Surgical Endoscopy

, Volume 32, Issue 3, pp 1397–1404 | Cite as

A proficiency-based virtual reality endoscopy curriculum improves performance on the fundamentals of endoscopic surgery examination

  • Daniel A. HashimotoEmail author
  • Emil Petrusa
  • Roy Phitayakorn
  • Christina Valle
  • Brenna Casey
  • Denise GeeEmail author



The fundamentals of endoscopic surgery (FES) examination is a national test of knowledge and skill in flexible gastrointestinal endoscopy. The skill portion of the examination involves five tasks that assesses the following skills: scope navigation, loop reduction, mucosal inspection, retroflexion, and targeting. This project aimed to assess the efficacy of a proficiency-based virtual reality (VR) curriculum in preparing residents for the FES skills exam.


Experienced (>100 career colonoscopies) and inexperienced endoscopists (<50 career colonoscopies) were recruited to participate. Six VR modules were identified as reflecting the skills tested in the exam. All participants were asked to perform each of the selected modules twice, and median performance was compared between the two groups. Inexperienced endoscopists were subsequently randomized in matched pairs into a repetition (10 repetitions of each task) or proficiency curriculum. After completion of the respective curriculum, FES scores and pass rates were compared to national data and historical institutional control data (endoscopy-rotation training alone).


Five experienced endoscopists and twenty-three inexperienced endoscopists participated. Construct valid metrics were identified for six modules and proficiency benchmarks were set at the median performance of experienced endoscopists. FES scores of inexperienced endoscopists in the proficiency group had significantly higher FES scores (530 ± 86) versus historical control (386.7 ± 92.2, p = 0.0003) and higher pass rate (proficiency: 100%, historical control 61.5%, p = 0.01).


Trainee engagement in a VR curriculum yields superior FES performance compared to an endoscopy rotation alone. Compared to the 2012–2016 national resident pass rate of 80, 100% of trainees in a proficiency-based curriculum passed the FES manual skills examination.


Proficiency Graduate medical education Clinical competence Fundamentals of endoscopic surgery Task performance and analysis Curriculum 



The authors would like to thank Brenessa Lindeman, MD MEHP for her assistance in educational research methodology and Michelle Lynn Sanchez for her administrative support.


This project was funded by a grant from the MGH Executive Committee on Teaching and Education. The FES Committee of the Society of American Gastrointestinal and Endoscopic Surgeons provided reduced cost testing vouchers for the FES manual skills examination for the purposes of this study. Daniel Hashimoto is funded by the National Institutes of Health National Institute of Diabetes and Digestive and Kidney Diseases (NIH NIDDK Grant #: T32DK007754-16A1) and the Massachusetts General Hospital (MGH) Edward D. Churchill Research Fellowship. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Compliance with ethical standards


Daniel A. Hashimoto, Emil Petrusa, Roy Phitayakorn, Christina Valle, Brenna Casey, and Denise Gee declare that they have no conflicts of interest or financial ties to disclose.


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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Daniel A. Hashimoto
    • 1
    Email author
  • Emil Petrusa
    • 1
    • 3
  • Roy Phitayakorn
    • 1
  • Christina Valle
    • 1
    • 3
  • Brenna Casey
    • 2
  • Denise Gee
    • 1
    • 4
    Email author
  1. 1.Department of SurgeryMassachusetts General HospitalBostonUSA
  2. 2.Division of Gastroenterology, Department of MedicineMassachusetts General HospitalBostonUSA
  3. 3.Learning LaboratoryMassachusetts General HospitalBostonUSA
  4. 4.Department of SurgeryMassachusetts General HospitalBostonUSA

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