"All beginnings are hard!" I congratulate Lightdale et al for their important article in the July 2010 issue of Gastrointestinal Endoscopy. They note that beginning gastroenterology fellows "are uncomfortable performing invasive procedures for the first time on real patients, where there is appropriate concern for patient safety." Although the authors demonstrate that computer-based simulation "may offer the benefit of facilitating training at no risk to patients" to beginning gastroenterology fellows, simulation may be impractical because of inadequate fellowship time for computer-based simulation and unavailability of teaching attending physicians to proctor such simulations. Simulation may also be relatively inefficient because of its artificiality, and beginning endoscopists must still learn on real patients even after simulation training.
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