Gerson L B, Van Dam J
Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California 94305, USA.
Endoscopy. 2003 Jul;35(7):569-75. doi: 10.1055/s-2003-40243.
Clinical investigation using endoscopy simulators is now possible due to recent advances in virtual reality technology. A prospective randomized trial was conducted to compare the exclusive use of a virtual reality endoscopy simulator with bedside teaching for training in sigmoidoscopy.
Internal medicine residents were randomly assigned to training exclusively using a virtual reality simulator (group 1) or via bedside teaching (group 2). Residents were then observed performing five sigmoidoscopic procedures in asymptomatic patients referred for colorectal cancer screening. Endoscopic examinations were evaluated for procedure duration, completion, ability to perform retroflexion, and level of patient comfort/discomfort. Each examination was scored from 1 (inability to insert the endoscope beyond the rectum) to 5 (able to complete the entire examination independently in less than 20 min).
Sixty-six sigmoidoscopic examinations were completed by nine residents in group 1 (simulator-trained group) and seven residents in group 2 (traditional teaching group). Participants in group 1 had more difficulty with initial endoscope insertion and negotiation of the rectosigmoid junction (mean score +/- SEM 2.9 +/- 0.2) than those in group 2 (3.8 +/- 0.2) ( P < 0.001). The splenic flexure was reached independently in 10 of 34 examinations (29 %) in group 1, compared with 23 of 32 examinations (72 %) in group 2 ( P = 0.001). Retroflexion was successfully performed by 19 of 34 (56 %) in group 1 compared to 27 of 32 (84 %) in group 2 ( P = 0.02). The average procedure time, patient satisfaction, and discomfort associated with the procedure did not differ statistically between the two groups.
The use of a state-of-the-art virtual reality-based endoscopy simulator is inferior to traditional bedside teaching techniques when used exclusively for training medical residents to perform sigmoidoscopy.
由于虚拟现实技术的最新进展，现在可以使用内镜模拟器进行临床研究。进行了一项前瞻性随机试验，以比较单纯使用虚拟现实内镜模拟器与床边教学在乙状结肠镜检查培训中的效果。
内科住院医师被随机分配至单纯使用虚拟现实模拟器进行培训的组1，或通过床边教学进行培训的组2。然后观察住院医师对因结直肠癌筛查前来就诊的无症状患者进行5次乙状结肠镜检查的操作情况。对内镜检查的操作时间、完成情况、进行反转的能力以及患者的舒适/不适程度进行评估。每次检查从1分（无法将内镜插入直肠以外）到5分（能够在不到20分钟内独立完成整个检查）进行评分。
组1（模拟器培训组）的9名住院医师和组2（传统教学组）的7名住院医师共完成了66次乙状结肠镜检查。组1的参与者在最初插入内镜以及通过直肠乙状结肠交界处时比组2的参与者遇到更多困难（平均得分±标准误为2.9±0.2），而组2为（3.8±0.2）（P<0.001）。组1的34次检查中有10次（29%）独立到达脾曲，而组2的32次检查中有23次（72%）（P = 0.001）。组1的34次中有19次（56%）成功进行了反转，而组2的32次中有27次（84%）（P = 0.02）。两组之间的平均操作时间、患者满意度以及与操作相关的不适在统计学上没有差异。
当单纯用于培训住院医师进行乙状结肠镜检查时，使用先进的基于虚拟现实的内镜模拟器不如传统的床边教学技术。
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