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


Background Recently, virtual reality 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 22 trainees, without colonoscopy experience were randomised 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. Retention/transfer tests on simulator were performed 4–6 weeks after the last repetition. The proficiency levels were based on the performance of eight experienced colonoscopists.

Results All subjects were able to complete the procedure on the simulator. There were no perforations in the feedback group versus seven in the non-feedback group. Subjects in the feedback group reached expert proficiency levels in percentage of mucosa visualised and time to reach the caecum 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.

  • Colonoscopy training
  • simulator training
  • feedback in medical education
  • colonoscopy
  • endoscopic procedures
  • endoscopy
  • VR
  • virtual reality

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  • Funding The study was generously supported from the Educational Council, Region Midt, Denmark.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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