Virtual reality tools for training in gastrointestinal endoscopy: A systematic review

Table 1 Description of studies included in this systematic review of virtual reality training in gastrointestinal endoscopy

Ref.	Study design	Study setting	Duration	Types of trainees	No. of participants	Types of colonoscopies	Types of VR training
Buzink et al[4], 2007	Pre and post study	Academic medical centers		Novice endoscopists, expert endoscopists	30	Colonoscopy	GI Mentor II
Cohen et al[15], 2006	Multicenter RCT	Academic medical centers	2 yr	Gastroenterology fellows	45	Colonoscopy	GI Mentor
Ferlitsch et al[10], 2002	Single-center RCT	Academic institution	3 wk	Medical residents	13	Upper endoscopy and colonoscopy	GI Mentor
Ferlitsch et al[12], 2010	Single-center RCT	Academic institution	4 yr	Internal medicine residents	28	Upper endoscopy	GI Mentor
Gerson and Van Dam[19], 2003	Single-center RCT	Academic institution	9 months	Internal medicine residents	16	Sigmoidoscopy	VR sigmoidoscopy simulator
Gomez et al[20], 2015	Single-center RCT	Academic institution	1 month	Surgery residents	27	Colonoscopy	GI Mentor
Grover et al[8], 2015	Single-center RCT	Academic medical centers	6 wk	Surgery residents, medicine residents, gastroenterology fellows	33	Colonoscopy	VR endoscopy simulator
Hashimoto et al[9], 2018	Two-phase study	Academic medical centers	6 months	Endoscopists	44	Upper endoscopy and colonoscopy	GI Mentor
Koch et al[11], 2015	Prospective study	Academic institution		Trainees	18	Colonoscopy	GI Mentor II
McIntosh et al[21], 2014	Single-center RCT	Academic institution	1 month	Residents between year 2-4	18	Colonoscopy	GI Mentor II
Park et al[22], 2007	Single-center RCT	Academic medical centers		Surgery residents, internal medicine residents	24	Colonoscopy	Computer-based colonoscopy simulator
Piskorz et al[16], 2020	Pre and post study	Academic medical centers		1st yr fellows of gastroenterology	126	Upper endoscopy and colonoscopy	GI Mentor
Shirai et al[23], 2008	Single-center RCT	Academic institution	17 months	Residents	20	Upper endoscopy	GI Mentor II
Silva Mendes et al[24], 2021	Prospective, multicenter study	Academic institution	6 months	1st yr gastroenterology residents	23	Upper endoscopy and colonoscopy	GI Mentor II
Telem et al[18], 2014	Prospective study	Academic institution	6 wk	Novice surgical interns, attending physicians	12	Colonoscopy	GI Mentor
Van Sickle et al[17], 2011	Multicenter pre and posttest study	Academic institution	8 wk	Postgraduate year 1-4	41	Upper endoscopy and colonoscopy	GI Mentor II

RCT: Randomized controlled trial; VR: Virtual reality; GI: Gastrointestinal.

Table 2 Training methods, evaluation, comparator and outcomes of studies included in this systematic review of virtual reality training in gastrointestinal endoscopy

Ref.	Training methods	Duration of training and frequency of training sessions	Self-evaluation methods	Evaluation by trainers	Comparator	Main outcomes measured
Buzink et al[4], 2007	Basic skills training	4 sessions, each session: One EndoBubble task and managed multiple VR colonoscopy cases (two in first session and three in subsequent sessions)		Objective metrics		Proecess skills, procedure time
Cohen et al[15], 2006	Basic skills training	10 h of unsupervised training on the GI Mentor or no simulator experience during the first 8 wk of fellowship		Expert evaluations	No intervention	Procedure completion, global rating of performance, patient discomfort
Ferlitsch et al[10], 2002	Basic skills training	2 h per d, 3 wk		Objective metrics	No intervention	Proecess skills, procedure time
Ferlitsch et al[12], 2010	Basic skills training	2 h per d, 5 h to 20 h in total		Expert evaluations	Conventional, patient-based training only	Precedure time, patient discomfort
Gerson and Van Dam[19], 2003	Basic skills training	2 wk or ten sigmoidoscopy examination with attending gastroenterologists		Expert evaluations	Bedside teaching	Procedure time, procedure completion, patient discomfort, complication or critical flaw, global rating performance
Gomez et al[20], 2015	Basic skills training	3 modules, 3 wk in total		Expert evaluations (GAGES scale)	Physical simulator group, combination group	Composite score of competency, performance time, visualization of mucosa
Grover et al[8], 2015	Basic skills training	6 h of didactic lectures and 8 h of VR simulation-based training with expert feedback		Expert evaluations (JAG DOPS scale)	VR simulation training only (no experts feedback)	Composite score of competency
Hashimoto et al[9], 2018	Basic skills training	Not limited		Objective metrics	Ten repetitions of each VR simulator	Precedure skills
Koch et al[11], 2015	Basic skills training	50 (group I) or 100 (group II) VR colonoscopies		Expert evaluations	50 (group I) or 100 (group II) VR colonoscopies	Procedure time, procedure completion
McIntosh et al[21], 2014	Basic skills training	16 h of VR simulator training		Expert evaluations, objective metrics	No intervention	The number of proctors 'assists' required per colonoscopy. Precedure time, precedure skills, patient discomfort
Park et al[22], 2007	Basic skills training			Expert evaluations (global rating scale)	No intervention	Procedure completion, complication or critical flaw
Piskorz et al[16], 2020	Basic skills training	8-h worked utilizing two GI Mentor™ in a specialized clinical simulation center		Objective metrics		Precedure time, precedure skills
Shirai et al[23], 2008	Basic skills training	5 h simulation training + bedside training vs bedside training		Expert evaluations	Conventional, patient-based training only	Precedure time
Silva Mendes et al[24], 2021	Basic skills training	Theoretical and a hands-on module (20 h) in the GI Mentor II		Objective metrics		Cognitive score, precudure time, precedure skills, patient discomfort
Telem et al[18], 2014	Basic skills training	2 h a wk, 6 wk		Expert evaluations (GAGES scale), objective metrics	No intervention	Precudure skills, precudure time
Van Sickle et al[17], 2011	Basic skills training, advanced skills		Self-rating score	Expert evaluations (GAGES scale), objective metrics		Precedure time, precedure skills, patient discomfort

GAGES: Global assessment of gastrointestinal endoscopic skills; JAG DOPS: Advisory group direct observation of procedural skills; VR: Virtual reality; GI: Gastrointestinal.