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Improving safety and reducing error in endoscopy: simulation training in human factors
  1. Srivathsan Ravindran1,2,
  2. Siwan Thomas-Gibson1,2,
  3. Sam Murray3,
  4. Eleanor Wood4,5
  1. 1 Wolfson Unit for Endoscopy, St Mark’s Hospital, London, UK
  2. 2 Department of Surgery and Cancer, Imperial College London, London, UK
  3. 3 Department of Gastroenterology, North Bristol NHS Trust, Bristol, UK
  4. 4 Department of Gastroenterology, Homerton University Hospital, London, UK
  5. 5 Simulation Centre, Homerton University Hospital, London, UK
  1. Correspondence to Dr Srivathsan Ravindran, Wolfson Unit for Endoscopy, St Mark’s Hospital, London HA1 3UJ, UK; sravindran1{at}


Patient safety incidents occur throughout healthcare and early reports have exposed how deficiencies in ‘human factors’ have contributed to mortality in endoscopy. Recognising this, in the UK, the Joint Advisory Group for Gastrointestinal Endoscopy have implemented a number of initiatives including the ‘Improving Safety and Reducing Error in Endoscopy’ (ISREE) strategy. Within this, simulation training in human factors and Endoscopic Non-Technical Skills (ENTS) is being developed. Across healthcare, simulation training has been shown to improve team skills and patient outcomes. Although the literature is sparse, integrated and in situ simulation modalities have shown promise in endoscopy. Outcomes demonstrate improved individual and team performance and development of skills that aid clinical practice. Additionally, the use of simulation training to detect latent errors in the working environment is of significant value in reducing error and preventing harm. Implementation of simulation training at local and regional levels can be successfully achieved with collaboration between organisational, educational and clinical leads. Nationally, simulation strategies are a key aspect of the ISREE strategy to improve ENTS training. These may include integration of simulation into current training or development of novel simulation-based curricula. However used, it is evident that simulation training is an important tool in developing safer endoscopy.

  • endoscopy

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  • Contributors SR drafted and edited the article. SM, ST-G and EW reviewed and edited the article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests ST-G is Chair of Joint Advisory Group for Gastrointestinal Endoscopy (JAG). She has received academic honoraria from Olympus, course fees from Aquilant/Fujifilm and equipment loans from Pentax and Olympus.

  • Patient consent Not required.

  • Provenance and peer review Commissioned; externally peer reviewed.

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