Assessing the realism of colonoscopy simulation: the development of an instrument and systematic comparison of 4 simulators

• Published in: Gastrointestinal endoscopy Vol. 75; no. 3; pp. 631 - 640.e3
• Main Authors: Hill, Andrew, LLB(Hons), BA(Hons), Horswill, Mark S., PhD, Plooy, Annaliese M., PhD, Watson, Marcus O., PhD, Karamatic, Rozemary, MBBS, Basit, Tabinda A., BA(Hons), Wallis, Guy M., PhD, Riek, Stephan, PhD, Burgess-Limerick, Robin, PhD, Hewett, David G., MBBS, MSc, PhD, FRACP
• Format: Journal Article
• Language: English
• Published: Maryland heights, MO Mosby, Inc 01.03.2012; Elsevier
• Subjects: Biological and medical sciences; Colonoscopy; Computer Simulation - standards; Digestive system. Abdomen; Endoscopy; Gastroenterology and Hepatology; Gastroenterology. Liver. Pancreas. Abdomen; Investigative techniques, diagnostic techniques (general aspects); Manikins; Medical sciences; Surveys and Questionnaires; CSRQ; virtual reality; analysis of variance; CSRQ-IS; ANOVA; Colonoscopy Simulator Realism Questionnaire; VR; PM; physical model; Colonoscopy Simulator Realism Questionnaire—Importance Supplement; Endoscopy; Simulation; Colonoscopy; Comparative study; Gastroenterology
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2011.10.030

Background No useful comparative data exist on the relative realism of commercially available devices for simulating colonoscopy. Objectives To develop an instrument for quantifying realism and provide the first wide-ranging empiric comparison. Design Repeated measures, observational study. Nineteen experienced colonoscopists completed cases on 4 colonoscopy simulators (AccuTouch, GI Mentor II, Koken, and Kyoto Kagaku) and evaluated each device. Setting A medical simulation center in a large tertiary hospital. Main Outcome Measures For each device, colonoscopists completed the newly developed Colonoscopy Simulator Realism Questionnaire (CSRQ), which contains 58 items grouped into 10 subscales measuring the realism of different aspects of the simulation. Subscale scores are weighted and combined into an aggregated score, and there is also a single overall realism item. Results Overall, current colonoscopy simulators were rated as only moderately realistic compared with real human colonoscopy (mean aggregated score, 56.28/100; range, 48.39–60.45, where 0 = “extremely unrealistic” and 100 = “extremely realistic”). On both overall realism measures, the GI Mentor II was rated significantly less realistic than the AccuTouch, Kyoto Kagaku, and Koken ( P < .001). There were also significant differences between simulators on 9 subscales, and the pattern of results varied between subscales. Limitations The study was limited to commercially available simulators, excluding ex-vivo models. The CSRQ does not assess simulated therapeutic procedures. Conclusions The CSRQ is a useful instrument for quantifying simulator realism. There is no clear “first choice” simulator among those assessed. Each has unique strengths and weaknesses, reflected in the differing results observed across 9 subscales. These findings may facilitate the targeted selection of simulators for various aspects of colonoscopy training.