Virtual reality simulation training in endoscopy: a Cochrane review and meta-analysis

We included 18 trials with 3817 endoscopic procedures. VR training provided no advantage over no training or conventional training based on the primary outcome of composite score of competency. VR training was advantageous over no training based on independent procedure completion (relative risk RR = 1.62, 95 % confidence interval CI 1.15 - 2.26, moderate-quality evidence), overall rating of performance (mean difference MD 0.45, 95 %CI 0.15 - 0.75, very low-quality evidence), and mucosal visualization (MD 0.60, 95 %CI 0.20 - 1.00, very low-quality evidence). Compared with conventional training, VR training resulted in fewer independent procedure completions (RR = 0.45, 95 %CI 0.27 - 0.74, low-quality evidence). We found no differences between VR training and no training or conventional training for other outcomes. Based on qualitative analysis, we found no significant differences between VR training and other forms of simulation training. VR curricula based in educational theory provided benefit with respect to composite score of competency, compared with unstructured curricula. CONCLUSIONS : VR simulation training is advantageous over no training and can supplement conventional endoscopy training. There is insufficient evidence that simulation training provides benefit over conventional training.