This PIVI reviews the current literature on simulator use in endoscopy and assesses what data are required to support a wider adoption of their use for endoscopy training and skills assessment. Specifically, the following two questions are considered: How much benefit must be demonstrated from the use of simulators to justify widespread adoption into standard endoscopy training? How reliable do simulator-based assessments need to be as a predictor of patient-based skills to justify their use in credentialing and recredentialing for endoscopy? The document outlines the following:
• Thresholds recommended for this PIVI
• Threshold for incorporation of a simulator into training: For an endoscopy simulator to be integrated into the standard instruction for a procedure, it must demonstrate a 25 percent or greater reduction in the median number of clinical cases required for the trainees to achieve the minimal competence parameters for that procedure.
• Threshold for using a simulator to assess skill: Simulator-based assessment tools must be procedure specific and predictive of independently defined minimal competence parameters from real procedures with a к value (i.e. correlation coefficient with value of 0 meaning that skills on a simulator had no correlation with real procedures and value of 1.0 had perfect correlation of simulator skills with real procedures) of at least 0.70 for high-stakes assessment.
• Summary of PIVI methodology and literature review
• A comprehensive review of published trials using ex vivo and computer simulators was performed and circulated to the members of the PIVI committee.
• Training: Despite their varied capabilities and promising potential, use of the current endoscopic simulators appears to help primarily with early learning curves for endoscopic procedures. However, to date, simulator use has not yet led to an accelerated achievement of competency benchmarks or improved outcomes for patients.
• Assessing skill: There are only limited data examining the ability of endoscopy simulators to be used as tools to assess endoscopic skill. The limited literature available in this respect has shown these models to lack performance metrics of adequate sensitivity or reliability for use as meaningful assessment tools.