Impact and assessment of training models in interventional endoscopic ultrasound

Interventional endoscopic ultrasound (IEUS) has gained significant popularity in recent years because of its diagnostic and therapeutic capabilities. The proper training of endoscopists is critical to ensure safe and effective procedures. This review study aims to assess the impact of different training models on the competence of trainees performing IEUS. Eight studies that evaluated simulators for IEUS were identified in the medical literature. Various training models have been used, including the EASIE-R, Mumbai EUS, EUS Magic Box, EndoSim, Thai Association for Gastrointestinal Endoscopy model, and an ex vivo porcine model (HiFi SAM). The trainees underwent traditional didactic lectures, hands-on training using simulators, and direct supervision by experienced endoscopists. The effectiveness of these models has been evaluated based on objective and subjective parameters such as technical proficiency, operative time, diagnostic success, and participant feedback. As expected, the majority of skills were improved after the training sessions concluded, although the risk of bias is high in the absence of external validation. It is difficult to determine the ideal simulator among the existing ones because of the wide variation between them in terms of costs, reusability, design, fidelity of anatomical structures and feedback, and types of procedures performed. There is a need for a standardized approach for the evaluation of IEUS simulators and the ways skills are acquired by trainees, as well as a clearer definition of the key personal attributes necessary for developing a physician into a skilled endoscopist capable of performing basic and advanced therapeutic EUS interventions.