Moving from training to competency testing

Simulation in gastrointestinal endoscopy has shown promise for training but currently has little evidence to support its use for assessment or competency testing. Patient safety concerns have created a pressing need to reliably assess performance prior to independent practice certification. This article reviews the theoretic framework and evidence base supporting the use of simulation in this role. It raises questions regarding the tools used for both clinical and simulated assessment and identifies 2 gaps that must be filled before simulation can fulfill the potential to enable high-quality, reliable, and, most importantly, repeatable assessments of competency.