Efficacy of next-generation endoscopy training simulator in improving international trainees’ endoscopic submucosal dissection skills

ABSTRACT Background: Off-the-job training (OFF-JT) ensures that all trainees receive a standardized level of ESD training, regardless of the clinical workload or the regional context. This study aimed to evaluate the efficacy of OFF-JT using a next-generation laptop-based mock-up endoscopy simulator (NLMES) in improving endoscopic submucosal dissection (ESD) skills among international trainees. Methods: This study was a single-center, prospective pilot study employing a crossover design. International trainees in Group A underwent designated NLMES training and ESD observation during the early phase (Days 1-14), followed by ESD observation during the late phase (Days 15-28), whereas those in Group B followed the reverse schedule. On Days 1, 15, and 29, the trainees performed ESD using a biomaterial-free ESD model, and the ESD skills were assessed at each time point. The primary endpoint was the between-group comparison of improvement in dissection speed on Day 15. Results: A total of 10 international trainees were enrolled in this study. On Day 15, the improvement in dissection speed was greater in Group A than in Group B, although the statistical difference was not significant (6.40 mm2/min [95% CI: 0.50 – 12.31] vs. -0.76 mm2/min [95% CI: -8.91 – 7.39], p = 0.087). The within-group comparison of dissection speed between before and after NLMES training demonstrated significant differences in both groups. Conclusions: OFF-JT using NLMES might be a promising approach improving the international trainees’ ESD skills. Dissection speed increased in the period receiving NLMES training, highlighting the importance of OFF-JT.