Training esophagogastroduodenoscopy skills: a randomized multicenter trial comparing simulation-based training versus clinical training

Abstract

Background

The quality of esophagogastroduodenoscopy (EGD) performed by trainees depends on their competency level and training. This study assessed whether the addition of simulation-based training (SBT) reduces the number of supervised clinical procedures needed to achieve independent procedural completion compared with conventional clinically based training (CBT) alone.

Methods

EGD novices were randomized (1 : 1) to either SBT followed by CBT or CBT alone in a randomized controlled trial. The primary outcome was the number of EGD procedures required to reach independent procedural completion, defined as adequate competence to perform EGDs without direct supervision. Secondary outcomes were patient satisfaction and estimated training costs. The study was powered to include 13 participants per group, including 20% dropout (power 0.80; two-sided significance level P < 0.05).

Results

26 physicians from nine departments performed 1183 EGDs. A total of 661 patient satisfaction surveys were included. The SBT group required fewer procedures to achieve independent procedural completion than the CBT only group (median 31 [95%CI 25–37] vs. 44 [95%CI 33–55]; P = 0.006). No significant differences were found in patient satisfaction or median training costs (US$2993 vs. $3150, respectively; P = 0.55).

Conclusions

SBT prior to CBT reduces the number of supervised procedures required to achieve independent procedural completion without negatively affecting patient satisfaction or increasing training costs. These findings support the routine implementation of SBT when learning EGD.

Publication History

Received: 07 November 2024

Accepted after revision: 15 June 2025

Article published online:
19 August 2025

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