The Simulated Colonoscopy Objective Performance Evaluation (S.C.O.P.E.) was developed by Col E. Matthew Ritter, MD and colleagues at the Uniformed Services University of the Health Sciences (USU) as a training and assessment tool for physicians who perform colonoscopies.

Through a CRADA between USU, HJF, Kyoto Kagaku Co Ltd and Limbs and Things, Inc. a prototype was modified into the Endoscopy Training System (ETS), a low-technology, quality product, that allows surgeons to practice and gain proficiency in flexible endoscopy skills without risk to patients. ETS also saves time and money while reducing the risk inherent in medical training. An exclusive license to the technology was executed, and the CRADA enabled collaboration to develop and launch ETS within four months of license execution. ETS has had sales to USU, as well as U.S. and international medical schools.

In training tests, prior to using ETS, only 18 percent of residents with no colonoscopy experience passed an endoscopy surgery exam; after training with ETS, 100 percent of the residents passed.

ETS, validated in real-world training and clinical settings, has enhanced the education and training of military, U.S. Public Health Service, and civilian surgeons in the skills required to perform endoscopy.