Training Simulators and Education in Gastrointestinal Endoscopy: Current Status and Perspectives in 2001

Introduction

High tech medicine, optimal patient care and quality management are current topics in clinical medicine. While evidence-based medicine is rapidly becoming the “gold standard” for treatment modalities, the responsibility for education, the theoretical background as well as the acquisition and refinement of the manual skills of gastrointestinal endoscopy, remains in the hands of the individual physician. Practical skills are routinely acquired by practicing on the patient, initially under the supervision of a senior endoscopist. Over the years specialist medical societies have worked out guidelines and recommendations for establishing minimal quality requirements for the unsupervised performance of the various endoscopic techniques. However, structured training programs and mandatory teaching curricula for gastrointestinal endoscopy are still not established. The advent of new endoscopy simulators has rekindled the discussion as to whether it would be better to teach basic manual skills outside the patient. In the following review, we present a short overview of currently available training simulators. Present and potential future educational concepts in gastrointestinal endoscopy are discussed.

References

• 1 Classen M, Ruppin H. Practical training using a new gastrointestinal phantom.  Endoscopy. 1974;  6 127-131
• 2 Williams C B, Saunders B P, Bladen J S. Development of colonoscopy teaching simulation.  Endoscopy. 2000;  32(11) 901-905
• 3 Lucero R S, Zarate J O, Espinella F, et al. Introducing digestive endoscopy with the “SimPrac-EDF y VEE” simulator, other organ models and mannquins: Teaching experience in 21 courses attended by 422 physicians.  Endoscopy. 1995;  27 93-100
• 4 Rey J F, Romanczyk T. The development of experimental models in the teaching of endoscopy: an overview.  Endoscopy. 1995;  27 101-105
• 5 Grund K E, Bräutigam D, Zindel C, et al. Interventionsfähiges Tübinger Simulationsmodell INTERPHANT für die flexible Endoskopie.  Endoskopie heute. 1998;  11(1) 134
• 6 Williams C B, Baillie J, Gillies D F, et al. Teaching gastrointestinal endoscopy by computer simulation: A prototype for colonoscopy and ERCP.  Gastrointest Endosc. 1990;  36 49
• 7 Noar M D. Robotics interactive endoscopy simulation of ERCP/sphincterotomy and EGD.  Endoscopy. 1992;  24 (Suppl. 2) 539-541
• 8 Noar M D, Soehendra N. Endoscopy simulation training devices.  Endoscopy. 1992;  24 159-166
• 9 Beer-Gabel M, Delmotte S, Muntlak L. Computer assisted training in endoscopy (C.A.T.E): from a simulator to a learning station.  Endoscopy. 1992;  24 (Suppl. 2) 534-538
• 10 Bar-Meir S. A new endoscopic simulator.  Endoscopy. 2000;  32(11) 898-900
• 11 Aabakken L, Adamsen S, Kruse A. Performance of a colonoscopy simulator: experience from a hands-on endoscopy course.  Endoscopy. 2000;  32(11) 911-913
• 12 Gholson C F, Provenza J M, Silver R C, Bacon B R. Endoscopic retrograde cholangiography in the swine: a new model for endoscopic training and hepatobiliary research.  Gastrointest Endosc. 1990;  36 600-603
• 13 Noar M D. An established porcine model for animate training in diagnostic and therapeutic ERCP.  Endoscopy. 1995;  27 77-80
• 14 Freys S M, Heimbucher J, Fuchs K H. Teaching upper gastrointestinal endoscopy: the pig stomach.  Endoscopy. 1995;  27 73-76
• 15 Hochberger J, Neumann M, Maiss J, et al. Erlanger Ausbildungs-Simulator für die interventionelle Endoskopie (EASIE) - Eine neue Perspektive für die qualitätsorientierte praktische Ausbildung.  Endoskopie heute. 1998;  4 23-25
• 16 Neumann M, Mayer G, Ell C, Felzmann T, et al. The Erlangen Endo-Trainer: Life-like simulation for diagnostic and interventional endoscopic retrograde cholangiography.  Endoscopy. 2000;  32 (11) 906-910
• 17 Hochberger J, Neumann M, Maiss J, Hohenberger W, Hahn E G. EASIE - Erlangen Active Simulator for Interventional Endoscopy - a new bio-simulation-model - first experiences gained in training workshops.  Gastrointest Endosc. 1998;  47 (Suppl.) AB116
• 18 Scinicz G, Beller S, Bodner W, et al. Simulated operations by pulsatile organ perfusion in minimally invasive surgery.  Surg Laparosc Endosc. 1993;  3 315-317
• 19 Reh H, Hochberger J, Brather A, et al. Comparison of different variceal single- and multiple-band ligators for ring elasticity and ligation volume using a multicylindrical stretching apparatus and porcine esophagi in vitro.  Gastrointest Endosc. 1996;  43(4) 344
• 20 Hochberger J, Neumann M, Hohenberger W, Hahn E G. Neuer Endoskopie-Trainer für die therapeutische flexible Endoskopie.  Z Gastroenterol. 1997;  35 722-723
• 21 Maiss J, Nägel A, Tex S, et al. EASIE-team-training ERCP - experiences with a new training concept for interventional ERCP.  Endoscopy. 2000;  32 (Suppl. 1) E65
• 22 Hochberger J, Maiss J, Neumann M, et al. EASIE-Team-Training in endoscopic hemostasis - acceptance of a systematic training in interventional endoscopy by 134 trainees.  Gastrointest Endosc. 1999;  49(4) AB143
• 23 Maiss J, Hildebrand V, Bayer J, et al. MiniEASIE - ein neues, auf die Belange der interventionellen Endoskopie reduziertes Trainingsmodell.  Endoskopie heute. 1999;  12(1) 53
• 24 Hochberger J, Maiss J, Nägel A, et al. Polypectomy/vital endoscopic staining/mucosectomy: a new structured team-training in a close-to-reality endoscopy simulator (EASIE).  Endoscopy. 2000;  32 (Suppl. 1) E23
• 25 Vennes J A, Ament M, Boyce H W, et al. Principles of training in gastrointestinal endoscopy. American Society of Gastrointestinal Endoscopy, Standards of Training Committees 1989 - 1990.  Gastrointest Endosc. 1992;  38 743-747
• 26 Maiss J, Hahn E G, Hochberger J. A prospective evaluation of 14 EASIE team-training workshops on endoscopic hemostasis.  Endoscopy. 2000;  32 (Suppl. 1) E23
• 27 Dafnis G, Granath F, Påhlman L, et al. The impact of endoscopist experience and learning curves and interendoscopist variation on colonoscopy completion rates.  Endoscopy. 2001;  33(6) 511-517
• 28 Hochberger J, Maiss J, Hahn E G. The Erlangen “EASIE” model for a close-to-reality team-training of doctors and nurses in interventional endoscopy. In: Bhutani MS, Tandon RK (eds). Advances in gastrointestinal endoscopy.  New Dehli; Jaypee Brothers Medical Publishers (P) LTD, 2001