Effects of Simulation-Based Training in Gastrointestinal Endoscopy: A Systematic Review and Meta-analysis

Siddharth Singh, Robert E. Sedlack, David A. Cook

Research output: Contribution to journalReview articlepeer-review

39 Scopus citations


Background & Aims: Simulation-based training (SBT) in gastrointestinal endoscopy has been increasingly adopted by gastroenterology fellowship programs. However, the effectiveness of SBT in enhancing trainee skills remains unclear. We performed a systematic review with a meta-analysis of published literature on SBT in gastrointestinal endoscopy. Methods: We performed a systematic search of multiple electronic databases for all original studies that evaluated SBT in gastrointestinal endoscopy in comparison with no intervention or alternative instructional approaches. Outcomes included skills (in a test setting), behaviors (in clinical practice), and effects on patients. We pooled effect size (ES) using random-effects meta-analysis. Results: From 10,903 articles, we identified 39 articles, including 21 randomized trials of SBT, enrolling 1181 participants. Compared with no intervention (n= 32 studies), SBT significantly improved endoscopic process skills in a test setting (ES, 0.79; n= 22), process behaviors in clinical practice (ES, 0.49; n= 8), time to procedure completion in both a test setting (ES, 0.79; n= 16) and clinical practice (ES, 0.75; n= 5), and patient outcomes (procedural completion and risk of major complications; ES, 0.45; n= 10). Only 5 studies evaluated the comparative effectiveness of different SBT approaches; which provided inconclusive evidence regarding feedback and simulation modalities. Conclusions: Simulation-based education in gastrointestinal endoscopy is associated with improved performance in a test setting and in clinical practice, and improved patient outcomes compared with no intervention. Comparative effectiveness studies of different simulation modalities are limited.

Original languageEnglish (US)
Pages (from-to)1611-1623.e4
JournalClinical Gastroenterology and Hepatology
Issue number10
StatePublished - Oct 1 2014


  • CI
  • EGD
  • ERCP
  • ES
  • Education
  • Gastrointestinal Endoscopy
  • Outcomes
  • SBT
  • Simulation

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology


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