Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
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Simulator-based training method in gastrointestinal endoscopy training and currently available simulators

  • Yuri Kim (Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Jeong Hoon Lee (Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Gin Hyug Lee (Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Ga Hee Kim (Department of Internal Medicine, Chung-Ang University College of Medicine) ;
  • Gunn Huh (Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Seung Wook Hong (Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Hwoon-Yong Jung (Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine)
  • Received : 2022.07.15
  • Accepted : 2022.10.19
  • Published : 2023.01.30
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Abstract

The apprenticeship-based training method (ABTM) is highly effective for gastrointestinal (GI) endoscopic training. However, the conventional ABTM has significant issues. Although many supplementary training methods (TMs) have been developed and utilized, they cannot entirely replace the ABTM, which remains the major TM strategy. Currently, new TM construction is crucial and necessary due to financial constraints, difficulty of obtaining sufficient training time due to patient safety-related regulations, and catastrophic damage caused by disasters such as the coronavirus disease 2019 pandemic. The simulator-based TM (SBTM) is widely accepted as an alternative to the ABTM, owing to the SBTM's advantages. Since the 1960s, many GI endoscopy training simulators have been developed and numerous studies have been published on their effectiveness. While previous studies have focused on the simulator's validity, this review focused on the accessibility of simulators that were introduced by the end of 2021. Although the current SBTM is effective in GI endoscopic education, extensive improvements are needed to replace the ABTM. Incorporating simulator-incorporated TMs into an improved ABTM is an attempt to overcome the incompleteness of the current SBTM. Until a new simulator is developed to replace the ABTM, it is desirable to operate a simulator-integrated and well-coordinated TM that is suitable for each country and institution.

Keywords

References

  1. Finocchiaro M, Cortegoso Valdivia P, Hernansanz A, et al. Training simulators for gastrointestinal endoscopy: current and future perspectives. Cancers (Basel) 2021;13:1427. 
  2. Khan R, Grover SC. A standardized technique for gastroscopy: still missing? Endosc Int Open 2020;8:E1231-E1232.  https://doi.org/10.1055/a-1216-1933
  3. Hwang JH, Jamidar P, Kyanam Kabir Baig KR, et al. GIE editorial board top 10 topics: advances in GI endoscopy in 2019. Gastrointest Endosc 2020;92:241-251.  https://doi.org/10.1016/j.gie.2020.05.021
  4. Walsh CM, Cohen J, Woods KL, et al. ASGE EndoVators Summit: simulators and the future of endoscopic training. Gastrointest Endosc 2019;90:13-26.  https://doi.org/10.1016/j.gie.2018.10.031
  5. Whitson MJ, Williams RL, Shah BJ. Ensuring quality in endoscopic training: tools for the educator and trainee. Tech Innov Gastrointest Endosc 2022;24:354-363.  https://doi.org/10.1016/j.tige.2022.02.002
  6. Zhang W, Liu X, Zheng B. Virtual reality simulation in training endoscopic skills: a systematic review. Laparosc, Endosc Robot Surg 2021;4:97-104.  https://doi.org/10.1016/j.lers.2021.09.002
  7. Dolan RD, Ryou M. Endoscopic simulators: training the next generation. Curr Opin Gastroenterol 2021;37:589-595.  https://doi.org/10.1097/MOG.0000000000000788
  8. ASGE Technology Committee, Goodman AJ, Melson J, et al. Endoscopic simulators. Gastrointest Endosc 2019;90:1-12.  https://doi.org/10.1016/j.gie.2018.10.037
  9. Mahmood T, Scaffidi MA, Khan R, et al. Virtual reality simulation in endoscopy training: current evidence and future directions. World J Gastroenterol 2018;24:5439-5445.  https://doi.org/10.3748/wjg.v24.i48.5439
  10. Singh S, Sedlack RE, Cook DA. Effects of simulation-based training in gastrointestinal endoscopy: a systematic review and meta-analysis. Clin Gastroenterol Hepatol 2014;12:1611-1623.  https://doi.org/10.1016/j.cgh.2014.01.037
  11. Khan R, Plahouras J, Johnston BC, et al. Virtual reality simulation training in endoscopy: a Cochrane review and meta-analysis. Endoscopy 2019;51:653-664.  https://doi.org/10.1055/a-0894-4400
  12. Armellini ST, Rossini LG, Dias EL, et al. Simulators for endoscopic retrograde cholangiopancreatography training: systematic review and meta-analysis. Rev Assoc Med Bras (1992) 2021;67:1187-1191.  https://doi.org/10.1590/1806-9282.20210373
  13. ASGE Training Committee, Adler DG, Bakis G, et al. Principles of training in GI endoscopy. Gastrointest Endosc 2012;75:231-235.  https://doi.org/10.1016/j.gie.2011.09.008
  14. Soetikno R, Cabral-Prodigalidad PA, Kaltenbach T, et al. Simulation-based mastery learning with virtual coaching: experience in training standardized upper endoscopy to novice endoscopists. Gastroenterology 2020;159:1632-1636.  https://doi.org/10.1053/j.gastro.2020.06.096
  15. Fudman DI, Falchuk KR, Feuerstein JD. Complication rates of trainee- versus attending-performed upper gastrointestinal endoscopy. Ann Gastroenterol 2019;32:273-277.  https://doi.org/10.20524/aog.2019.0372
  16. Kim JS, Kim BW. Endoscopy training in Korea. Korean J Intern Med 2019;34:237-241.  https://doi.org/10.3904/kjim.2019.028
  17. Yang D, Wagh MS, Draganov PV. The status of training in new technologies in advanced endoscopy: from defining competence to credentialing and privileging. Gastrointest Endosc 2020;92:1016-1025.  https://doi.org/10.1016/j.gie.2020.05.047
  18. Waschke KA, Coyle W. Advances and challenges in endoscopic training. Gastroenterology 2018;154:1985-1992.  https://doi.org/10.1053/j.gastro.2017.11.293
  19. Siau K, Hawkes ND, Dunckley P. Training in endoscopy. Curr Treat Options Gastroenterol 2018;16:345-361.  https://doi.org/10.1007/s11938-018-0191-1
  20. Waschke KA, Anderson J, Valori RM, et al. ASGE principles of endoscopic training. Gastrointest Endosc 2019;90:27-34.  https://doi.org/10.1016/j.gie.2018.10.017
  21. Han S. Achieving competence in endoscopy. ACG Case Rep J 2019;6:e00155. 
  22. Siau K, Crossley J, Dunckley P, et al. Direct observation of procedural skills (DOPS) assessment in diagnostic gastroscopy: nationwide evidence of validity and competency development during training. Surg Endosc 2020;34:105-114.  https://doi.org/10.1007/s00464-019-06737-7
  23. Siau K, Green JT, Hawkes ND, et al. Impact of the joint advisory group on gastrointestinal endoscopy (JAG) on endoscopy services in the UK and beyond. Frontline Gastroenterol 2019;10:93-106.  https://doi.org/10.1136/flgastro-2018-100969
  24. Han S, Obuch JC, Duloy AM, et al. A prospective multicenter study evaluating endoscopy competence among gastroenterology trainees in the era of the next accreditation system. Acad Med 2020;95:283-292.  https://doi.org/10.1097/ACM.0000000000002885
  25. Siau K, Dunckley P, Feeney M, et al. ERCP assessment tool: evidence of validity and competency development during training. Endoscopy 2019;51:1017-1026.  https://doi.org/10.1055/a-0991-0044
  26. Wani S, Keswani RN, Han S, et al. Competence in endoscopic ultrasound and endoscopic retrograde cholangiopancreatography, from training through independent practice. Gastroenterology 2018;155:1483-1494.  https://doi.org/10.1053/j.gastro.2018.07.024
  27. Min JK, Cha JM, Cho YK, et al. Revision of quality indicators for the endoscopy quality improvement program of the national cancer screening program in Korea. Clin Endosc 2018;51:239-252.  https://doi.org/10.5946/ce.2018.075
  28. Azzam N, Khamis N, Almadi M, et al. Development and validation of metric-based-training to proficiency simulation curriculum for upper gastrointestinal endoscopy using a novel assessment checklist. Saudi J Gastroenterol 2020;26:179-187.  https://doi.org/10.4103/sjg.SJG_113_20
  29. Khan R, Scaffidi MA, Grover SC, et al. Simulation in endoscopy: practical educational strategies to improve learning. World J Gastrointest Endosc 2019;11:209-218.  https://doi.org/10.4253/wjge.v11.i3.209
  30. Nguyen-Vu T, Malvar C, Chin YK, et al. Simulation-based mastery learning (SBML) for rapid acquisition of upper endoscopy knowledge and skills-initial observation. VideoGIE 2020;5:222-225.  https://doi.org/10.1016/j.vgie.2020.02.014
  31. Dilly CK, Sewell JL. How to give feedback during endoscopy training. Gastroenterology 2017;153:632-636.  https://doi.org/10.1053/j.gastro.2017.07.023
  32. Waschke KA, Anderson J, Macintosh D, et al. Training the gastrointestinal endoscopy trainer. Best Pract Res Clin Gastroenterol 2016;30:409-419.  https://doi.org/10.1016/j.bpg.2016.05.001
  33. Sedlack RE. The state of simulation in endoscopy education: continuing to advance toward our goals. Gastroenterology 2013;144:9-12.  https://doi.org/10.1053/j.gastro.2012.11.007
  34. Vignesh S, Butt AS, Alboraie M, et al. Impact of COVID-19 on endoscopy training: perspectives from a global survey of program directors and endoscopy trainers. Clin Endosc 2021;54:678-687.  https://doi.org/10.5946/ce.2021.140
  35. Shin HP, Cha JM, Kim BK, et al. Impact of COVID-19 on gastroenterology fellowship training. Korean J Gastroenterol 2021;77:205-213.  https://doi.org/10.4166/kjg.2021.049
  36. Koo CS, Siah KT, Koh CJ. Endoscopy training in COVID-19: challenges and hope for a better age. J Gastroenterol Hepatol 2021;36:2715-2719.  https://doi.org/10.1111/jgh.15524
  37. Soetikno R, Teoh AY, Kaltenbach T, et al. Considerations in performing endoscopy during the COVID-19 pandemic. Gastrointest Endosc 2020;92:176-183.  https://doi.org/10.1016/j.gie.2020.03.3758
  38. Keswani RN, Sethi A, Repici A, et al. How to maximize trainee education during the coronavirus disease-2019 pandemic: perspectives from around the world. Gastroenterology 2020;159:26-29.  https://doi.org/10.1053/j.gastro.2020.05.012
  39. Forbes N, Smith ZL, Spitzer RL, et al. Changes in gastroenterology and endoscopy practices in response to the coronavirus disease 2019 pandemic: results from a North American survey. Gastroenterology 2020;159:772-774.  https://doi.org/10.1053/j.gastro.2020.04.071
  40. Paleti S, Sobani ZA, McCarty TR, et al. Impact of COVID-19 on gastroenterology fellowship training: a multicenter analysis of endoscopy volumes. Endosc Int Open 2021;9:E1572-E1578.  https://doi.org/10.1055/a-1526-1419
  41. Khan R, Tandon P, Scaffidi MA, et al. COVID-19 and Canadian gastroenterology trainees. J Can Assoc Gastroenterol 2020;4:156-162.  https://doi.org/10.1093/jcag/gwaa034
  42. Siau K, Iacucci M, Dunckley P, et al. The impact of COVID-19 on gastrointestinal endoscopy training in the United Kingdom. Gastroenterology 2020;159:1582-1585.  https://doi.org/10.1053/j.gastro.2020.06.015
  43. Roemmele C, Manzeneder J, Messmann H, et al. Impact of the COVID-19 outbreak on endoscopy training in a tertiary care centre in Germany. Frontline Gastroenterol 2020;11:454-457.  https://doi.org/10.1136/flgastro-2020-101504
  44. Pawlak KM, Kral J, Khan R, et al. Impact of COVID-19 on endoscopy trainees: an international survey. Gastrointest Endosc 2020;92:925-935.  https://doi.org/10.1016/j.gie.2020.06.010
  45. Ravindran S, Thomas-Gibson S, Murray S, et al. Improving safety and reducing error in endoscopy: simulation training in human factors. Frontline Gastroenterol 2019;10:160-166.  https://doi.org/10.1136/flgastro-2018-101078
  46. Cha JM, Lee JI, Joo KR, et al. The box simulator is useful for training novice endoscopists in basic endoscopic techniques. Yonsei Med J 2012;53:304-309.  https://doi.org/10.3349/ymj.2012.53.2.304
  47. Thompson CC, Jirapinyo P, Kumar N, et al. Development and initial validation of an endoscopic part-task training box. Endoscopy 2014;46:735-744.  https://doi.org/10.1055/s-0034-1365463
  48. Lee S, Ahn JY, Han M, et al. Efficacy of a three-dimensional-printed training simulator for endoscopic biopsy in the stomach. Gut Liver 2018;12:149-157.  https://doi.org/10.5009/gnl17126
  49. Hochberger J, Matthes K, Maiss J, et al. Training with the compactEASIE biologic endoscopy simulator significantly improves hemostatic technical skill of gastroenterology fellows: a randomized controlled comparison with clinical endoscopy training alone. Gastrointest Endosc 2005;61:204-215.  https://doi.org/10.1016/S0016-5107(04)02471-X
  50. Ende A, Zopf Y, Konturek P, et al. Strategies for training in diagnostic upper endoscopy: a prospective, randomized trial. Gastrointest Endosc 2012;75:254-260.  https://doi.org/10.1016/j.gie.2011.07.063
  51. Adamsen S, Tolboll TH, Matthes K. Evaluation of a modified Erlangen Simulator for ERCP (EASIE-RTM) using two different duodenoscopes. Endoscopy 2021;53(S01):S162. 
  52. Ahlberg G, Hultcrantz R, Jaramillo E, et al. Virtual reality colonoscopy simulation: a compulsory practice for the future colonoscopist? Endoscopy 2005;37:1198-1204.  https://doi.org/10.1055/s-2005-921049
  53. Sahakian AB, Laine L, Jamidar PA, et al. Can a computerized simulator assess skill level and improvement in performance of ERCP? Dig Dis Sci 2016;61:722-730.  https://doi.org/10.1007/s10620-015-3939-7
  54. Ferlitsch A, Schoefl R, Puespoek A, et al. Effect of virtual endoscopy simulator training on performance of upper gastrointestinal endoscopy in patients: a randomized controlled trial. Endoscopy 2010;42:1049-1056.  https://doi.org/10.1055/s-0030-1255818
  55. Bittner JG, Mellinger JD, Imam T, et al. Face and construct validity of a computer-based virtual reality simulator for ERCP. Gastrointest Endosc 2010;71:357-364.  https://doi.org/10.1016/j.gie.2009.08.033
  56. Van Sickle KR, Buck L, Willis R, et al. A multicenter, simulation-based skills training collaborative using shared GI Mentor II systems: results from the Texas Association of Surgical Skills Laboratories (TASSL) flexible endoscopy curriculum. Surg Endosc 2011;25:2980-2986.  https://doi.org/10.1007/s00464-011-1656-7
  57. Plooy AM, Hill A, Horswill MS, et al. The efficacy of training insertion skill on a physical model colonoscopy simulator. Endosc Int Open 2016;4:E1252-E1260.  https://doi.org/10.1055/s-0042-114773
  58. Na HK, Ahn JY, Lee GH, et al. The efficacy of a novel percutaneous endoscopic gastrostomy simulator using three-dimensional printing technologies. J Gastroenterol Hepatol 2019;34:561-566.  https://doi.org/10.1111/jgh.14527
  59. Sato H, Mizuno KI, Sato Y, et al. Development and use of a non-biomaterial model for hands-on training of endoscopic procedures. Annals of translational medicine 2017;5:182. 
  60. Desilets DJ, Banerjee S, Barth BA, et al. Endoscopic simulators. Gastrointest Endosc 2011;73:861-867.  https://doi.org/10.1016/j.gie.2011.01.063
  61. Tanimoto MA, Torres-Villalobos G, Fujita R, et al. Learning curve in a Western training center of the circumferential en bloc esophageal endoscopic submucosal dissection in an in vivo animal model. Diagn Ther Endosc 2011;2011:847831. 
  62. Siegel JH, Korsten MA. ERCP in a nonhuman primate. Gastrointest Endosc 1989;35:557-559.  https://doi.org/10.1016/S0016-5107(89)72912-6
  63. Wagh MS, Waxman I. Animal models for endoscopic simulation. Gastrointest Endosc Clin N Am 2006;16:451-456.  https://doi.org/10.1016/j.giec.2006.03.011
  64. Parra-Blanco A, Gonzalez N, Arnau MR. Ex vivo and in vivo models for endoscopic submucosal dissection training. Clin Endosc 2012;45:350-357.  https://doi.org/10.5946/ce.2012.45.4.350
  65. Moss A, Bourke MJ, Tran K, et al. Lesion isolation by circumferential submucosal incision prior to endoscopic mucosal resection (CSI-EMR) substantially improves en bloc resection rates for 40-mm colonic lesions. Endoscopy 2010;42:400-404.  https://doi.org/10.1055/s-0029-1243990
  66. Freys SM, Heimbucher J, Fuchs KH. Teaching upper gastrointestinal endoscopy: the pig stomach. Endoscopy 1995;27:73-76.  https://doi.org/10.1055/s-2007-1005637
  67. Qiao W, Bai Y, Lv R, et al. The effect of virtual endoscopy simulator training on novices: a systematic review. PLoS One 2014;9:e89224. 
  68. Triantafyllou K, Lazaridis LD, Dimitriadis GD. Virtual reality simulators for gastrointestinal endoscopy training. World J Gastrointest Endosc 2014;6:6-12.  https://doi.org/10.4253/wjge.v6.i1.6
  69. Grover SC, Scaffidi MA, Khan R, et al. Progressive learning in endoscopy simulation training improves clinical performance: a blinded randomized trial. Gastrointest Endosc 2017;86:881-889. https://doi.org/10.1016/j.gie.2017.03.1529
  70. Kneebone RL, Nestel D, Moorthy K, et al. Learning the skills of flexible sigmoidoscopy: the wider perspective. Med Educ 2003;37 Suppl 1:50-58.  https://doi.org/10.1046/j.1365-2923.37.s1.2.x
  71. Menabawey TE, Dimmock V, Gadock R, et al. PTH-133 Five years of HIFIVE (human factors in virtual endoscopy): an endoscopic non-technical skills simulation programme. Gut 2018;67:A272. 
  72. Classen M, Ruppin H. Practical endoscopy training using a new gastrointestinal phantom. Endoscopy 1974;6:127-131. https://doi.org/10.1055/s-0028-1098609