endoscopy is possible and feasible. In these days where travel is difficult and the internet is becoming more and more a part of everybody’s lives due to the COVID‐19 virus, we can still reach out and teach in areas where usual teaching techniques are not currently possible and do it safely and well. Other students as well as multiple teachers can participate during these sessions via one of several internet programs. We currently use the Zoom platform. The internet provides a great capability to reach out and teach what we usually do in a one‐to‐one apprentice fashion: eye‐hand coordination based on simultaneous intralumenal visualization, coached by continuous verbal stimulation.For the technical aspects, the key seems to be that the internet bandwidth need not be more than 15 MBs upload and download, but that a part of the bandwidth (perhaps 10 MBs) is dedicated and reserved for remote teaching purposes. Our system is a fiberoptic feed (although a dedicated cellular line could be used) where the transmitting computers are connected directly to a LAN not through WiFi.
3 The GI societies worldwide will likely adapt new curricula and incorporate remote and video learning into their existing offerings as these new modalities become more popular and are reviewed. Ongoing innovation, as in the concept of video mentoring and video proctoring mentioned above, likely will continue and will expand.
Conclusion
Training in endoscopy began with a pioneering spirit of self‐taught innovators and quickly transitioned to a traditional apprenticeship model of learning during one‐on‐one proctored clinical experiences. Over the last 20 years, the advent of simulator‐based teaching tools and a heightened scrutiny of the optimal methods, components, and end points of training have sparked a transformation in the way endoscopy is taught.
On the technology of training, there are now an array of realistic simulators that in sum allow for an excellent training experience in most of the therapeutic procedures comprising current endoscopic practice. There is growing evidence that training using these models is of benefit. These hands‐on complementary methods are certainly popular, and thanks to the vision of the leadership of endoscopic societies and the support of the industry, opportunities to use them are increasingly available. The area of simulator‐based skills assessment remains a relatively undeveloped field, awaiting increased realism, and the development and validation of proper tests. Still, the combination of static models, ex vivo artificial models, ex vivo animal models, and computer simulators, collectively represent a substantial and powerful tool for education and training in gastrointestinal endoscopy. It is easy to see the day when there will be ready availability of hands‐on training via simulators beyond the gastroenterology fellowship setting. Paralleling the progression of technology and the continuous introduction of new devices and procedures will be a compelling need for hands‐on experience on simulators for all such new tools and techniques.
Parallel to this transformation in the methods of training have been key new concepts about how this process ought to occur. Realizing that simulator work is generally costly and labor intensive, attention is being paid to learn how to best deploy simulator experience during training; for example, work with static models might be more cost‐effective for novices than hands‐on ex vivo workshops. The benefit from such workshops is intuitively greater for trainees who already have attained some basic skills. The growing experience with simulator‐based training has taught the value of concepts such as team training of assistants along with the endoscopists, deconstructing complex procedures into their component skills, training that incorporates troubleshooting unplanned adverse events, and increasing emphasis on self‐assessment and feedback within the training process.
At the same time, the growing emphasis on maximizing quality in endoscopy has also affected guidelines and attitudes about endoscopic training. From the early days of endoscopy, thought leaders have aimed to train new endoscopists who were competent to perform procedures independently. But recently, the question they have asked has changed from “How many procedures are required for a trainee to become competent?” to “What are the objective measures of competency for a particular procedure and has a trainee reached that level of skill?” There is increasing recognition of the importance of objective measurement of success both during training and beyond. The process of keeping track of outcomes during training has the potential not only to ensure that benchmark end points of training are attained before endoscopists perform procedures independently on patients but also to facilitate that training process itself, by virtue of the feedback this information provides.
As endoscopy has evolved from its emergence to the present, there remains an optimistic conviction among endoscopy educators that training is essential to the future of the field—and the future of endoscopic training looks bright.
Videos
Video 1.1 The EASIE hemostasis ex vivo training workshop.
Video 1.2 Box simulator for teaching and skills assessment of deconstructed set of five core colonoscopy technical skills.
Video 1.3 Neo‐papilla developed by Cohen and Matthes utilizing chicken heart attachment to ex vivo porcine model to simulate repeated pancreatic and biliary interventions during a hands‐on training workshop.
Video 1.4 Tips for teaching using ex vivo models.
Video 1.5 Use of simulator to teach what not to do: improper submucosal lift in EMR leads to perforation on purpose.
Video 1.6 Virtual reality colonoscopy simulator training.
Video 1.7 A tour of the DAVE project: a free versatile multimedia resource for endoscopy education.
Video 1.8 Remote video telementoring. Remote teaching of flexible endoscopy from New York to Kyabirwa, Uganda by Jerome D. Waye, MD, Professor Emeritus Icahn School of Medicine at Mount Sinai.
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