Abstract
Simple SummaryOver the last decades, visual endoscopy has become a gold standard for the detection and treatment of gastrointestinal cancers. However, mastering endoscopic procedures is complex and requires long hours of practice. In this context, simulation-based training represents a valuable opportunity for acquiring technical and cognitive skills, suiting the different trainees’ learning pace and limiting the risks for the patients. In this regard, the present contribution aims to present a critical and comprehensive review of the current technology for gastrointestinal (GI) endoscopy training, including both commercial products and platforms at a research stage. Not limited to it, the recent revolution played by the technological advancements in the fields of robotics, artificial intelligence, virtual/augmented reality, and computational tools on simulation-based learning is documented and discussed. Finally, considerations on the future trend of this application field are drawn, highlighting the impact of the most recent pandemic and the current demographic trends.Gastrointestinal (GI) endoscopy is the gold standard in the detection and treatment of early and advanced GI cancers. However, conventional endoscopic techniques are technically demanding and require visual-spatial skills and significant hands-on experience. GI endoscopy simulators represent a valid solution to allow doctors to practice in a pre-clinical scenario. From the first endoscopy mannequin, developed in 1969, several simulation platforms have been developed, ranging from purely mechanical systems to more complex mechatronic devices and animal-based models. Considering the recent advancement of technologies (e.g., artificial intelligence, augmented reality, robotics), simulation platforms can now reach high levels of realism, representing a valid and smart alternative to standard trainee/mentor learning programs. This is particularly true nowadays, when the current demographic trend and the most recent pandemic demand, more than ever, the ability to cope with many patients. This review offers a broad view of the technology available for GI endoscopy training, including platforms currently in the market and the relevant advancements in this research and application field. Additionally, new training needs and new emerging technologies are discussed to understand where medical education is heading.
Highlights
Medical simulators are artificial platforms that offer the opportunity to train clinical procedures in a non-patient care environment
The World Organization for Animal Health (OIE) [67] refers to three key elements to enable the use of animals for research and education purposes: (i) the existence of a project/training proposal review developed under a risk-based approach, (ii) the identification of transparent inspections procedures of the facilities to ensure their suitability for the project/training, and (iii) the ethical evaluation of the overall procedures involving animals [68]
American Society for Gastrointestinal Endoscopy (ASGE) suggests that the introduction of a specific simulator into a training program is justified if its use by novices leads to a reduction of 25% of the clinical cases needed to learn the procedure
Summary
Medical simulators are artificial platforms that offer the opportunity to train clinical procedures in a non-patient care environment. The standard training system includes the mentoring of the trainee by an expert endoscopist In this context, the novice progressively learns to manage a procedure by first assisting the expert clinician and later directly practicing on the patient [3]. As opposed to standard mentored supervision, simulation-based training allows trainees to repeatedly perform a specific set of skills without increasing the length of the clinical procedures and/or reducing the patient’s comfort and safety. These platforms could allow the standardization of the endoscopy related metrics and the assessment of technical skills [4,6]. Ainccthorisdifnieglldy., Athcecofirndainl ggloya,lthisetofinparlesgeonatl aisbtrooapdrevseienwt aofbrthoeadtevcihenwoloofgitehse atvecahilnaoblloegfioers tarvaainilianbgleinfoGr ItreanindionsgcoinpGy.ITeontdhoissceonpdy,.tThoe trheivsieenwdp, tahpeerrefvoiceuwsepsaopnerhfiogchulisgehstoinnghbigohthligthhtebinegnebfiocthialthaespbeecntesfoicfiathl easdpeevcitcseosfatnhde tdheeviccreitsicaanldonthees.cIrnititchailsocnoenst.eIxnt,tthhise croonleteoxfta, rthtieficroialle ionftaerlltiigfiecniaclein(AteIl)liagnendcreo(bAoIt)icasnids raolsbootdicisscius saslesod daisscaunssaeddvaans caendasdovlaunticoend tsoolaudtdiornestso tahdeudnremssetthcehaulnlemngetesc.hallenges
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