ required per colonoscopy. Secondary outcomes included insertion time, depth of insertion, cecal intubation rate, proctor- and nurse-rated competence, and patient-rated pain.

RESULTS:

The simulator group required significantly fewer proctor assists than the control group (1.94 versus 3.43; P≤0.001), inserted the colonoscope further unassisted (43 cm versus 24 cm; P=0.003) and there was a trend to intubate the cecum more often (26% versus 10%; P=0.06). The simulator group received higher ratings of competence from both the proctors (2.28 versus 1.88 of 5; P=0.02) and the endoscopy nurses (2.56 versus 2.05 of 5; P=0.001). There were no significant differences in proctor-, nurse- or patient-rated pain, or attention to discomfort.

CONCLUSIONS:

Computer-based colonoscopy simulation in the initial stages of training improved novice trainees’ patient-based colonoscopy performance.     

Multicenter, randomized, controlled trial of virtual-reality simulator training in acquisition of competency in colonoscopy

BACKGROUND: The GI Mentor is a virtual reality simulator that uses force feedback technology to create a realistic training experience. OBJECTIVE: To define the benefit of training on the GI Mentor on competency acquisition in colonoscopy. DESIGN: Randomized, controlled, blinded, multicenter trial. SETTING: Academic medical centers with accredited gastroenterology training programs. PATIENTS: First-year GI fellows. INTERVENTIONS: Subjects were randomized to receive 10 hours of unsupervised training on the GI Mentor or no simulator experience during the first 8 weeks of fellowship. After this period, both groups began performing real colonoscopies. The first 200 colonoscopies performed by each fellow were graded by proctors to measure technical and cognitive success, and patient comfort level during the procedure. MAIN OUTCOME MEASUREMENTS: A mixed-effects model comparison between the 2 groups of objective and subjective competency scores and patient discomfort in the performance of real colonoscopies over time. RESULTS: Forty-five fellows were randomized from 16 hospitals over 2 years. Fellows in the simulator group had significantly higher objective competency rates during the first 100 cases. A mixed-effects model demonstrated a higher objective competence overall in the simulator group (P < .0001), with the difference between groups being significantly greater during the first 80 cases performed. The median number of cases needed to reach 90% competency was 160 in both groups. The patient comfort level was similar. CONCLUSIONS: Fellows who underwent GI Mentor training performed significantly better during the early phase of real colonoscopy training.     

表象训练在虚拟现实内镜模拟器培训胃镜初学者中的应用

目的:探讨表象训练在胃镜技能获得中的作用.方法:分层抽样法抽取我校08级临床医学专业男学员30人,随机分为3组.A组(n=10)在常规模拟器练习过程中加入表象训练,B组(n=10)进行常规模拟器练习,C组(n=10)不做任何练习.完成培训结束时所有学员操作病例1,模拟器给出的评分,比较3组间的考核评分.所有学员接受培训前、后心理测评,评价心理状态是否稳定.结果:比较3组考核成绩显示,3组间总分差异有统计学意义,3组组间两两比较显示差异有统计学意义,其中A组优于B组,A组优于C组,B组优于C组.进一步分析差异原因,结果表明,安全性评分和准确性评分、残气量评分、患者痛苦指数评分、操作时间评分A、B、C3组间差异均有统计学意义;而A、B组两组之间比较,只有残气量评分、操作时间评分差异有统计学意义.结论:表象训练可提高使用虚拟现实内镜模拟器培训胃镜技能的效果,教学方法容易实施,学员容易掌握,是一种可行性较高的教学辅助方法.     

Prospective randomized study on the use of a computer-based endoscopic simulator for training in esophagogastroduodenoscopy

Background and Aim:  Computer-based endoscopic simulators have been developed in recent years, and their usefulness has been reported. However, there is no blinded prospective randomized controlled study on esophagogastroduodenoscopy (EGD) training using virtual reality simulators. The present study aimed to assess the effectiveness of a computer-based simulator for basic training in EGD.
Methods:  The GI-Mentor II simulator was used. The subjects were 20 hospital medical residents. After receiving an explanation regarding the fundamentals of endoscopy, 10 trainees were each randomized into a simulator group and a non-simulator group. The simulator group received 5 h of training with the GI-Mentor II plus bedside training, while the non-simulator group received bedside training. Subsequently, each subject performed endoscopy twice for assessment. Performance was evaluated according to a five-grade scale for a total of 11 items.
Results:  The score was significantly higher in the skills required for insertion into the esophagus, passing from the esophagogastric junction (EGJ) to the antrum, passing through the pylorus, and examination of the duodenal bulb and the fornix.
Conclusions:  The performance of endoscopy was improved by 5 h of simulator training. The simulator was more effective with regard to the items related to manipulation skills. Computer-based simulator training in EGD is useful for beginners.     

Evaluation of hands-on training in colonoscopy: Is a computer-based simulator useful?

Background and aimsThe advantages of using a computer-based simulator during colonoscopy training are debated. We aimed to explore its usefulness in objectively measuring trainees’ competence in colonoscopy.MethodsTwelve colonoscopy trainees (fully trained in upper GI endoscopy) were evaluated using a computer-based simulator (GI-Mentor, Symbionix) before and during hands-on training (i.e. after 60 colonoscopies); the controls were 15 experts (>90% of caecal intubation). Both trainees and experts performed two “screening” simulations (easy and difficult) in a randomised order, and the time to reach the caecum and withdrawal time was assessed.ResultsThe percentage of caecal intubation progressively increased during hands-on training. All of the trainees intubated the caecum during the easy and difficult simulations, both before and during hands-on training. The median time (interquartile range) to reach the caecum upon easy simulation was the only variable influenced by hands-on training: 2.7 min (2.1–3.2) before and 1.9 min (1.6–2) during training (p < 0.01). Withdrawal time was ≥6 min in the case of five trainees before training, and three during hands-on training. Computer-based simulator performance did not correlate with hands-on training performance.ConclusionsThe computer-based simulator was not found to be useful in evaluating competence during hands-on training in colonoscopy.     

Simulation-Based Training for Colonoscopy: Establishing Criteria for Competency

The aim of this study was to create simulation-based tests with credible pass/fail standards for 2 different fidelities of colonoscopy models.Only competent practitioners should perform colonoscopy. Reliable and valid simulation-based tests could be used to establish basic competency in colonoscopy before practicing on patients.Twenty-five physicians (10 consultants with endoscopic experience and 15 fellows with very little endoscopic experience) were tested on 2 different simulator models: a virtual-reality simulator and a physical model. Tests were repeated twice on each simulator model. Metrics with discriminatory ability were identified for both modalities and reliability was determined. The contrasting-groups method was used to create pass/fail standards and the consequences of these were explored.The consultants significantly performed faster and scored higher than the fellows on both the models (P < 0.001). Reliability analysis showed Cronbach α = 0.80 and 0.87 for the virtual-reality and the physical model, respectively. The established pass/fail standards failed one of the consultants (virtual-reality simulator) and allowed one fellow to pass (physical model).The 2 tested simulations-based modalities provided reliable and valid assessments of competence in colonoscopy and credible pass/fail standards were established for both the tests. We propose to use these standards in simulation-based training programs before proceeding to supervised training on patients.     

计算机辅助仿真模拟器对心血管专业研究生在冠状动脉造影技能培训中的作用

目的:明确计算机辅助仿真模拟器在心血管专业研究生培养中,是否有助于掌握冠状动脉造影技术。方法:选取我院14名无心血管放射介入经验的在读心血管专业硕士或博士研究生在接受相同课时的冠状动脉介入理论学习后,随机抽取7名研究生接受Angiomentor计算机辅助仿真模拟器培训课程,模拟冠状动脉造影操作;其余7名心血管专业在读硕士研究生未接受仿真模拟器培训,随后在有经验的冠状动脉介入医师指导下于真实临床环境中操作冠状动脉造影,评价操作错误的频数、平均造影时间、造影剂使用量、术中累计放射线剂量及单位面积X线累计曝光剂量。结果:培训组平均操作错误的频数减少50%、平均造影时间减少26·7%、造影剂使用量减少22·2%及术中放射线曝光总剂量明显减少45·7%,单位面积X线累计曝光剂量减少52·1%,少于非培训组。结论:仿真模拟器有助于心血管专业研究生熟练掌握冠状动脉造影技术。     

Validation of a computer-based colonoscopy simulator

BACKGROUND: The computer-based colonoscopy simulator is intended to provide a realistic colonoscopic experience and feedback to operators regarding procedure skills. Advocates hope that computer-based colonoscopy simulators will enhance the mastery of colonoscopy by trainees. Before this hypothesis can be tested, the claims made for a simulator must be validated. The aims of this study were to answer the following: Does a computer-based colonoscopy simulator provide a "realistic" experience? Do computer-based colonoscopy simulators' performance parameters differentiate varying levels of experience? METHODS: Ten staff gastroenterologists, 6 gastroenterology fellows, and 6 residents each performed 2 computer-based colonoscopy simulator colonoscopies and performance parameters were recorded. Staff colonoscopists then completed a 6-item survey grading the "realism" of the simulation and procedure difficulty. Survey responses and performance scores were compared with the Wilcoxon rank-sum test. RESULTS: Faculty found the computer-based colonoscopy simulator experience to be realistic despite the "cases" being markedly easier than actual colonoscopy. The computer-based colonoscopy simulator distinguishes subjects according to endoscopic experience with 3 of its measured parameters (total procedure time, insertion time, time in "red-out"). No significant difference in the ability to distinguish among user types was found for the other 10 computer-based colonoscopy simulator measurements for which data were analyzable. CONCLUSION: The computer-based colonoscopy simulator provides a favorable degree of virtual realism with regard to visual simulation and colonoscope mechanics, although the "cases" were regarded as considerably easier than actual colonoscopy. The computer-based colonoscopy simulator has only limited capability for distinguishing varying levels of competence at actual colonoscopy. These findings suggest that a study to determine the role of computer-based colonoscopy simulators in the curriculum of trainees is warranted.     

Evaluation of virtual reality bronchoscopy as a learning and assessment tool

BACKGROUND: Conventional training in bronchoscopy involves a trainee performing on a real patient under supervision. This method of training is not only expensive, but there is also potential for increased patient discomfort. Simulators permit the acquisition of necessary technical skills required for the procedure. Virtual reality (VR) has been an integral part of training in aviation, and the application of this technology in medical training needs to be evaluated. OBJECTIVE: This study was conducted to evaluate the efficacy of a VR bronchoscopy simulator as a learning and assessment tool. METHODS: The bronchoscopic simulator (HT Medical Systems, Maryland, USA) is a VR computer programme. The simulator has the ability to assess competence by a set of parameters, which formed the data for the study. Nine novices without previous bronchoscopic experience formed the study group (group 1). Nine experienced bronchoscopists having performed between 200 and 1000 bronchoscopies formed the other group (group 2). We assessed the efficacy of the system as a learning tool by studying whether there was a significant difference between the first and subsequent sessions of the subjects from group 1 and by comparing the performance of the two groups. Statistical analysis was done using the Mann-Whitney U test and the Wilcoxon signed ranks test. RESULTS: There was a significant difference in performance between the first attempt of group 1 and the performance of the experts in terms of percentage of segments visualised and number of wall collisions and the economy of performance. Among the subjects from group 1, there was a significant improvement in percentage of segments visualised by the third attempt (p = 0.04), in the economy of performance by the sixth attempt (0.008) and in the number of wall collisions by the sixth attempt (0.024). When each attempt of the novices was compared with the performance of group 2, the significance in the difference of the percentage of segments studied (p = 0.09) and the economy of performance disappeared by the third attempt (0.06), while the difference in the number of wall collisions disappeared by the fifth attempt (p = 0.06). CONCLUSIONS: This study has been able to establish the face, construct and content validity of the simulator and the potential for it to be an effective training tool.