• Pietro Mascagni, Andrea Spota, Margherita Pizzicannella, Giovanni Guglielmo Laracca, Anton Svendrovski, Claudio Fiorillo, Sun Gyo Lim, Oudkerk PoolMarinkaMInstitut Hospitalo-Universitaire (IHU), Institute of Image-Guided Surgery, Strasbourg, France (Mascagni, Pizzicannella, Fiorillo, Lim, Oudkerk Pool, Dallemagne, Swanstrom, Shlomovitz, Perretta)., Bernard Dallemagne, Jacques Marescaux, Lee Swanstrom, Eran Shlomovitz, and Silvana Perretta.
• From the Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy (Mascagni, Fiorillo).
• J. Am. Coll. Surg. 2022 Jun 1; 234 (6): 1201-1210.

BackgroundA 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 DesignIn 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.ResultsSeventy-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).ConclusionsSimulation-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.Copyright © 2022 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.

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