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All important ideas pass through three stages. First, they are ridiculed. Second, they are violently opposed. Third, they are accepted as being self-evident. - Schopenhauer Twenty years ago I stumbled upon an idea that changed my life. In a study of preventive medicine behaviors by family physicians, the introduction of a new procedural technology (flexible gastroin­ testinal endoscopy) markedly improved the long­ standing noncompliance of physicians and pa­ tients in the prevention of colorectal cancer. 1 ,2 The fiberoptic bundles of short colonoscopy and flexible sigmoidoscopy translated into a re­ producibly constant group of diagnostic advan­ tages. 3 Improved patient tolerance led to greater insertion depth and better diagnostic yield. Few, however, have commented on the process that led to displacement of old technology (rigid sigmoi­ doscopy) by a continuum of newer technologies (flexible sigmoidoscopy, endoscopic biopsy, and colonoscopy; and esophagogastroduodenoscopy [EGD]).4,5 Even fewer have described the lengthy technology transfer curve (30 years) and the em­ barrassing resistance of established physicians who were trying to protect the status quo. 6 - 8

journal of the american board of family medicine

Will Virtual Reality Simulators End the Credentialing Arms Race in Gastrointestinal Endoscopy or the Need for Family Physician Faculty With Endoscopic Skills?