Benefits and limitations of simulation in endoscopic training

Training in the performance of endoscopic procedures has traditionally been given in the endoscopy suite under the supervision of a guiding physician. This approach typically results in a significant learning curve, showing enhanced cognitive skills and “hand–eye” coordination. Recent developments in medical simulation seem promising with regard to the possibility of training outside the endoscopy suite, thereby minimizing potential patient discomfort and being less stressful for both the trainee and the supervising physician. Various types of simulators are available and have been promoted as an educational tool to accelerate the training curve and to provide objective measures of procedural competency. The purpose of this paper is to review the studies performed using various simulators, comparing computer-based endoscopic simulators, animal models, and mechanical simulators with traditional endoscopy training, and to recognize the place for simulation training in a residency or fellowship program.