title: Video-based supervision for training of endoscopic submucosal dissection.
abstract: OBJECTIVE
  Adoption of endoscopic submucosal dissection (ESD) in Western countries has been limited by the difficulty in learning the procedure. Although a porcine model is commonly used for ESD training, without expert guidance the procedure is difficult to master. The availability of Western ESD experts is limited, and expert supervision through a remote video-based system may be a practical method for Western endoscopists to learn ESD. The aim of this study was to assess the value of video-based remote evaluation in supervising ESD training.
  
  
  METHODS
  Two Western endoscopists performed ESD training procedures in an ex vivo porcine model at least every 2 weeks until competency was achieved. Competency was defined as consistent en bloc resection of a 3-cm area within 30 minutes, and without perforation, using the proper ESD technique. A Japanese ESD expert at the National Cancer Center in Tokyo, Japan, analyzed the training videos, scored them, and provided written feedback for improvement after each training session and before the trainee's next training session.
  
  
  RESULTS
  Endoscopist 1 reached competency at 23 procedures and endoscopist 2 reached competency at 25 procedures. No difference in skill improvement between the two endoscopists was noted. One trainee subsequently completed eight ESD procedures in patients, with curative en bloc resection and no complications.
  
  
  CONCLUSIONS
  A standardized ESD training program including educational presentations/videos and preclinical animal training with expert guidance through a remote video-based system is an effective tool for learning ESD techniques in preparation for performing the procedure in humans.
authors.affiliation: Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, United States.
authors.forename: Amit
authors.initials: A
authors.lastname: Bhatt
authors.affiliation: Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Seiichiro
authors.initials: S
authors.lastname: Abe
authors.affiliation: Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, United States.
authors.forename: Arthi
authors.initials: A
authors.lastname: Kumaravel
authors.affiliation: Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, United States.
authors.forename: Mansour A
authors.initials: MA
authors.lastname: Parsi
authors.affiliation: Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, United States.
authors.forename: Tyler
authors.initials: T
authors.lastname: Stevens
authors.affiliation: Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, United States.
authors.forename: Sunguk
authors.initials: S
authors.lastname: Jang
authors.affiliation: Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, United States.
authors.forename: Rocio
authors.initials: R
authors.lastname: Lopez
authors.affiliation: Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Oda
authors.affiliation: Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, United States.
authors.forename: John J
authors.initials: JJ
authors.lastname: Vargo
authors.affiliation: Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Saito
mesh_terms: D000818:Animals; D002983:Clinical Competence; D000069916:Endoscopic Mucosal Resection / Q000193:education* / Q000295:instrumentation / Q000379:methods; D005246:Feedback; D006801:Humans; D007564:Japan; D059032:Learning Curve; D061646:Operative Time; D013552:Swine; D013663:Teaching; D014481:United States; D014741:Video Recording