User, expert, and construct validation of a new colonoscopy simulator: correlation with National Endoscopy Database key performance indicators

IGIE. 2025 Aug 22;5(1):2-8.e1. doi: 10.1016/j.igie.2025.08.007. eCollection 2026 Mar.

ABSTRACT

BACKGROUND AND AIMS: Training in flexible gastrointestinal endoscopy is increasingly challenging. Simulation tools may help impart essential skills, but existing simulators lack real-time feedback, may be unrealistic, and are not aligned with recognized key performance indicators (KPIs). As a result, translating from simulator to real-world procedures has achieved variable outcomes. The Mikoto colonoscopy simulator (R Zero Inc, Tokyo, Japan) aims to address this gap by providing real-time feedback based on procedural dynamics, including patient comfort, producing a single performance-focused score (out of a maximum possible 100; the Mikoto Simulator Score [MSS]).We sought to establish construct and user validation for the MSS, with endoscopists' KPIs and structured user feedback.

METHODS: Twenty endoscopists of varying experience levels were recruited and categorized into novice, training, competent, and expert experience levels, based on lifetime colonoscopy numbers (national accreditation criteria). Participants provided their United Kingdom National Endoscopy Database (NED) KPIs before using the simulator. After standardized introduction and acclimatization, each then performed 3 full colonoscopies on the simulator, with the main test parameters being cecal intubation time and MSS. User validity was determined by means of a structured feedback questionnaire assessing utility and realism.

RESULTS: Significant differences were observed in median NED KPIs and MSS across all experience levels (n = 5 in each group, P = .046), with a linear correlation between lifetime colonoscopy numbers and MSS (P = .027). There were also highly significant correlations demonstrated between MSS and NED colonoscopy comfort score (P < .001), polyp detection rate (P < .001), and cecal intubation rate (P < .001).

CONCLUSIONS: The Mikoto simulator demonstrates close alignment with NED KPIs for colonoscopy, with linear correlation in most cases, providing initial validation as an indicator of endoscopic competence in a nonpatient-contact setting. Further studies are warranted to assess integration into endoscopy training. The Mikoto simulator represents a promising tool for enhancing endoscopic training and improving patient outcomes.

PMID:41969773 | PMC:PMC13064475 | DOI:10.1016/j.igie.2025.08.007