Original Article
Electronic Endoscopy
Meet EBE: The Development of an Evidence-Based Endoscopy Simulator

https://doi.org/10.1016/j.cgh.2021.11.041Get rights and content

Background and Aims

In the digital era of evidence-based medicine, there is a paucity of video endoscopy teaching platforms that use evidence-based medicine principles, or that allow for cognitive simulation of endoscopic management strategies. We created a guideline-based teaching platform for fellows that incorporates these features, and tested it.

Methods

A pilot video module with embedded questions was drafted, and after incorporation of feedback from several attending gastroenterologists, an additional 2 modules were created. The embedded questions were designed to simulate cognitive management decisions as if the viewer were doing the endoscopy procedure in the video. A narrator explained the evidence behind the task being performed, and its certainty based on endoscopic guidelines. Quizzes and surveys were developed and administered to a sample of attendings and fellows who completed the video modules to test efficacy, usability, and likeability.

Results

Three video modules, named evidence-based endoscopy (EBE), incorporating low fidelity simulation, and utilizing evidence-based medicine principles, were created. Eight fellows and 10 attendings completed the video modules and all quizzes and surveys. Mean test scores improved from before to after completing the video modules (56% to 92%; mean difference = –35%; 95% confidence interval, 27%–47%). Surveys indicated that the product was viewed favorably by participants, and that there is a strong desire for this type of educational product.

Conclusions

The EBE simulator is a unique, desirable, and effective educational platform based on evidence-based medicine principles that fills a gap in available tools for endoscopy education. Further studies are needed to assess whether EBE can aid in long-term knowledge retention and increase adherence to guideline recommendations.

Section snippets

Pilot EBE Simulation Video

Permission was obtained to adapt a pedunculated polyp video from YouTube.10 This video was chosen because it pertains to an endoscopic situation most GI trainees encounter during fellowship. The video was then modified to incorporate the following educational features: interactivity, simulation, and transparent, guideline-based discussion of the evidence. We searched the literature for systematic reviews and guidelines pertaining to this topic, and identified a recent Multi-Society Task Force

Results

Seven attending gastroenterologists contributed feedback during the pilot development phase. (Supplementary Tables 1, 3, and 4: Feedback for Pilot Video, EDU Survey Feedback and Final Questions, and PROD Survey Feedback). All 18 enrolled participants completed the video modules, surveys, and pre- and posttesting. Ten (55.5%) were attendings and 8 (44.4%) were gastroenterology trainees. Among the trainees, 2 (25%) were first-year fellows, 1 (12.5%) was a second-year fellow, and 5 (62.5%) were

Discussion

The newly developed EBE platform allowed learners to engage in a low-fidelity, experiential simulation for cognitive endoscopy forcing the trainee to replicate the emotions and cognitions that they would experience in a real patient care setting. There is significant evidence that simulation is a useful educational tool in medical education, and our EDU and PROD survey results indicate that trainees value this style of learning.22, 23, 24 EBE, a self-learning, mobile platform, is complementary

Acknowledgments

The authors thank Sindoora Satyavada for graphical abstract and figure.

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    Conflicts of interest The authors disclose no conflicts.

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    Authors share co-first authorship.

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