Fidelity of computer-based simulators for fellows training in Taiwan

Little is known regarding the value of computer simulation in endoscopy training in Taiwan. The purpose of the present study was to validate the new computer-based simulation in preclinical esophagogastroduodenoscopy (EGD) training for novices and the possibility of future credentialing. Three staff-level, three intermediate-level (year-2 gastrointestinal fellows), and three novice-level (year-1 GI fellows) endoscopists completed five standardized EGD scenarios on a computer simulator. Their performance scores were recorded for four parameters: total time to reach duodenum (minutes), excessive wall pressure (%), air inflation (L), and maneuvers regarded as inappropriate (%). The endoscopists evaluated various aspects of simulation fidelity compared to live endoscopy. In addition, computer-recorded performance parameters were assessed by comparing the recorded scores of users on three different experience levels. After the simulator training, the endoscopists completed a questionnaire regarding their opinions on the degree of realism and the feasibility of using this model for training. Only in total time to reach duodenum did the experts outperform the novice group (1.9 minutes vs 4.8 minutes; P = 0.0002). Median scores of the simulator's fidelities demonstrate the aspects of maneuverability and degree of realism to have the same lowest scores of 5 (25%-75% interquartile range [IQR]: 5-6). The other parameters have median scores of 6 with 25% to 75% IQR from 5 to 6 to 6 to 7 that are better than the neutral scores of 4. This computer-based simulator showed "time to reach duodenum" was the only positive validity factor to differentiate among levels of EGD experiences. There was a relatively favorable factor for the degree of realism of the new simulator. Further patient-based endoscopy training and workplace assessments are needed to validate its applicability in training settings.