Some patients experience a degree of pain and discomfort during endoscopic examination of the large bowel. Sedatives and analgesics may be administered in low doses. Excessive dosage or intense pain may lead to hypotension and impaired level of consciousness. The purpose of the present study was to determine if simulation training of endoscopy staff in preventing pain and handling acute complications through effective teamwork could improve the quality of colonoscopy from the patients' perspective.

The study was carried out in a surgical department, where colonoscopies were performed on an out-patient basis under minimal sedation. The intervention consisted of a simulation based course for endoscopy staff. All endoscopy nurses and doctors participated (n=43). The course consisted of three short lectures followed by simulation training. The lectures dealt with technical aspects of colonoscopy, usage of medication and management of unexpected emergency events during the procedure, and finally with interprofessional teamwork and team communication. The lectures were followed by in situ simulation in an endoscopy room. For 2 months before and after the course a questionnaire based survey was carried out. The respondents were consecutive patients who had undergone colonoscopy under minimal sedation or no sedation (according to their own preference ). The questionnaire was filled out when the patient was fully recovered after sedation and ready to go home. The relevant nursing staff and doctor for the procedure also filled out their part of the questionnaire. Patients were invited to participate and gave written consent after oral and written information according to the Helsinki declaration .

Inclusion Criteria:

• All patients for colonoscopy under minimal sedation who are able to understand imformation

Exclusion Criteria:

• Unable to understand information

All patients for colonoscopy under minimal sedation