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The impact of constructive feedback on training in gastrointestinal endoscopy using high fidelity virtual reality simulation. A randomized controlled trial
  1. Irina Kruglikova1,*,
  2. Teodor P. Grantcharov2,
  3. Asbjorn M Drewes3,
  4. Peter Funch-Jensen1
  1. 1 Aarhus University Hospital, Denmark;
  2. 2 University of Toronto, St. Michael’s Hospital, Toronto, Canada;
  3. 3 Aalborg University Hospital, Aalborg, Denmark
  1. Correspondence to: Irina Kruglikova, Department of Surgical Gastroenterology L, Aarhus University Hospital, Noerrebrogade 44, bygn. 7, Aarhus C, 8000, Denmark; ikrugl{at}


Background: Recently, virtual-reality (VR) computer simulators have been used to enhance traditional endoscopy teaching. Previous studies have demonstrated construct validity of these systems and transfer of virtual skills to the operating room. However, to date no simulator-training curricula have been designed and there is very little evidence on the impact of external feedback on acquisition of endoscopic skills.

The aim of the present study was to assess the impact of external feedback on the learning curves on a VR colonoscopy simulator using inexperienced trainees.

Materials and methods: Twenty two trainees, without colonoscopy experience were randomized to a group which received structured feedback provided by an experienced supervisor and a controlled group. All participants performed 15 repetitions of task 3 from the Introduction colonoscopy module of the Accu Touch Endoscopy simulator (Immersion Medical Corporation, Gaithersburg, USA). Retention/transfer tests on simulator were performed 4-6 weeks after the last repetition. The proficiency levels were based on the performance of 8 experienced colonoscopists.

Results: All subjects were able to complete the procedure on the simulator. There were no perforations in the feedback group vs. 7 in the non-feedback group. Subjects in the feedback group reached expert proficiency levels in percentage of mucosa visualized and time to reach the cecum significantly faster compared with the control group. None of the groups demonstrated significant degradation of performance in simulator retention/transfer tests.

Conclusion: Concurrent feedback given by supervisor concur an advantage in acquisition of basic colonoscopy skills and achieving of proficiency level as compared to independent training.

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