The synergistic role of virtual coaching with simulation-based mastery learning for upper endoscopy

IntroductionOur simulation-based mastery learning (SBML) curriculum, delivered in person, has been shown to successfully train novices in structured esophagogastroduodenoscopy (EGD). SBML with virtual coaching (VC) has the potential to improve the effectiveness and efficiency of endoscopy training and expand access to trainees from around the world. We share our observations conducting an EGD training course using SBML with VC.MethodsWe conducted a 1-week virtual SBML course for novice trainees across seven academic centers in the USA and Asia. The cognitive component was delivered using an online learning platform. For technical skills, a virtual coach supervised hands-on training and local coaches provided assistance when needed. At the end of training, an independent rater assessed simulation-based performance using a validated assessment tool. We assessed the clinical performance of 30 EGDs using the ASGE Assessment of Competency in Endoscopy tool. We compared the trainees' scores to our cohort trained using in-person SBML training using non-inferiority t-tests.ResultsWe enrolled 21 novice trainees (mean age: 30.8 +/- 3.6 years; female: 52%). For tip deflection, the trainees reached the minimum passing standard after 31 +/- 29 runs and mastery after 52 +/- 37 runs. For structured EGD, the average score for the overall exam was 4.6 +/- 0.6, similar to the in-person cohort (4.7 +/- 0.5, p = 0.49). The knowledge-based assessment was also comparable (virtual coaching: 81.9 +/- 0.1; direct coaching: 78.3 +/- 0.1; p = 0.385). Over time, our novice trainees reached clinical competence at a similar rate to our historical in-person control.ConclusionsVC appears feasible and effective for training novice gastroenterology trainees. VC allowed us to scale our SBML course, expand access to experts, and administer SBML simultaneously across different sites at the highest standards.