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Simulators have been proposed as a way to facilitate endoscopic training from the time of the earliest development of the field. In fact, Rudolf Schindler described using a model stomach for practice in orientation [17]. Many of the items in the “skill sets” listed above, and particularly those that involve dexterity, hand–eye coordination, and recognition of normal anatomy and abnormal pathology, can be addressed through the use of various endoscopic simulators.

Endoscopy simulators, including ex vivo artificial tissue, animal tissue, and virtual reality computer‐based models, provide a unique method for endoscopic teaching. These devices allow for teaching which is free from the possibility of patient discomfort or injury. This factor alone confers several benefits to the learning process. First, the stress of the learning environment is reduced for the trainee and the trainer alike. There is more time for questions and feedback than available when an actual patient is involved. The issue of reduced trainee endoscope time due to critical clinical exigencies is eliminated, and there is ample opportunity for repetition. In fact, the sequence of demonstration of proper technique, repetitive practice of skills with expert feedback, and assessment of skill are all possible in this environment. Creative teaching exercises such as demonstrating common errors and what constitute poor technique are also uniquely possible using such alternative means of instruction to the traditional proctored human endoscopy setting for instruction (Video 1.1). In this way, simulators can confer excellent opportunities for “standard” techniques to be practiced by trainees and allow for new procedures to be taught to experienced clinicians [1]. To the extent that certain models might be used independently by trainees without real‐time instructor feedback, and to the extent that simulator work might hasten the time in which trainees can perform unsupervised procedures on their own, simulators also have the potential to address the time constraints facing endoscopy instructors with substantial nonteaching clinical responsibilities of their own to fulfill. However, as we will relate below, much of the actual effective learning using endoscopy simulators does require fairly labor‐intensive expert instruction, and to date, the potential for freeing up time spent mentoring trainees has not yet been realized.