仿真结肠镜训练模式的优化研究

仿真结肠镜可用于结肠镜初学者的培训,但不同训练模式的优劣仍存在争议。目的：研究不同仿真结肠镜训练模式对建立结肠镜技能的作用,以发现最优化训练模式。方法：学员分为整体训练法（A组）、分段训练法（B组）、整体训练与关键阶段相结合法（C组）三组进行训练。训练结束后根据评分判断最适合结肠镜受训学员的训练模式。结果：三种训练模式在安全性和准确度方面无明显差异,C组在残气量、肠袢形成和操作时间方面具有明显优势。结论：整体训练与关键阶段相结合法是仿真结肠镜最优化的训练模式。     

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。     

链霉蛋白酶服药时间对胃镜视野清晰度的影响

目的探讨链霉蛋白酶服药时间对胃镜视野清晰度的影响。方法将450例患者随机分为三组:A组患者在检查前15min口服温水和利多卡因胶浆;B组患者在检查前15 min口服链霉蛋白酶、碳酸氢钠和利多卡因胶浆;C组患者在检查前30 min口服链霉蛋白酶、碳酸氢钠和利多卡因胶浆;比较三组患者的不适程度、胃镜视野清晰度、微小病变检出率。结果在胃底、胃体、胃窦,胃镜视野清晰度在三组间比较及两两比较差异有统计学意义(P0.05),C组评分低于B组,B组评分低于A组(得分越低视野越清晰)。在食管、十二指肠,胃镜视野清晰度B组、C组与A组比较差异有统计学意义(P0.05),B组与C组比较差异无统计学意义(P0.05),B组、C组的评分均低于A组;B组、C组患者不适程度轻、微小病变(溃疡、糜烂、息肉样增生)特别是癌前期病变检出率高于A组,差异有统计学意义(P0.05),但B组与C组比较差异无统计学意义(P0.05)。结论胃镜检查前联合应用链霉蛋白酶可以有效改善胃镜视野清晰度,检查前30 min应用效果更好。     

神经康复机械手配合虚拟情景训练对脑卒中后偏瘫病人上肢功能的影响

目的探讨神经康复机械手联合虚拟情景训练对脑卒中后偏瘫病人上肢功能的作用效果。方法选择淮安市康复医院收治的脑卒中后偏瘫病人184例,随机分为A组、B组、C组和D组。A组给予常规康复训练,B组给予常规康复训练+虚拟情景训练,C组给予常规康复训练+神经康复机械手训练,D组给予常规康复训练+神经康复机械手训练+虚拟情景训练。对比4组病人干预前和干预3个月后上肢运动功能量表(FMA)评分和简易上肢功能量表(STEF)评分,干预前和干预3个月后病人改良Barthel指数量表(MBI)评分以及干预3个月后临床疗效。结果4组干预前FMA评分和STEF评分比较差异无统计学意义(P>0.05),干预3个月后4组FMA评分和STEF评分均较治疗前升高(P<0.05),B组与C组相近(P>0.05),其他两两组间比较差异均有统计学意义(P<0.05);4组干预前MBI评分比较差异无统计学意义(P>0.05),干预3个月后4组MBI评分均较治疗前升高(P<0.05),且D组>C组>B组>A组;干预3个月后4组两两比较疗效等级分布比较差异有统计学意义(P<0.05),D组总有效率高于其他3组(P<0.01)。结论对于脑卒中后偏瘫病人采用神经康复机械手配合虚拟情景训练能够改善上肢运动功能和手功能,提高病人生活质量,临床疗效确切。     

丙泊酚和右美托咪定对肥胖糖尿病患者胃旁路术后麻醉复苏质量改善临床观察

目的分析肥胖糖尿病患者行胃旁路手术采用丙泊酚、右美托咪啶取得的效果。方法收集医院2017年1月—2018年1月收治的肥胖糖尿病行胃旁路手术患者123例,采用随机分组方式,手术采用单一丙泊酚、单一美托咪定、丙泊酚复合右美托咪啶的分别纳入A组、B组、C组,分别为41例,对3组患者手术、麻醉情况、麻醉苏醒与疼痛症状以及不良反应情况观察。结果手术时间、麻醉时间3组患者组间差异无统计学意义(P0.05),睁眼时间A组、C组用时较少,与B组比较均差异有统计学意义(P0.05),定向力恢复时间A组少于B组、C组,C组少于B组,组间比较差异有统计学意义(P0.05),拔管时间A组少于B组、C组,C组少于B组,组间比较差异有统计学意义(P0.05)。疼痛症状评分观察,麻醉停止后1 h,B组与C组评分相比A组较低,差异有统计学意义(P0.05),麻醉停止后3 h评分结果C组相对较低,与其他两组组间差异有统计学意义(P0.05)。意识状态恢复评分,麻醉停止后1 h 3组对比差异无统计学意义,麻醉停止后3 h评分结果 C组相对较高,与其他两组组间差异有统计学意义(P0.05)。不良反应发生率A组19.51%(8/41)、B组17.07%(7/41)、C组2.44%(1/41),C组患者明显低于其他两组,差异有统计学意义(P0.05)。结论胃旁路手术中,对肥胖糖尿病患者给予丙泊酚与右美托咪啶联合应用,对改善术后麻醉复苏质量有明显作用,不良反应发生率较低,应在临床实践中应用推广。     

环磷酰胺联合泼尼松治疗特发性间质性肺炎的临床疗效观察

目的观察环磷酰胺联合泼尼松治疗特发性间质性肺炎(IIP)的临床疗效。方法选取2011年1月—2015年1月重庆市大足区人民医院确诊的IIP患者90例,采用随机数字表法分为A、B、C 3组,各30例。A组患者单独采用环磷酰胺治疗,B组患者单独采用泼尼松治疗,C组患者采用环磷酰胺联合泼尼松治疗;比较3组治疗前后的动脉氧分压(Pa O2)、肺活量(VC),临床影像生理(CRP)评分及不良反应发生率。结果 3组患者治疗前Pa O2、VC比较,差异均无统计学意义(P0.05);C组患者治疗后Pa O2、VC均高于A、B组(P0.05);A、B组患者治疗后Pa O2、VC比较,差异无统计学意义(P0.05)。3组患者治疗前临床评分、影像评分、生理评分比较,差异均无统计学意义(P0.05);C组患者治疗后临床评分、生理评分均低于A、B组(P0.05);3组患者治疗后影像评分比较,差异无统计学意义(P0.05)。C组患者不良反应发生率低于A、B组(P0.05)。结论环磷酰胺联合泼尼松治疗IIP的疗效和安全性均优于单独用药。     

口服橄榄油联合聚乙二醇电解质散对慢性便秘患者肠道准备效果的影响

目的 探讨口服橄榄油联合聚乙二醇电解质散（PEG）用于慢性便秘患者的结肠镜检查前肠道准备效果及安全性。方法 采用随机、单盲、前瞻性研究方法,将2017年11月至2018年5月于第四军医大学唐都医院接受结肠镜检查的180例慢性便秘患者均分成3组。C组检查前一晚8点服用1 500 mL PEG溶液,检查当日早5点再服用 1 500 mL PEG 溶液;A组检查前一晚7点半口服橄榄油60 mL和一块冰糖,后续同C组;B组检查前一晚服完PEG溶液后再口服橄榄油60 mL和一块冰糖,后续同C组。记录服药后首次排便时间,入眠前排便次数,排便总次数,各部分结肠的波士顿肠道准备评分及不良反应。计量资料3组间比较采用方差分析,发现差异后组间两两比较采用LSD-t检验;计数资料比较采用Pearson χ2检验。结果 B组有1例在检查过程中因无法继续配合而终止检查,B组和C组各有1例在检查中降结肠发现巨大肿物而被剔除,最终A组60例、B组58例、C组59例纳入数据分析,3组间在年龄、性别构成、身高、体重指数及术前便秘评分构成方面差异均无统计学意义（P均＞0.05）。服药后首次排便时间A组为（2.25±2.32）h、B组为（2.43±2.39）h、C组为（3.36±2.79）h,3组间差异有统计学意义（F=3.36,P=0.037）,两两比较中A、C组间和B、C组间差异有统计学意义（P＜0.05）。入眠前排便次数A组为（3.47±2.09）次、B组为（3.24±1.76）次、C组为（2.49±1.58）次,3组间差异有统计学意义（F=4.65,P=0.011）,两两比较中A、C组间和B、C组间差异有统计学意义（P＜0.05）。排便总次数A组为（7.20±2.67）次、B组为（6.81±2.31）次、C组为（5.64±2.22）次,3组间差异有统计学意义（F=6.68,P=0.002）,两两比较中A、C组间和B、C组间差异有统计学意义（P＜0.05）。左侧结肠评分、中段结肠评分及总评分方面,3组间差异均无统计学意义（P均＞0.05）;右侧结肠评分A组为（2.03±0.82）分、B组为（1.95±0.87）分、C组为（1.53±0.80）分,3组间差异有统计学意义（F=6.38,P=0.002）,两两比较中A、C组间和B、C组间差异有统计学意义（P＜0.05）。服药后不良反应包括恶心、呕吐、腹痛、腹胀,A组分别为7、3、0、3例,B组分别为5、3、0、6例,C组分别为4、2、1、4例,3组间在不良反应构成方面差异无统计学意义（χ2=4.35,P=0.824）。结论口服橄榄油联合PEG溶液可有效提高慢性便秘患者右侧结肠清洁度,在肠道准备过程中缩短首次排便时间,增加入眠前排便次数和排便总次数。对比检查前一晚在服用PEG溶液前还是服完后再口服橄榄油,未见对肠道准备效果及不良反应产生明显影响。     

美沙拉嗪及双歧三联活菌制剂对慢性末端回肠炎的疗效分析

[目的]总结分析美沙拉嗪及双歧三联活菌制剂对慢性末端回肠炎的疗效。[方法]将2010-01—2013-12期间确诊的264例慢性末端回肠炎患者随机分为A组、B组、C组。A组:采用马来酸曲美布汀+双歧三联活菌治疗;B组:采用马来酸曲美布汀+美沙拉嗪治疗;C组:采用马来酸曲美布汀+双歧三联活菌+美沙拉嗪治疗。疗程均为12周。观察各组疗效并进行对比分析。[结果](1)消化道症状,各组患者的症状均明显好转,A组、B组、C组的有效率分别为77.0%、76.5%、93.2%,A组与B组比较差异无统计学意义,但A组、B组与C组比较均差异有统计学意义(P0.05),C组疗效明显优于A、B组。(2)内镜下表现:治疗后A组、B组、C组内镜下有效率分别为71.0%、72.9%、93.2%,A组与B组比较差异无统计学意义,但A组、B组与C组比较均差异有统计学意义(P0.05),C组疗效明显优于A、B组。(3)病理组织学改变:各组治疗后组织学炎症评分与治疗前比较均差异有统计学意义(P0.05),A组与B组比较差异无统计学意义,但A组、B组与C组比较均差异有统计学意义(P0.05)。C组疗效明显优于A、B组。[结论]美沙拉嗪及双歧三联制剂对慢性末端回肠炎均有疗效,两者联用效果优于单药使用。     

不同雾霾防护措施预防石家庄地区哮喘患者急性发作的疗效

目的观察不同雾霾防护措施预防石家庄地区哮喘患者雾霾急性发作的疗效。方法选取2014年1月~2015年10月本院治疗的160例哮喘患者,随机分为A组(n=38)、B组(n=67)和C组(n=55)。A组患者采用防霾口罩+空气净化器进行防护,B组患者采用防霾口罩进行防护,C组患者不采用转业雾霾防护措施。观察比较三组患者哮喘急性发作发生情况、哮喘控制测试评分情况以评价三组的防护效果。结果 A组患者共36例完成研究,B组患者共62例完成研究,C组患者共50例完成研究;三组患者哮喘急性发作人数差异有统计学意义(χ~2=22.72,P0.01),两两比较显示A组与C组差异有统计学意义(χ~2=14.82,P0.01)、B组与C组差异有统计学意义(χ~2=16.19,P0.01),A组与B组患者差异无统计学意义(χ~2=0.27,P=0.60);三组患者哮喘急性发作次数及严重程度比较差异有统计学意义(H=15.18,P0.01),两两比较A组与B组(LSD,P0.01)、A组与C组(LSD,P0.05)、B组与C组(LSD,P0.05)差异均有统计学意义;干预前三组患者ACT评分差异无统计学意义(F=0.77,P0.01),干预后A、B组患者ACT评分与治疗前差异无统计学意义(P0.05),C组患者ACT评分较干预前明显下降,差异有统计学意义(U=10.32,P0.01)。结论应用空气净化器结合防霾口罩可以显著降低哮喘患者急性发作的发生率及严重程度,使患者保持良好的哮喘控制水平;单用防霾口罩也可以起到较好的防护作用,只是效果稍差,但仍明显优于不采取防护措施的患者。因此应广泛推荐哮喘患者采用科学的雾霾防护措施,从而降低哮喘急性发作的危险性。     

同侧短暂性脑缺血发作对继发脑梗死患者预后的影响研究

目的探讨同侧短暂性脑缺血发作(TIA)对继发脑梗死患者预后的影响。方法选取聊城市莘县人民医院2013年12月—2015年12月收治的继发脑梗死患者270例,根据年龄分为55岁者80例(A组)、55~70岁者130例(B组)、70岁者60例(C组);根据同侧TIA发生情况将A组患者分为A1组(发生同侧TIA,n=22)和A2组(未发生同侧TIA,n=58),将B组患者分为B1组(发生同侧TIA,n=34)和B2组(未发生同侧TIA,n=96),将C组患者分为C1组(发生同侧TIA,n=19)和C2组(未发生同侧TIA,n=41)。比较不同年龄段及相同年龄段不同TIA发生情况患者入院时与治疗1个月后美国国立研究院卒中量表(NIHSS)评分差值、治疗1个月后Barthel指数(BI)评分及入院后侧支循环建立情况。结果 3组患者入院时与治疗1个月后NIHSS评分差值和治疗1个月后BI评分比较,差异有统计学意义(P0.05);3组患者入院后侧支循环建立情况比较,差异无统计学意义(P0.05)。A1组和A2组患者入院时与治疗1个月后NIHSS评分差值比较,差异无统计学意义(P0.05);A1组患者治疗1个月后BI评分及入院后侧支循环建立良好率高于A2组(P0.05)。B1组和B2组患者入院时与治疗1个月后NIHSS评分差值比较,差异无统计学意义(P0.05);B1组患者治疗1个月后BI评分及入院后侧支循环建立良好率高于B2组(P0.05)。C1组和C2组患者入院时与治疗1个月后NIHSS评分差值、治疗1个月后BI评分及入院后侧支循环建立情况比较,差异均无统计学意义(P0.05)。结论同侧TIA可有效改善继发脑梗死患者预后并促进侧支循环建立,但对70岁的继发脑梗死患者则无明显影响。     

Training with the compactEASIE biologic endoscopy simulator significantly improves hemostatic technical skill of gastroenterology fellows: a randomized controlled comparison with clinical endoscopy training alone

BACKGROUND: The Erlangen Active Simulator for Interventional Endoscopy (EASIE) was introduced in 1997 for interventional endoscopy training. compactEASIE developed in 1998 is a modified, light-weight version of the original model. Objective evidence of the benefits of training with these models is limited. A randomized controlled study, therefore, was conducted to compare the effects of intensive 7-month, hands-on training in hemostatic techniques by using the compactEASIE model (in addition to clinical endoscopic training) vs. pure clinical training in endoscopic hemostatic methods. METHODS: Thirty-seven fellows in gastroenterology in New York City area training programs were enrolled. Baseline skills were assessed on the simulator for the following techniques: manual skills, injection and electrocoagulation, hemoclip application, and variceal ligation. Twenty-eight fellows were then randomized into two comparable groups. Those randomized to Group A received purely clinical training in endoscopic hemostatic techniques at their hospitals. Those in Group B, in addition, were trained by experienced tutors in 3 full-day hemostasis workshops over 7 months. Both groups underwent a final evaluation on the compactEASIE simulator conducted by their tutors and additional evaluators who were blinded to the method of training. Initial and final evaluation scores were compared for each group and between groups. Outcomes of actual clinical hemostatic procedures performed during the study period also were analyzed. RESULTS: Ten of 14 fellows randomized to Group A (standard training) and 13 of 14 in Group B (intensive training) returned for the final evaluation. For Group B, scores for all techniques were significantly improved. In Group A, a significant improvement was noted for variceal ligation alone. CONCLUSIONS: compactEASIE simulator training (3 sessions over 7 months), together with clinical endoscopic training resulted in objective improvement in the performance by fellows of all 4 endoscopic hemostatic techniques, whereas significant improvement was noted for variceal ligation alone for fellows who had standard clinical training. In clinical practice, fellows who had intensive simulator/clinical training had a significantly higher success rate and a nonsignificant reduction in the frequency of occurrence of complications.     

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.     

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。     

Application evaluation of virtual reality technology in dental implant training: a new dental implant training system: A CONSORT-compliant trial

To evaluate the application of virtual reality technology in a dental implant training system.A 3-dimensional model of mandible was established by Mimics17.0 software based on the Digital Imaging and Communications in Medicine data obtained from cone beam computed tomography scanning of the patient in mandibular. Thirty physicians were divided into 2 groups. The virtual reality dental implant training system was used for group A, while conventional theoretical knowledge training and clinical demonstration were performed in group B. All young physicians have a 1-month study. After training, all the physicians in groups A and B would conduct a questionnaire survey according to the training situation, which was compared between the 2 groups. The success rate of the operation was also evaluated and compared.The median scores in the 5 dimensions of postoperative assessment of group A was 9/9/9/8/8, and of group B was 6/7/6/7/7. The scores of the 5 dimensions were significantly higher than those of group B (P < .05), indicating that group A has a better grasp of the simulator. After the training of simulated mandibular implants in group A, the deviations in the 4 dimensions of mesiodistal, buccal and tongue, depth, and angle were significantly lower than those of group B (P < .05). Group A has smaller deviations in each of the 4 dimensions than those in group B, indicating group A has a higher operation success rate.We independently develop a set of virtual surgery system for dental implant training, which can be used for teaching and training, with good operability and predictability, to achieve a breakthrough in dental implant surgery training.     

The complementary Erlangen active simulator for interventional endoscopy training is superior to solely clinical education in endoscopic hemostasis--the French training project: a prospective trial

BACKGROUND: The Erlangen Active Simulator for Interventional Endoscopy (EASIE) using ex-vivo porcine organs was introduced in 1997. The present study should analyze whether repeated EASIE simulator training in endoscopic hemostasis led to superior performance compared with a traditionally educated group. The results were compared with a similar project in New York. METHODS: Thirty-five French GI fellows were enrolled. Baseline skills evaluation was performed in four disciplines (manual skills, injection/coagulation, clip application and variceal ligation) using the compactEASIE-simulator equipped with an upper gastrointestinal organ package for bleeding simulation. The same, translated evaluation forms (from the prior New York project) were used. Subsequently, fellows were randomized into group A (n=17, only clinical education) and group B (n=18, additional three simulator trainings). Group B was trained the next day and after 4 and 7 months by experts of the French Society of Gastrointestinal Endoscopy. Both groups performed routine and emergency endoscopies at their home hospitals during the study period. Both groups were re-evaluated blindly after 9 months. RESULTS: The learning curve for group B showed a significant improvement in all disciplines (P<0.004) whereas group A improved significantly in only two of four disciplines at blinded final evaluation (manual skills P=0.02, injection/coagulation P=0.013). The direct comparison of groups B and A at blinded final evaluation showed significantly superior ratings for group B in all disciplines (P<0.006) and significantly shorter performance times in two disciplines (P=0.016 each). The comparison with the similar 'New York project' revealed that preexisting differences in skills were adjusted by the training. CONCLUSION: Complementary trainings (three workshops in 7 months) in endoscopic hemostasis using the compactEASIE improved skills compared with a solely clinical education. The results of the 'New York project' were confirmed and benefits were independent from the medical educational system.     

The compactEASIE is a feasible training model for endoscopic novices: A prospective randomised trial

BACKGROUND: The objective benefit of a training using the compact Erlangen Active Simulator for Interventional Endoscopy-simulator was demonstrated in two prospective educational trials (New York, France). The present study analysed whether endoscopic novices are able to reach a comparable level of endoscopic skills as in the above-described projects. METHODS: Twenty-seven endoscopic novices (medical students, first year residents) were enrolled in this prospective, randomised trial. The compact Erlangen Active Simulator for Interventional Endoscopy-simulator with an upper GI-organ package and blood perfusion system was used as a training tool. Basic evaluation of endoscopic skills was performed after a practical and theoretical course in diagnostic upper GI endoscopy followed by a stratified randomisation according to the rating in endoscopic skills into intensive (n=14) and control group (n=13). The intensive group was trained 12 times every second week over 7 months in 4 endoscopic disciplines (manual skills, injection therapy, haemoclip, band ligation) by skilled endoscopist (three trainees/simulator). Assessment was performed (single steps/overall) using an analogue scale from 1 to 10 (1=worst, 10=optimal performance) by expert tutors. The control group was not trained. Blinded final evaluation of all participants was performed in January 2003. RESULTS: We observed in all techniques applied a significant improvement of endoscopic skills and of the performance time in the intensive group compared to the control group (p<0.001). The comparison with the previous projects showed that the intensively trained novices achieved comparable levels of performance to the GI fellows in the New York and France Project (at least 80% of the median score in three out of four techniques). CONCLUSION: Endoscopic novices acquired notable skills in interventional endoscopy in the simulator by an intensive, periodical training using the compactEASIE.     

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.