on educational outcomes and health care quality, and the need to provide clear guidance to educators who seek to enhance integration of simulation into training and practice.
While simulators are likely to play an increasingly important role in endoscopic training and retraining, key gaps were identified that must be addressed for simulation to have an even greater impact on endoscopic training. These include
1 Improved visual resemblance and haptic capabilities of computerized modules
2 Incorporation of more complex cases to enhance the range of difficulty and increase relevance for the skilled endoscopist
3 Improved functional task alignment of simulators with real‐life performance (i.e., similar sensory, cognitive, and/or motor processing required for the simulator as for the corresponding clinical task)
4 Simulator‐generated performance metrics with strong validity evidence to enhance assessment capabilities and provision of feedback and increased capacity for independent practice
5 Improved discriminative validity, capable of distinguishing between endoscopists with small differences in skill
6 Inexpensive portable models to facilitate local access to simulators
7 Cognitive training tools targeting lesion recognition and management decision‐making skills
8 Simulators for more complex procedures such as ERCP and EUS and low‐volume, high‐stakes therapeutic techniques.
Ongoing evolution of endoscopic training
The past two decades have been characterized by rapid expansion of the training modalities at our disposal and the general acceptance of their use. Much work remains to clarify the optimal way to integrate these tools into standard training, training in advanced procedures, and in the uncharted waters of maintaining skills.
A second major area for progress is in the area of creation and validation of simulator‐based skills assessments that predict performance level and competency on actual procedures. Simulator investigators have long realized that a key milestone would be the development of reliable simulator‐based assessments of competency.
A third area that will need to be addressed in coming years is the further integration of some of these new teaching modalities into local programs. For example, the ideal follow‐up of the national first year’s fellows hands‐on training experience at the ITT would be follow‐up hands‐on workshops at various intervals run and funded locally with support of local physicians and industry. Funding and logistic issues need to be addressed, but adoption will first require increased acknowledgment by local program directors of the importance of such activities. For example, a combination didactic and hands‐on training course for advanced and interventional endoscopy held regionally may be an alternative to a centralized approach. To date, such workshops at professional society national and regional meetings (such as at ASGE, ACG, and NYSGE meetings) have emerged, but have not yet been scaled to reach the vast majority of GI trainees. Further expansion of hands‐on ex vivo simulator training at the local level will also require a considerable effort to train a broader group of trainers on how best to utilize these simulators to teach endoscopy [38] (see also Chapter 4).
Finally, what about the introduction of new endoscopic technology and techniques? This would be another area of real promise for an expanded role of simulators and specific training program development. On the part of industry, this begins with the use of models to test early devices and procedures prior to more costly animal studies. Next is the growing recognition that innovative techniques require specific training programs to ensure both proper execution of the new procedures and acceptance of the innovation by practitioners. Busy clinicians will not adopt new skills unless an efficient and preferably validated training program is available to ensure that they can develop the proficiency to safely and effectively do the procedure. In contrast to the past when efforts to determine the best ways to train for techniques often came long after the procedure was adopted, in the future, there will be increasing pressure to address training upfront. One hopes that with this additional attention to training in parallel with technology development will come increasing avenues of support for simulator‐based training in general. This may be of particular importance as a partial solution to the problem of creating more opportunities for practicing endoscopists who desire to and will need to learn new techniques. The innovators will need to support those they hope will adopt the innovation; simulators are likely to facilitate this growing interdependence.
It is clear that since 2000, there has been an increased focus on how endoscopic training should occur and on achieving benchmarks for assessing progress before further training should continue. Progress in simulation has been steady but remains slow, yet sentiment for engaging both trainees and experienced endoscopists for simulator training is evidenced by summits, White Papers, and continued innovation. Moreover, there continue to be progress in e‐learning, accelerated by the expanded use of video recording, and easier access to high‐quality material with distribution by broadband internet and advertisement and amplification on social media platforms.
A peek into the future of endoscopic training to 2030
So where is endoscopic teaching likely to go? While the future is always hard to predict, certain things seem to be on the horizon. In general, one can predict increased training done by sharing of educational videos on platforms that are accessible worldwide. (see Table 1.2 for a summary of likely features of endoscopic training by 2030).
These changes to video and remote learning were already moving into place, but the COVID‐19 pandemic of 2020 and beyond may have accelerated this development. Important driving factors here include:
Table 1.2 A look at endoscopy training in 2030.
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Introductory learning assessment tools to identify personal learning styles and skills at outset:Verbal, visual, and tactile assessments to facilitate subsequent trainer–trainee interactionApplication of ongoing assessment tool data collection and AI‐enhanced digital mentoring to focus training on areas in need of greater attention to accelerate learning curves.Wider availability and full incorporation of simulators throughout the training processStaged simulator integrationNovices prior to patient experienceAdvanced beginners prior to participation in therapeuticsIntermediate/senior fellows to refine skills and practice entire techniques with team trainingAdvanced endoscopists learning new or complicated high‐risk and low‐volume procedures.Web‐based tools with self‐assessment to teach an array of cognitive skills and lesion recognitionCoupling of appropriate simulator‐based lesson plans and model types with particular stages of training or learning goalsDevelopment of training director consensus and professional society guidelines on specific applications for simulator work within trainingObjective competency assessment tools
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