Background and Aims: Simulation refers to educational tools that allow for repetitive instruction in a nonpatient care environment that is risk-free. In GI endoscopy, simulators include ex vivo animal tissue models, live animal models, mechanical models, and virtual reality (VR) computer simulators. Methods: After a structured search of the peer-reviewed medical literature, this document reviews commercially available GI endoscopy simulation systems and clinical outcomes of simulation in endoscopy. Results: Mechanical simulators and VR simulators are frequently used early in training, whereas ex vivo and in vivo animal models are more commonly used for advanced endoscopy training. Multiple studies and systematic reviews show that simulation-based training appears to provide novice endoscopists with some advantage over untrained peers with regard to endpoints such as independent procedure completion and performance time, among others. Data also suggest that simulation training may accelerate the acquisition of specific technical skills in colonoscopy and upper endoscopy early in training. However, the available literature suggests that the benefits of simulator training appear to attenuate and cease after a finite period. Further studies are needed to determine if meeting competency metrics using simulation will predict actual clinical competency. Conclusions: Simulation training is a promising modality that may aid in endoscopic education. However, for widespread incorporation of simulators into gastroenterology training programs to occur, simulators must show a sustained advantage over traditional mentored teaching in a cost-effective manner. Because most studies evaluating simulation have focused on novice learners, the role of simulation training in helping practicing endoscopists gain proficiency using new techniques and devices should be further explored.
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DISCLOSURE: The following authors disclosed financial relationships relevant to this publication: A. Goodman: Consultant for Invendo Medical. J. Melson: Grant-funded independent investigator for Boston Scientific; medical advisory board for Clinical Genomics. H. Aslanian, A. Sethi: Consultant for Olympus and Boston Scientific. M. Bhutani: Advisory board for Medi-Globe. D. Lichtenstein: Consultant for Olympus. U. Navaneethan: Consultant for Takeda, AbbVie, and Janssen. R. Pannala: Consultant for Boston Scientific; research support from Fujifilm and Apollo Endosurgery. M. Parsi: Consultant for and honoraria from Boston Scientific. A. Schulman: Consultant for Boston Scientific and MicroTech. S. Sullivan: Consultant for Aspire Bariatrics, Obalon, Elira, USGI Medical, and GI Dynamics; contracted research with Aspire Bariatrics, Allurion, Obalon, Elira, BARONova, USGI Medical, and GI Dynamics; stock warrants with Elira. N. Thosani: Consultant for Boston Scientific, Medtronic, and Mederi; speaker for Boston Scientific, Medtronic, and AbbVie. G. Trikudanathan: Advisory board for AbbVie. All other authors disclosed no financial relationships relevant to this publication.