A serious game for surgical endoscopy: an innovative virtual reality simulator to democratize endoscopic training

Background: Training on virtual reality simulators (VRS) is effective, shortening the learning curve to competency. However, current simulators are expensive and difficult to access. Low-cost portable VRS could help democratize and standardize endoscopic training. To meet this need, a novel, portable, gamified VRS- Rescue in the Deep (RID)- was developed. Our goal was to assess and validate the efficacy of RID in endoscopic skills assessment. Methods: A randomized comparative trial was performed at a single center from 7/1/22-9/1/22. Flexible endoscopy novices performed 5 standardized training sessions over a 2-week period using either the Experimental VRS (RID) or standard VRS (control). Trainee performance metrics were evaluated before and after training using the Fundamentals of Endoscopic Surgery manual skills (FES) examination. Univariate analysis was used to compare scores over time. Trainee feedback was evaluated on a Likert scale. Our primary endpoint was FESms improvement. Secondary endpoints were FESms pass rates and trainee feedback. Results: Twenty novices (60% medical students, 25% residents, 15% surgeons) were randomized into Standard and Experimental Arm. There was comparable FESms improvement (p=0.7685) and final passing rates (p=1.00) for RID vs. VRS, respectively. RID had a linear mean increased score of 1.417,9 [95% CI: 1.133.883 – 1.701,917] per session. VRS had a non-monotonic mean improvement in time/sessions and progression in efficiency of approximately 2.75 points [95% CI: 0.7341 – 4.7659]. All novices reported improvement in endoscopic skills after training. 80% Experimental Arm trainees found the training entertaining vs 70% Standard ArmTM trainees. Conclusions: Experimental arm training was as effective as the standard arm training in preparing novices for the FES exam, as evident in improvement of FES scores across both groups. Learning curve was linear and continual in the experimental arm, while disordered in standard group.