BACKGROUND: A considerable number of surgical residents fail the mandated endoscopy exam despite having completed the required clinical cases. Low-cost endoscopy box trainers (BTs) could democratize training; however, their effectiveness has never been compared with higher-cost virtual reality simulators (VRSs).STUDY DESIGN: In this randomized noninferiority trial, endoscopy novices trained either on the VRS used in the Fundamental of Endoscopic Surgery manual skills (FESms) exam or a validated BT-the Basic Endoscopic Skills Training (BEST) box. Trainees were tested at fixed timepoints on the FESms and on standardized ex vivo models. The primary endpoint was FESms improvement at 1 week. Secondary endpoints were FESms improvement at 2 weeks, FESms pass rates, ex vivo tests performance, and trainees' feedback.RESULTS: Seventy-seven trainees completed the study. VRS and BT trainees showed comparable FESms improvements (25.16 +/- 14.29 vs 25.58 +/- 11.75 FESms points, respectively; p = 0.89), FESms pass rates (76.32% vs 61.54%, respectively; p = 0.16) and total ex vivo tasks completion times (365.76 +/- 237.56 vs 322.68 +/- 186.04 seconds, respectively; p = 0.55) after 1 week. Performances were comparable also after 2 weeks of training, but FESms pass rates increased significantly only in the first week. Trainees were significantly more satisfied with the BT platform (3.97 +/- 1.20 vs 4.81 +/- 0.40 points on a 5-point Likert scale for the VRS and the BT, respectively; p < 0.001).CONCLUSIONS: Simulation-based training is an effective means to develop competency in endoscopy, especially at the beginning of the learning curve. Low-cost BTs like the BEST box compare well with high-tech VRSs and could help democratize endoscopy training. (C) 2022 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.
Mascagni, P., Spota, A., Pizzicannella, M., Laracca, G. G., Svendrovski, A., Fiorillo, C., Lim, S. G., Oudkerk Pool, M., Dallemagne, B., Marescaux, J., Swanstrom, L., Shlomovitz, E., Perretta, S., Democratizing Flexible Endoscopy Training: Noninferiority Randomized Trial Comparing a Box-Trainer vs a Virtual Reality Simulator to Prepare for the Fundamental of Endoscopic Surgery Exam, <<JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS>>, 2022; 234 (6): 1201-1210. [doi:10.1097/XCS.0000000000000157] [https://hdl.handle.net/10807/260342]
Democratizing Flexible Endoscopy Training: Noninferiority Randomized Trial Comparing a Box-Trainer vs a Virtual Reality Simulator to Prepare for the Fundamental of Endoscopic Surgery Exam
Mascagni, Pietro;Fiorillo, Claudio;
2022
Abstract
BACKGROUND: A considerable number of surgical residents fail the mandated endoscopy exam despite having completed the required clinical cases. Low-cost endoscopy box trainers (BTs) could democratize training; however, their effectiveness has never been compared with higher-cost virtual reality simulators (VRSs).STUDY DESIGN: In this randomized noninferiority trial, endoscopy novices trained either on the VRS used in the Fundamental of Endoscopic Surgery manual skills (FESms) exam or a validated BT-the Basic Endoscopic Skills Training (BEST) box. Trainees were tested at fixed timepoints on the FESms and on standardized ex vivo models. The primary endpoint was FESms improvement at 1 week. Secondary endpoints were FESms improvement at 2 weeks, FESms pass rates, ex vivo tests performance, and trainees' feedback.RESULTS: Seventy-seven trainees completed the study. VRS and BT trainees showed comparable FESms improvements (25.16 +/- 14.29 vs 25.58 +/- 11.75 FESms points, respectively; p = 0.89), FESms pass rates (76.32% vs 61.54%, respectively; p = 0.16) and total ex vivo tasks completion times (365.76 +/- 237.56 vs 322.68 +/- 186.04 seconds, respectively; p = 0.55) after 1 week. Performances were comparable also after 2 weeks of training, but FESms pass rates increased significantly only in the first week. Trainees were significantly more satisfied with the BT platform (3.97 +/- 1.20 vs 4.81 +/- 0.40 points on a 5-point Likert scale for the VRS and the BT, respectively; p < 0.001).CONCLUSIONS: Simulation-based training is an effective means to develop competency in endoscopy, especially at the beginning of the learning curve. Low-cost BTs like the BEST box compare well with high-tech VRSs and could help democratize endoscopy training. (C) 2022 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.
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