Portable Simulator Research Articles

Developing and evaluating a brief, socially primed video intervention to enable bystander cardiopulmonary resuscitation: A randomised control trial.

Over 30,000 people experience out-of-hospital cardiac arrest in the United Kingdom annually, with only 7-8% of patients surviving. One of the most effective methods of improving survival outcomes is bystander intervention in the form of calling the emergency services and initiating chest compressions. Additionally, the public must feel empowered to act and use this knowledge in an emergency. This study aimed to evaluate an ultra-brief CPR familiarisation video that uses empowering social priming language to frame CPR as a norm in Scotland. In a randomised control trial, participants (n = 86) were assigned to view an ultra-brief CPR video intervention or a traditional long-form CPR video intervention. Following completion of a pre-intervention questionnaire examining demographic variables and prior CPR knowledge, participants completed an emergency services-led resuscitation simulation in a portable simulation suite using a CPR manikin that measures resuscitation quality. Participants then completed questionnaires examining social identity and attitudes towards performing CPR. During the simulated resuscitation, the ultra-brief intervention group's cumulative time spent performing chest compressions was significantly higher than that observed in the long-form intervention group. The long-form intervention group's average compressions per minute rate was significantly higher than the ultra-brief intervention group, however both scores fell within a clinically acceptable range. No other differences were observed in CPR quality. Regarding the social identity measures, participants in the ultra-brief condition had greater feelings of expected emergency support from other Scottish people when compared to long-form intervention participants. There were no significant group differences in attitudes towards performing CPR. Socially primed, ultra-brief CPR interventions hold promise as a method of equipping the public with basic resuscitation skills and empowering the viewer to intervene in an emergency. These interventions may be an effective avenue for equipping at-risk groups with resuscitation skills and for supplementing traditional resuscitation training.

Building Global Partnerships: A Qualitative Exploration of In-Person Training for HealthCare Simulation Educators Working in Low-Resource Settings.

Effective educational initiatives can elevate the quality of patient care globally. Simulation-based education is widely used in high-resource settings, but barriers exist to its widespread use in low-resource settings. Vital Anesthesia Simulation Training (VAST) overcomes these barriers by offering immersive, low-cost portable simulation along with simulation facilitator training. During the COVID-19 pandemic, in-person courses were stopped for more than 2 years. Postpandemic, a 3-day VAST SIMposium was hosted in Rwanda to unite 42 VAST facilitators from 12 widespread countries to introduce new and revised course materials and to rejuvenate dormant skills. The purpose of this study was to explore how the VAST SIMposium influenced perceived development of skills, confidence, and engagement in a community of practice for simulation educators working in low-resource settings. This qualitative study involved in-depth interviews with a purposive sample of 16 VAST SIMposium attendees. Transcripts of audio recordings were analyzed using inductive thematic analysis. Six themes were identified during data analysis: 1) Diversity with shared passion for medical education; 2) Supportive in-person learning environment; 3) Simulation-based education relevant to low-resource settings; 4) Camaraderie; 5) Building knowledge, skills, and confidence; and 6) Being part of a community of practice. The SIMposium rejuvenated passion, knowledge, skills, and, most importantly, strengthened global connections and partnerships. These collaborations will benefit areas that are underrepresented in simulation and will ultimately improve patient outcomes. A SIMposium of this format is an efficient and effective way to foster sustainable global dissemination of simulation-based global health education.

New Highly Portable Simulator (SECMA) Based on Virtual Reality for Teaching Essential Skills in Minimally Invasive Surgeries

This study presents a new minimal access surgery training system, SECMA, and its constructive validation to determine its usefulness for training basic laparoscopic skills. SECMA is an affordable, highly portable, mobile virtual reality training tool for laparoscopic techniques that integrates the Oculus Quest with a mechanical interface for surgeon simulation of forceps using the hand controllers of these devices. It allows the execution of structured activities (supported by virtual scenarios simulating operating rooms developed in Unity), performance evaluation, and real-time data capture. Two experiments were carried out: 1) coordination; and 2) capture and transport, with a total of 21 individuals divided into two groups: a novice group (inexperienced) of 10 participants and an expert group (>100 endoscopic procedures) of 11 participants. Total task time score, right-hand speed, path length, and other metrics from several consecutive runs on the simulator were compared between experts and novices. Data automatically recorded by SECMA during the experiments were analyzed using hypothesis tests, linear regressions, analysis of variance, principal component analysis, and machine learning-supervised classifiers. In the experiments, the experts scored significantly better than the novices in all the parameters used. The tasks evaluated discriminated between the skills of experienced and novice surgeons, giving the first indication of construct validity for SECMA.

Leveling the Battlefield: Development of a Pre-Deployment Vascular Access Curriculum for the Nonsurgical Provider.

Timely vascular access is critical, as hemorrhage is the number one cause of death on the battlefield. Anecdotal evidence in the Military Health System identified an operationally relevant procedural skills gap in vascular access, and data exist in civilian literature showing high rates of iatrogenic injuries when lack of robust procedural opportunity exists. Multiple pre-deployment training courses are available for surgical providers, but no comprehensive pre-deployment vascular access training exists for non-surgical providers. This mixed-method review aimed to find relevant, operationally focused, vascular access training publications. A literature review was done to identify both relevant military clinical practice guidelines (CPGs) and full text articles. Reviewers also investigated available pre-deployment trainings for both surgeons and non-surgeons in which course administrators were contacted and details regarding the courses were described. We identified seven full-text articles and four CPGs. Two existing surgical training programs and Army, Navy, and Air Force pre-deployment training standards for non-surgeons were evaluated. A cost-effective and accessible pre-deployment curriculum utilizing reviewed literature in a "learn, do, perfect" structure is suggested, building on pre-existing structures while incorporating remotely accessible didactics, hands-on practice with portable simulation models, and live-feedback training.

Bridging the realism gap: using ‘low-fidelity’ simulation for high quality training

The Royal College of Anaesthetists recommends use of simulation-based-education (SBE) during the initial 12-week novice placement for new anaesthetic trainees [1]. For many UK anaesthetic departments, the complexity and cost of patient simulators [2] may reduce opportunities for SBE during novice training. However, avoiding the physical fidelity trap [3] and utilising both conceptual and psychological fidelity to good effect might mitigate this issue. As novice trainees are already familiar with the theatre environment from day-to-day clinical practice, the learning outcomes from SBE generally cover rarer emergencies which can still be covered during SBE outside of the theatre environment. We aimed to assess the feasibility of running weekly low physical fidelity SBE across the entire 12-week novice period instead of the smaller number of ad-hoc sessions delivered previously. Our new SBE programme consisted of 30-minute sessions held in the anaesthetic department conference room to minimise impact on stretched theatre capacity and educator availability. To further maximise efficiency, we created a portable simulation set-up using a basic resuscitation manikin on a patient trolley, a disused anaesthetic machine, and a tablet device with a simulated monitor application. This could all be set-up and stored away in under 5 minutes. Our focus on conceptual and psychological fidelity led to the creation of a new scenario bank which identified common issues encountered by new anaesthetic trainees, rather than emergencies rarely encountered by even an experienced anaesthetist. Scenarios needed to be highly plausible and solvable by the novice trainee. Learners were then asked to complete a feedback survey after each session. Feedback from this new simulation programme was very positive and comparable to previous feedback. Across all sessions (n=12) and trainees (n=5), the median Likert scores for perceived relevance, realism, and appropriate challenge were 6/7, 5/7, and 6/7 respectively. All trainees across all sessions indicated they found it useful, enjoyable, and would attend again. In particular, free text responses praised the ability to focus on a single simulated issue without the cognitive overload of the wider theatre environment experienced by new trainees, and the psychological safety benefits of simulation and debriefing in a more relaxed non-theatre setting. This appears to be a feasible and well accepted alternative to our traditional approach, with additional benefits for trainees and reduced impact on service delivery. We now intend to explore use of this approach to deliver increased SBE to the wider anaesthetic and multidisciplinary team. 1. Royal College of Anaesthetists. Simulation Strategy 2018–2023. London: RCoA 2018 2. Fletcher J, Wind A. Cost Considerations in Using Simulations for Medical Training. Military Medicine. 2013;178(10S):37–46. 3. Helyer R, Dickens P. Progress in the utilization of high-fidelity simulation in basic science education. Advances in Physiology Education. 2016;40(2):143–144.

Longitudinal Impacts of Simulated Long-Duration Spaceflight Missions on Operationally Relevant Measures of Human Performance Using a Portable Simulation Platform.

This project quantifies operationally relevant measures of flight performance and workload in a high-fidelity long-duration spaceflight analog, longitudinally across mission duration, using a portable simulation platform. Real-time performance measures allow for the objective assessment of task performance and the timely identification of performance degradations. Measures of flight performance on a piloted lunar lander task were collected on 32 total crewmembers across 8 simulated space missions of 45days each (623 total sessions). Mission duration demonstrated a significant effect on measures of flight performance across all campaigns. Flight measures showed a general pattern of peaking in accuracy during the middle-late quartiles of overall mission time, then degrading again towards baseline. On the workload measure, however, a general linear decrease in workload consistent with progressive task learning was observed in both campaigns. This investigation demonstrated the disruptive effect of time in mission on some, but not all, aspects of task performance. While mission interval differentially impacted measures of flight accuracy, workload, by contrast, seemed to steadily decrease with in-mission time. While more work is needed, the observed discrepancy between progression of flight performance and workload assessment highlights the importance of sensitive and specific measurement tools for the tracking of distinct performance metrics.

Scotland's “Incentivised Laparoscopy Practice” programme: Engaging trainees with take-home laparoscopy simulation

BackgroundThe transfer validity of portable laparoscopy simulation is well established. However, attempts to integrate take-home simulation into surgical training have met with inconsistent engagement worldwide, as for example in our 2014-15 study of an Incentivised Laparoscopy Practice programme (ILPv1). Drawing on learning from our subsequent multi-centre study examining barriers and facilitators, we revised the programme for 2018 onwards. We now report on engagement with the 2018–2022 versions of this home-based simulation programme (ILP v2.1–2.3). MethodsIn ILP v2.1–2.3, three consecutive year-groups of new-start Core Surgical Trainees (n = 48, 46 and 53) were loaned portable simulators. The 6-month education programme included induction, technical support, and intermittent feedback. Six tasks were prescribed, with video instruction and charting of metric scores. Video uploads were required and scored by faculty. A pass resulted in an eCertificate, expected at Annual Review (but not mandatory for progression). ILP was set within a wider reform, “Improving Surgical Training”. ResultsILP v2.1–2.3 saw pass rates of 94%, 76% and 70% respectively (45/48, 35/46 and 37/53 trainees), compared with only 26% (7/27) in ILP v1, despite now including some trainees not intending careers in laparoscopic specialties. The ILP v2.2 group all reported their engagement with the whole simulation strategy was hampered by the COVID19 pandemic. ConclusionsSimply providing take-home simulators, no matter how good, is not enough. To achieve trainee engagement, a whole programme is required, with motivated learners, individual and group practice, intermittent feedback, and clear goals and assessments. ILP is a complex intervention, best understood as a “reform within a reform, within a context.”

Verification of Overhead Crane Simulator in a Training Centre

This article presents the results from a practical test of a portable overhead crane simulator. The test was carried out to determine the usability of the simulator in the training being conducted. The simulator is developed using virtual reality (VR). With this solution, the user can be immersed in a virtual work environment.

Precipitation impacts on earthen architecture for better implementation of cultural resource management in the US Southwest

Changing seasonal precipitation patterns prompted by climate change are likely causing increasing degradation of adobe architecture in the American Southwest. This deterioration includes surface erosion and catastrophic collapse. This study examines the impact of changing rainfall patterns on untreated adobe walls to understand how damage occurs and anticipate future impacts. To complete the study, we constructed 20 adobe test walls. Using a portable rain simulator, each wall was subjected to two rainfall experiments: high-intensity rainfall simulations (rain intensity variable) and low-intensity rainfall simulations (rain event number variable). Wall-degradation metrics (material loss, volume loss, affected surface area, and cavity depth) were calculated for each wall using pre- and post-simulation LiDAR scans. Internal wall moisture was also measured with embedded volumetric water content sensors. In the high-intensity experiment, the lines of best-fit for material loss and affected surface area show that surface erosion increases with rain intensity, while cavity depth remains consistent. Linear models and post-hoc tests indicate material loss and affected surface area is significantly different for each high-intensity rainfall treatment. Furthermore, the interior of each wall remained relatively dry demonstrating that rain intensity is not a strong predictor of interior wall moisture. In the low-intensity rainfall experiment, the rainfall simulations yielded statistically similar erosion and interior wall moisture results. Greater infiltration occurred under low-intensity long-duration rain conditions, while greater surficial damage occurred under high-intensity rain conditions. In conclusion, changing weather regimes are bringing more intense rainfall events to the arid American Southwest. This study suggests that more frequent high intensity rain events will cause increasing damage to adobe walls. Resource managers will need to adapt current management strategies to account for this change.

Stress urinary incontinence in women. Possibilities of conservative therapy

The relevance of this study is due to the high prevalence of stress urinary incontinence in women of different age groups and the search for effective conservative treatment methods.
 The aim of this study was to present scientific data based on modern evidence on the effectiveness of conservative treatment methods and their safety in the treatment of stress urinary incontinence in women.
 A review of the literature (original articles, systematic reviews) on the use of conservative therapy for the treatment of stress urinary incontinence in women was carried out.
 Depending on the severity of stress urinary incontinence in women, their age and concomitant diseases, the options for the proposed treatment may vary. For the conservative treatment of the disease, along with lifestyle modification and the use of hygiene products, it is possible to use training and electromyostimulation of the pelvic floor muscles, innovative laser technologies, and drug therapy. The first line therapy is to train ones pelvic floor muscles. The best effect of the training is observed in younger patients with mild to moderate severity of the disease using stationary biofeedback simulators under the supervision of medical staff. An alternative to this type of treatment is to conduct training of the pelvic floor muscles in the biofeedback mode with portable simulators remotely under the supervision of specially trained personnel. In connection with the coronavirus pandemic, this therapy is gaining wide popularity, as every patient should be offered acceptable and effective treatment options.

TinyMD: Mapping molecular dynamics simulations to heterogeneous hardware using partial evaluation

This paper investigates the suitability of the AnyDSL partial evaluation framework to implement tinyMD: an efficient, scalable, and portable simulation of pairwise interactions among particles. We compare tinyMD with the miniMD proxy application that scales very well on parallel supercomputers. We discuss the differences between both implementations and contrast miniMD’s performance for single-node CPU and GPU targets, as well as its scalability on SuperMUC-NG and Piz Daint supercomputers. Additionally, we demonstrate tinyMD’s flexibility by coupling it with the waLBerla multi-physics framework. This allow us to execute tinyMD simulations using the load-balancing mechanism implemented in waLBerla.

Driving and cognitive function in people with stroke and healthy age-matched controls

ABSTRACT The decision to return to driving is both complex and difficult. It is often made with clinician support, perhaps on the basis of results from standardized paper and pencil tests, and less frequently an assessment of on-road driving. However, the resources required and inherent reliability and validity challenges suggest that greater use of computerization and driving simulation may play a useful role in the assessment process. In this study, thirty-six age-matched healthy and post-stroke drivers completed standard psychometric assessments (including NART, MMSE, BADS, IADL), computer delivered cognitive assessments (including SART, N-Back, Simple Reaction Time), as well as simulated and on-road assessments of driving. While significantly different in terms of psychometric and computer-based assessments, the healthy and post-stroke drivers who completed the on-road test did not differ. In contrast, driving in the portable simulator showed impaired driving, on some but not all driving manoeuvres, for those who failed the on-road test or had voluntarily ceased to drive. These results are discussed in terms of the implications they have for the multi-faceted nature of driving as a skill, and the need to involve simulation when assessing fitness to drive.

Use of a Low-Cost Portable 3D Virtual Reality Simulator for Psychomotor Skill Training in Minimally Invasive Surgery: Task Metrics and Score Validity.

BackgroundThe high cost and low availability of virtual reality simulators in surgical specialty training programs in low- and middle-income countries make it necessary to develop and obtain sources of validity for new models of low-cost portable simulators that enable ubiquitous learning of psychomotor skills in minimally invasive surgery.ObjectiveThe aim of this study was to obtain validity evidence for relationships to other variables, internal structure, and consequences of testing for the task scores of a new low-cost portable simulator mediated by gestures for learning basic psychomotor skills in minimally invasive surgery. This new simulator is called SIMISGEST-VR (Simulator of Minimally Invasive Surgery mediated by Gestures - Virtual Reality).MethodsIn this prospective observational validity study, the authors looked for multiple sources of evidence (known group construct validity, prior videogaming experience, internal structure, test-retest reliability, and consequences of testing) for the proposed SIMISGEST-VR tasks. Undergraduate students (n=100, reference group), surgical residents (n=20), and experts in minimally invasive surgery (n=28) took part in the study. After answering a demographic questionnaire and watching a video of the tasks to be performed, they individually repeated each task 10 times with each hand. The simulator provided concurrent, immediate, and terminal feedback and obtained the task metrics (time and score). From the reference group, 29 undergraduate students were randomly selected to perform the tasks 6 months later in order to determine test-retest reliability.ResultsEvidence from multiple sources, including strong intrarater reliability and internal consistency, considerable evidence for the hypothesized consequences of testing, and partial confirmation for relations to other variables, supports the validity of the scores and the metrics used to train and teach basic psychomotor skills for minimally invasive surgery via a new low-cost portable simulator that utilizes interaction technology mediated by gestures.ConclusionsThe results obtained provided multiple sources of evidence to validate SIMISGEST-VR tasks aimed at training novices with no prior experience and enabling them to learn basic psychomotor skills for minimally invasive surgery.

Easy and efficient agent-based simulations with the OpenABL language and compiler

Agent-based simulations represent an effective scientific tool, with numerous applications from social sciences to biology, which aims to emulate or predict complex phenomena through a set of simple rules performed by multiple agents. To simulate a large number of agents with complex models, practitioners have developed high-performance parallel implementations, often specialized for particular scenarios and target hardware. It is, however, difficult to obtain portable simulations, which achieve high performance and at the same time are easy to write and to reproduce on different hardware. This article gives a complete presentation of OpenABL, a domain-specific language and a compiler for agent-based simulations that enable users to achieve high-performance parallel and distributed agent simulations with a simple and portable programming environment. OpenABL is comprised of (1) an easy-to-program language, which relies on domain abstractions and explicitly exposes agent parallelism, synchronization and locality, (2) a source-to-source compiler, and (3) a set of pluggable compiler backends, which generate target code for multi-core CPUs, GPUs, and cloud-based systems. We evaluate OpenABL on simulations from different fields. In particular, our analysis includes predator–prey and keratinocyte, two complex simulations with multiple step functions, heterogeneous agent types, and dynamic creation and removal of agents. The results show that OpenABL-generated codes are portable to different platforms, perform similarly to manual target-specific implementations, and require significantly fewer lines of codes.

Use of a Low-Cost Portable 3D Virtual Reality Gesture-Mediated Simulator for Training and Learning Basic Psychomotor Skills in Minimally Invasive Surgery: Development and Content Validity Study.

BackgroundSimulation in virtual environments has become a new paradigm for surgeon training in minimally invasive surgery (MIS). However, this technology is expensive and difficult to access.ObjectiveThis study aims first to describe the development of a new gesture-based simulator for learning skills in MIS and, second, to establish its fidelity to the criterion and sources of content-related validity evidence.MethodsFor the development of the gesture-mediated simulator for MIS using virtual reality (SIMISGEST-VR), a design-based research (DBR) paradigm was adopted. For the second objective, 30 participants completed a questionnaire, with responses scored on a 5-point Likert scale. A literature review on the validity of the MIS training-VR (MIST-VR) was conducted. The study of fidelity to the criterion was rated using a 10-item questionnaire, while the sources of content-related validity evidence were assessed using 10 questions about the simulator training capacity and 6 questions about MIS tasks, and an iterative process of instrument pilot testing was performed.ResultsA good enough prototype of a gesture-based simulator was developed with metrics and feedback for learning psychomotor skills in MIS. As per the survey conducted to assess the fidelity to the criterion, all 30 participants felt that most aspects of the simulator were adequately realistic and that it could be used as a tool for teaching basic psychomotor skills in laparoscopic surgery (Likert score: 4.07-4.73). The sources of content-related validity evidence showed that this study’s simulator is a reliable training tool and that the exercises enable learning of the basic psychomotor skills required in MIS (Likert score: 4.28-4.67).ConclusionsThe development of gesture-based 3D virtual environments for training and learning basic psychomotor skills in MIS opens up a new approach to low-cost, portable simulation that allows ubiquitous learning and preoperative warm-up. Fidelity to the criterion was duly evaluated, which allowed a good enough prototype to be achieved. Content-related validity evidence for SIMISGEST-VR was also obtained.

A low-cost portable simulator of a domestic cat larynx for teaching endotracheal intubation

ObjectiveTo design and construct an affordable simulator of the cat larynx for training intubation maneuvers and to share the designs for its fabrication. Study designResearch and development study. AnimalsA domestic cat. MethodsThe cadaver of a cat, dead by natural causes, was frozen in sternal recumbency with the neck extended and the mouth wide open. A computed tomography image was acquired and used to construct a digital three-dimensional (3D) model of the pharynx and trachea. A digitally adapted model was 3D-printed and used to generate a silicone model of these structures, which was placed within a wooden container. The quality of the simulator was assessed by 46 veterinary anesthesiologists and veterinarians with experience in tracheal intubation maneuvers, and their opinions were obtained through an anonymous questionnaire. ResultsSeveral preliminary prototypes were assessed regarding stability, texture and cost. Finally, a silicone model of a cat larynx (LaryngoCUBE) was produced and encased in a wooden container. Results from the questionnaire showed high scores regarding anatomy, tissue texture and intubation maneuver realism, compared with the real procedure. Conclusionsand clinical relevance Use of LaryngoCUBE as a training tool may improve the skills of students and reduce the use of animals for teaching endotracheal intubation. Blueprints and computational models are provided online so that the simulator can be fully reproduced.

Transforming Nursing Education Through Interprofessional Collaborative Innovation: A Project Story.

This project story is about transforming nursing education through interprofessional collaborative innovation to develop and use a complement of technology-based portable simulation devices collectively known as the Healthcare Education Simulation Station. This collection of inexpensive, simulated point-of-care instruments controlled wirelessly by an instructor or simulation operator were developed and field tested by an interdisciplinary team to enhance learning experiences in several configurations, including those using standardized patients and those using static and low-, mid-, and high-fidelity manikins. The core feature of this project story is the collaboration of students and faculty from two unrelated disciplines, nursing and engineering. The story includes a description of the development, field testing, and initial deployment of a simulated pulse oximeter, capnograph, automated sphygmomanometer, cardiac monitor, thermometer, and fetal monitor. Underpinning this project story is Rogers' Diffusion of Innovation theory and how the characteristics of the innovation, the personnel, and the environment worked together to enable this project and the innovation's subsequent diffusion into nursing education. The aspiration to improve learning experiences for students in multiple disciplines was paramount. The desire to acquire high-quality, dynamic educational tools for nursing educators, coupled with an environment that encourages collaboration, led to an innovation that can transform nursing preparation and ultimately improve patient care, while minimizing cost.

Simulation training for the endoscopic management of upper gastrointestinal bleeding: a nationwide survey of rural surgeons' needs and preferences analysis.

Published needs analyses of rural surgeons have identified a need for training in the endoscopic management of non-variceal upper gastrointestinal bleeding (NVUGIB). The study aim was to survey rural surgeons regarding their requirements and preferences for a simulation model on which they could rehearse the endoscopic management of NVUGIB. Rural surgeons were contacted via the American College of Surgery Advisory Council listserv and invited to complete an online survey. A total of 66 responses were received, representing all 4 US regional divisions. Seventy-seven percent of respondents perform > 100 endoscopy cases per year. A majority have no experience with simulation models (77%), citing cost, time, and access to training courses as the three most limiting factors. Thirty-three percent lacked confidence in managing UGIBs, and 73% were interested in receiving additional training. Preference analysis revealed that respondents preferred a portable simulation model (81%) that costs between $500 and $1000 (46%), and requires 1-2weeks of training (34%). Verbal feedback from an expert was viewed as the most helpful type of feedback (61%). Rural surgeons frequently perform flexible endoscopy in their practice and are interested in further training for the endoscopic management of NVUGIB. These results will be used to develop a simulation platform for training in the endoscopic management of NVUGIB that meets rural surgeons' needs.

Novel Low-Cost, High-Fidelity, Portable Simulation Device for Off-Pump Coronary Artery Bypass Graft

Novel Low-Cost, High-Fidelity, Portable Simulation Device for Off-Pump Coronary Artery Bypass Graft

Exploring Use of Endoscopy Simulation in North American Pediatric Gastroenterology Fellowship Training Programs.

Increasing evidence supports simulation-based training; however, limited data exist regarding its use in pediatric gastroenterology (GI). We explored the use of simulation-based endoscopy training in pediatric GI fellowship programs across North America. GI fellowship program directors (PDs) from the United States and Canada were surveyed between August to November 2018. The pretested, electronic survey comprised 3 sections: program demographics; details of current simulation-based training; and PDs' perceptions of endoscopy simulation. Responses were analyzed using descriptive statistics. Forty-three of 71 (61%) PDs responded (6 Canadian, 37 US). Programs were predominantly academic (95%) and enrolled 1.87 ± 1.01 fellows/yr. Twenty-four programs (56%) reported using simulation for endoscopy training, whereas 8 (19%) used simulation for nonprocedural education. Only 2 programs (5%) used endoscopy simulation for assessment. Of those using simulation (n = 24), upper endoscopy and colonoscopy were trained most frequently, and mechanical simulators were used most commonly. Eight programs (33%) required simulation training prior to clinical performance. Although 10 programs (42%) provided protected training time, only 2 (8%) tracked hours. Three programs (13%) reported having an organized curriculum and 6 (25%) train their endoscopic trainers. Cost, time constraints, and lack of a standardized curriculum were perceived as key barriers to integration. Most PDs reported a need for endoscopy simulation to train both technical and nontechnical skills; however, they felt simulation cannot replace clinical experience. PDs recognize the potential importance of endoscopy simulation, particularly for novices; however, only 56% report using it. Perceived barriers indicate the need for inexpensive portable simulators and a validated pediatric simulation curriculum to promote uptake.