Simulation in endoscopy: Practical educational strategies to improve learning

Table 1 Best practices in endoscopic simulation-based training

Educational Strategy	Key points
Deliberate practice with mastery learning	Deliberate practice: repetitive performance of a skill, constructive feedback, and exercises to correct errors and improve performance
	Mastery learning: consistently demonstrating a predefined level of proficiency in a task. Key principles include: baseline assessment; clear and progressive learning objectives; minimum passing standards; educational activities based on predefined objectives and standards; and serial formative assessments to gauge progress
Feedback and debriefing	Endoscopic simulation in the absence of feedback may be ineffective
	Feedback should be simple, goal-directed, based on observable behaviors, and ideally delivered during a debrief at the end of a simulated procedure
	Educators may supplement feedback with validated endoscopic assessment tools and input from other sources, such as nurses, anesthesiologists, and standardized patients
	Debriefing should be a two-way process through which trainees and their trainers identify gaps in performance, explore the basis of those gaps, and establish tasks to improve performance
Contextual learning	Initial training should focus on acquisition of basic skills such as endoscope navigation and torque steering, and progress to simulated tasks of increasing complexity and difficulty
	The introduction of team-based practice through hybrid simulation models can allow trainees to practice non-technical skills, such as communication, decision making, leadership, and crisis management
	Varying tasks during training can better prepare trainees to handle variation in anatomy, pathology, and difficulty during real procedures
Innovative educational design	Endoscopy simulation curricula grounded in educational theory and empirical data have been shown to improve transfer of learning outcomes to the clinical environment
	Training programs can improve learning by implementing simulation sessions at more widely spaced intervals
	Just-in-time simulation training may be used to allow trainees to “warm-up” before performing complex tasks in the clinical environment
	Novel educational strategies emerging in simulation include the application of game design elements and the use of head-mounted displays to create an immersive experience