Overview of methods for flexible endoscopic training and description of a simple explant model

The question of how to train surgeons in flexible endoscopy has been debated over the years as these skills have become an essential part of residency and practice. As many as two-thirds of surgeons perform flexible endoscopy, and for many, endoscopy represents up to 50% of their practice. Training in flexible endoscopy has evolved over many decades from an apprenticeship-type model to a more formal training program. Surgical residencies vary widely in their approach, with some having dedicated endoscopy rotations and others using an integrated approach. Innate to a good training program are faculty dedicated to teaching, an established curriculum, and adequate exposure of residents to proper training tools, whether as patient-based learning or supplemented by simulators. Hands-on models for teaching surgical endoscopy include mechanical, animal, and computer-based platforms. Herein, we describe our experience with a low-cost approach using porcine stomach explants that offers a breadth of endoscopic training including scope navigation, band ligation, endoscopic mucosal resection, hemostasis management, esophageal stenting, foreign body extraction, and ERCP. Simulation-based learning must be validated from a construct and internal validity perspective to be considered useful. Correlation between simulator learning and improvement in clinically relevant skills must then be shown using a validated scale, such as the Global Assessment of Gastrointestinal Endoscopy Skills. Competency in flexible endoscopy, which is currently measured by case volume, may be replaced by objective programs, such as Fundamentals of Endoscopic Surgery, that combine didactic teaching, cognitive assessment, and hands-on technical skills evaluation to determine a minimum level of proficiency.