Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria.
Endoscopy. 2010 Dec;42(12):1049-56. doi: 10.1055/s-0030-1255818. Epub 2010 Oct 22.
Skills in gastrointestinal endoscopy mainly depend on experience and practice. Patients upon whom trainees perform their first endoscopic examinations are likely to suffer more discomfort and prolonged procedures. Training on endoscopy simulators may reduce the time required to reach competency in patient endoscopy.
Residents in internal medicine without experience of endoscopy were randomized to a group who trained on a simulator before conventional training (group S) or one that received conventional training only (group C) before starting upper gastrointestinal endoscopy in patients. After endoscopy, discomfort and pain were evaluated by patients, who were blind to the beginners' training status. Results in terms of time, technique (intubation, pyloric passage, J-maneuver), and diagnosis of pathological entities were evaluated by experts.
From 2003 to 2007, 28 residents were enrolled. Comparing group S with group C in their first ten endoscopic examinations in patients, time taken to reach the duodenum (239 seconds (range 50 - 620) vs. 310 seconds (110 - 720; P < 0.0001) and technical accuracy ( P < 0.02) were significantly better in group S. Diagnostic accuracy did not differ between the groups. Fourteen residents (7 simulator-trained, 7 not simulator-trained) continued endoscopy training. After 60 endoscopic examinations, investigation time was still shorter in group S. Technical and diagnostic accuracy improved during on-patient training in both groups; here differences between groups were no longer observable. There were no significant differences in discomfort and pain scores between the groups after 10 and after 60 endoscopies. Discomfort and pain were higher than for endoscopy performed by experts.
This randomized controlled trial shows that virtual simulator training significantly affects technical accuracy in the early and mid-term stages of endoscopic training. It helps reduce the time needed to reach technical competency, but clinically the effect is limited. Simulator training could be useful in an endoscopy training curriculum but cannot replace on-patient training.
胃肠内镜技能主要依赖于经验和实践。在接受培训的医生进行首次内镜检查时，患者可能会感到更多的不适，并且手术时间延长。在内镜模拟训练器上进行培训可能会减少在患者内镜检查中达到胜任力所需的时间。
无内镜经验的内科住院医师被随机分为两组，一组在常规培训前使用模拟器进行培训（S 组），另一组仅在开始对患者进行上消化道内镜检查前接受常规培训（C 组）。内镜检查后，患者对不适和疼痛进行评估，他们对初学者的培训状态不知情。专家评估时间、技术（插管、幽门通过、J 手法）和病理实体的诊断结果。
2003 年至 2007 年，共有 28 名住院医师入组。在患者的前 10 次内镜检查中，将 S 组与 C 组进行比较，S 组到达十二指肠的时间（239 秒（50-620）比 310 秒（110-720；P<0.0001）和技术准确性（P<0.02）均显著更好。两组间诊断准确性无差异。14 名住院医师（7 名接受过模拟器培训，7 名未接受过模拟器培训）继续进行内镜培训。在进行了 60 次内镜检查后，S 组的调查时间仍然更短。在两组的患者培训中，技术和诊断准确性均有所提高；两组之间的差异不再明显。两组在 10 次和 60 次内镜检查后的不适和疼痛评分无显著差异。不适和疼痛均高于专家进行的内镜检查。
这项随机对照试验表明，虚拟模拟器培训在早期和中期内镜培训阶段显著影响技术准确性。它有助于减少达到技术胜任力所需的时间，但在临床上效果有限。模拟器培训可能对内镜培训课程有用，但不能替代患者培训。
