[Training simulators in digestive endoscopy]

Advanced techniques, optimal patient care, and quality management are currently important topics in clinical medicine. The increasing numbers of minimally invasive procedures being carried out in gastroenterology and surgery, and the effects of the learning curve on complication rates with various procedures, have given rise a recently debate on training standards. Public awareness and increasing legal pressure to show and document competence have further contributed to the importance of training in interventional medicine. Although evidence-based medicine is rapidly becoming the gold standard for treatment modalities, responsibility for education-including the theoretical background, as well as acquiring and refining manual skills in gastrointestinal endoscopy--is still a matter for the individual physician. Practical skills are routinely acquired by practicing on patients, initially under the supervision of a senior endoscopist. The development of new endoscopy simulators has brought out the debate whether training in basic manual skills is better obtained outside the patient. This paper presents an overview of the training simulators currently available and issues associated with them.