Systematic review of validity testing in Colonoscopy simulation

1. Systematic review of validity testing in Colonoscopy simulation J. Ansell, J. Mason, N. Warren, P. Donnelly, N. Hawkes, S. Dolwani, J. Torkington The Welsh Institute for Minimal Access Therapy (WIMAT), Heath Park, Cardiff, UK Background: Simulation is a useful adjunct to skills based training. This may be of particular relevance in colonoscopy where the learning curve can be long. The aim of this review was to evaluate the evidence for validity testing of colonoscopy simulators and in turn, grade the strength of this research. This may suggest ways in which colonoscopy simulators should be used in medical training. Method: MEDLINE (1947 to present), PubMed, Embase classic + Embase, metaRegister of Controlled Trials and the Education Resources Information Centre (ERIC) were searched for studies validating colonoscopy simulators (Figure 1). We recorded the type of simulator used, the tasks being assessed, the endpoints reported and the type of validity measured. Common endpoints between studies were compared and the evidence graded. Results: 13 studies met the inclusion criteria. Construct validity was reported in 5 (41.7%) studies for the Accutouch HT immersion (cases 1, 3 and 4), 4 studies (33.3%) for the GI mentor II (Simbionix) (modules 1.1, 1.3, 1.7, 2.1 and 5), 2 studies (16.7%) for the Olympus Endo Ts-1 2nd Generation and 1 study for the Endo X bovine model. Face validity was reported for the Accutouch HT immersion, the Olympus 2nd Generation and the KAIST-Ewha. Content validity was reported for the all simulators excluding the KAIST-Ewha. The only report of criterion validity was for the Endo X bovine model. Conclusion: There is evidence to support the face, content and construct validity of several colonoscopy simulators for specific diagnostic and therapeutic modules with selected endpoints. Further studies are needed to demonstrate the criterion validity of these devices. Records identified through database searching n=1141(Embase 320, Medline 609, Pubmed 209, mRCT 2, ERIC 1) Duplicates removed n=402 Records screened by title and abstract n=739 Irrelevant records excluded n= 678 Full text assessed n=61 Cross referenced n= 5 Records excluded n=53 Studies included in review n=13 Figure 1: Flow diagram for search strategy Table 1: Level of validity evidence and recommendation for each colonoscopy simulator Studies included in systematic review: 1. Koch AD et al (2008) Surg Endosc. Jan 22(1):158-62. 2. Fayez R et al (2010) Surg Endosc May 24(5):1060-5 3. 3. Felsher JJ et al (2005) Am J Surg Apr 189(4):497-5004. 4.Grantcharov TP et al (2005) JSLS Apr-Jun 9(2):130-3. 5. Haycock AV et al (2009) Endoscopy Nov 41(11):952-8. 6.Koch AD et al (2008) Endoscopy Sep;40(9):735-8. 7. Datta V et al (2002) Surg Endosc Oct 16(10):1459-63. 8.MacDonald J et al (2003) Surg Endosc Jun 17(6):896-8. 9. Mahmood T et al (2003) Surg Endosc Oct 17(10):1583-9. 10. Sedlack RE et al (2003) Gastrointest Endosc Feb 57(2):214-8. 11. Woo HS et al (2008) IEEE Trans Inf Technol Biomed Nov 12(6):746-53. 12. Moorthy K et al (2004) Surg Endosc 18(11):1613-9. 13. Sedlack RE et al (2007). Am J Gastroenterol Jan 102(1):64-74.