The American Society for Reproductive Medicine Embryo Transfer Simulator Initiative has come full circle: an editorial

In this issue of F&S Reports, Baker et al. (1Baker K.M. Leung A.Q. Shah J.S. Korkidakis A. Sakkas D. Penzias A. et al.Simulation-based training for embryo transfer for clinicians with differing levels of expertise: an application of the ASRM Embryo Transfer Simulator.F&S Reports. 2023; 4: 29-34Abstract Full Text Full Text PDF Scopus (1) Google Scholar) present data from a study that used the American Society for Reproductive Medicine (ASRM) Embryo Transfer (ET) Simulator. They enrolled participants from 1 of 3 groups to assess the usefulness of the simulator in training individuals from different backgrounds: Reproductive Endocrinology and Infertility (REI) attendings, obstetrics and gynecology residents, REI nurses, and advanced practice providers. Both ET simulation scores and self-assessed comfort levels demonstrated various degrees of improvement, allowing the investigators to conclude that a simulator is a valuable tool for training ET to various types of obstetrics and gynecology practitioners. With this publication, the ASRM ET Simulator Initiative has come full circle. Although I acknowledge bias, this program has been a success in all the following aspects. First, it identified an important gap in training fellows an essential technique (i.e., ET). Over 50% of fellows previously did not perform any ET or fewer than 10 during their fellowship. Now that number has decreased. In addition, simulation training is available to all fellows. A partnership was developed with the simulation industry (VirtaMed of Zurich) to develop the hardware and software critical for a successful ET simulator. Through this initiative, a robust curriculum was developed for different training programs. The ET simulators were deployed worldwide for programs designed for the new trainers and others for seasoned practitioners. After deployment in regional fellowship workshops and individual fellowship programs, a thorough analysis of all data collected was published in Fertility and Sterility and demonstrated a statistically significant improvement in skills and self-confidence (2Ramaiah S.D. Ray K.A. Reindollar R.H. Simulation training for embryo transfer: findings from the American Society for Reproductive Medicine Embryo Transfer Certificate Course.Fertil Steril. 2021; 115: 852-859Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar). The Baker et al. (1Baker K.M. Leung A.Q. Shah J.S. Korkidakis A. Sakkas D. Penzias A. et al.Simulation-based training for embryo transfer for clinicians with differing levels of expertise: an application of the ASRM Embryo Transfer Simulator.F&S Reports. 2023; 4: 29-34Abstract Full Text Full Text PDF Scopus (1) Google Scholar) manuscript now demonstrates that the ET simulator can be used for clinical research in addition to training the ET technique, thus, providing another valuable opportunity for ultimately improving in vitro fertilization success. On May 9, 2015, the ASRM assembled an ET Simulator Task Force in Washington, D.C., with 2 goals: 1) to review and finalize a detailed survey that would be sent to all Society for Assisted Reproductive Technology programs and from which the results would be used to develop an ET simulator and an ET Simulator curriculum, and 2) to review the prototype uterine and pelvic models created by VirtaMed with the integration of 3-dimentional whole pelvis ultrasounds from real patients. One-on-one assessment of these early models occurred during this meeting between individual VirtaMed program employees and individual ASRM Task Force members. Information from these discussions was taken back to VirtaMed for refining the hardware and software for the simulator. The challenge given to VirtaMed was to have a prototype simulator for display in an ASRM Pavilion at the upcoming (2015) annual ASRM Congress, barely 6 months away. In the interim, 2 trips by ASRM staff to Zurich were organized to make final refinements to the prototype simulator. The ASRM ET Simulator was showcased at the 2015 meeting, generatingtremendous enthusiasm. Back in Birmingham, a simulation laboratory was built, and the first 8 simulators were delivered on January 5, 2016. The ET Taskforce was gathered in Birmingham after the delivery of the simulators, and faculty were recruited for Train-the-Trainer sessions in preparation for upcoming workshops. The simulators were deployed initially at all fellows’ educational programs (eg, the Fellows Retreat, PCRS, etc.) for demonstrations and short training sessions. An ASRM Simulation Pavilion was constructed in the 2016 ASRM Exhibit Hall, and for 3 years, it provided demonstration sessions for 300 meeting attendees each year. In parallel with the development of the hardware for the simulator, a robust curriculum was developed with the completion of The ASRM Guide to Learning Embryo Transfer and, ultimately, the ET Certificate Course to be used by REI Fellows and other practitioners who were new ET learners. Parts of the Certificate Course were used for shorter simulation programs for more seasoned or experienced clinicians in ET or others who wanted to brush up their skills. The ET survey, which was finalized during the District of Columbia meeting, was the foundation of curricula that were subsequently developed. It consisted of 82 questions and was sent to all SART medical directors, being completed by 41%. The results of this survey were published in Fertility and Sterility (3Toth T.L. Lee M.S. Bendikson K.A. Reindollar R.H. Embryo transfer techniques: an ASRM survey of current SART practices.Fertil Steril. 2017; 107 (1003–11, Level II-2)Google Scholar) and were used to guide the development of the simulator. In addition, a Common Practice protocol was developed, and the Practice Committee completed a systematic literature review and published an ET Guideline (4Practice Committee of the American Society for Reproductive Medicine Performing the embryo transfer: a guideline.Fertil Steril. 2017; 107: 882-896Abstract Full Text Full Text PDF PubMed Scopus (72) Google Scholar) and an ET protocol template (5Practice Committee of the American Society for Reproductive Medicine ASRM standard embryo transfer protocol template: a committee opinion.. 2017; 107: 897-901Google Scholar). Early demonstrations and workshops helped refine the training programs and ultimately to develop a Certificate Course with 4 to 6 hours of online learning followed by a hands-on 1 to 1 ½ day fellow’s regional workshop. The first version of the ET Certificate Course was online in February 2018 for the first regional workshop held in Boston for the New England fellows that same month. These 1.5 days regional Certificate Course workshops have been held at least 4 times yearly, and a certificate of completion is given to fellows who successfully complete the program. Two types of training programs for fellows were developed. In addition to the quarterly regional workshops, a loaner program emerged in which fellowship programs have a simulator for 4 to 6 weeks for a relatively small fee. These programs follow the Certificate Course design. Ideally, fellows work together under the direction of a faculty member and, during their free time, can return for repetitive practice. The loaner program has also been used by private practices for seasoned physicians and those who want to improve their skills. One hundred thirty-three fellows have completed the Certificate Course to date. The simulators have also been deployed internationally, beginning at the European Society of Human Reproduction and Embryology as a preCongress course in 2016 and continuing yearly since then except in 2020 and 2021. In addition to the European Society of Human Reproduction and Embryology, the simulators have been deployed for preCongress courses at annual meetings for Asia Pacific Initiative on Reproduction, International Federation of Fertility Societies, Mexican Association of Reproductive Medicine, Indian Society for Assisted Reproduction, and Canadian Society Canadian Andrology and Fertility Society. Programs have been held in Finland, Switzerland, Austria, Spain, Italy, Taiwan, Russia, China, Mexico, India, Canada, and Argentina. Although follow-up data are planned to be collected during the next year, the word is out!!! The ASRM ET Simulation program has been an international success. At home, a real need was identified by our ET survey, with more than 50% of programs not allowing fellows to perform (and thus learn) embryo transfers. Throughout the deployment, word has come back from fellows that more and more programs are allowing fellows to perform ETs, particularly after completing the Certificate Course. The ASRM 2014 Strategic Plan sought to bring value to our members but, more importantly, to affect the care of our patients. The ASRM ET Simulation Initiative does both!! Another lesson learned is that medical societies can partner with industries, including pharma and medical device companies, to move bold initiatives forward. Furthermore, the success of this program is the result of work by many ASRM members who have helped every step of the way. With the manuscript of Baker et al. (1Baker K.M. Leung A.Q. Shah J.S. Korkidakis A. Sakkas D. Penzias A. et al.Simulation-based training for embryo transfer for clinicians with differing levels of expertise: an application of the ASRM Embryo Transfer Simulator.F&S Reports. 2023; 4: 29-34Abstract Full Text Full Text PDF Scopus (1) Google Scholar) in this issue of F&S Reports, the ET Simulator initiative has come full circle. Although the primary focus will always be on training with the simulator, these investigators have used the simulator for research. As such, they have opened the door for others to do the same. Using the simulators for research is yet another way to ultimately improve in vitro fertilization success. Simulation-based training for embryo transfer for clinicians with differing levels of expertise: an application of the American Society for Reproductive Medicine Embryo Transfer SimulatorF&S ReportsVol. 4Issue 1PreviewTo compare the learning curve of clinicians with different levels of embryo transfer (ET) experience using the American Society for Reproductive Medicine (ASRM) Embryo Transfer Simulator. Full-Text PDF Open Access