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World J Gastroenterol. Dec 28, 2018; 24(48): 5439-5445
Published online Dec 28, 2018. doi: 10.3748/wjg.v24.i48.5439
Virtual reality simulation in endoscopy training: Current evidence and future directions
Tahrin Mahmood, Michael Anthony Scaffidi, Rishad Khan, Samir Chandra Grover
Tahrin Mahmood, Michael Anthony Scaffidi, Rishad Khan, Samir Chandra Grover, Division of Gastroenterology, St. Michael’s Hospital, University of Toronto, Toronto M5B 1W8, Canada
Author contributions: Mahmood T, Scaffidi MA, Khan R, and Grover SC drafted the manuscript, critically appraised it for important intellectual content, and approved the final version of this manuscript.
Conflict-of-interest statement: No authors have any conflicts of interest to report of relevance to the subject matter of this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Samir Chandra Grover, MD, MEd, FRCPC, Assistant Professor, Division of Gastroenterology, St. Michael’s Hospital, University of Toronto, 30 Bond Street, Toronto M5B 1W8, Canada. samir.grover@utoronto.ca
Telephone: +1-416-864-5628 Fax: +1-416-864-5882
Received: September 29, 2018
Peer-review started: September 29, 2018
First decision: October 26, 2018
Revised: November 22, 2018
Accepted: November 30, 2018
Article in press: December 1, 2018
Published online: December 28, 2018
Abstract

Virtual reality simulation is becoming the standard when beginning endoscopic training. It offers various benefits including learning in a low-stakes environment, improvement of patient safety and optimization of valuable endoscopy time. This is a review of the evidence surrounding virtual reality simulation and its efficacy in teaching endoscopic techniques. There have been 21 randomized controlled trials (RCTs) that have investigated virtual reality simulation as a teaching tool in endoscopy. 10 RCTs studied virtual reality in colonoscopy, 3 in flexible sigmoidoscopy, 5 in esophagogastroduodenoscopy, and 3 in endoscopic retrograde cholangiopancreatography. RCTs reported many outcomes including distance advanced in colonoscopy, comprehensive assessment of technical and non-technical skills, and patient comfort. Generally, these RCTs reveal that trainees with virtual reality simulation based learning improve in all of these areas in the beginning of the learning process. Virtual reality simulation was not effective as a replacement of conventional teaching methods. Additionally, feedback was shown to be an essential part of the learning process. Overall, virtual reality endoscopic simulation is emerging as a necessary augment to conventional learning given the ever increasing importance of patient safety and increasingly valuable endoscopy time; although work is still needed to study the nuances surrounding its integration into curriculum.

Keywords: Endoscopy, Gastrointestinal/education, Endoscopy, Gastrointestinal/standards, Simulation, Educational measurement, Clinical competence/standards, Competency-based medical education

Core tip: There is substantial evidence to support that virtual reality simulation is an excellent augment to the traditional apprenticeship model in learning endoscopic procedures. Further work is still needed to study the nuances surrounding its integration into curriculum.