Pediatric Web-based Video Capsule Endoscopy Curriculum: A Pilot Study to Determine the Ability to Implement a Standardized Educational Curriculum

**Background:** Video capsule endoscopy (VCE) is a noninvasive method to visualize the small bowel, approved for children ≥2 years. Despite its availability for nearly two decades, objective measures for establishing competence in pediatric VCE are limited. Current training relies on nonstandardized mentorship and expert opinion, with NASPGHAN recommending at least 20 VCEs for competence. Pediatric and adult VCE differ in indications, preparation, and equipment, highlighting the need for pediatric-specific curricula. The authors hypothesized that a structured web-based pediatric VCE curriculum could be broadly implemented and improve comfort and knowledge.

**Methods:** A web-based VCE curriculum was created using REDCap database, with a homepage containing introductory instructions, links to NASPGHAN capsule endoscopy clinical report, Medtronic/Covidien Rapid Reader software, deidentified pediatric VCE cases, and pre/posttest questions. An email invitation was sent to the Pediatric GI Bulletin Board listserv ([email protected]). Enrolled participants completed a pretest survey (self-reported comfort on 0–100 scale) and a multiple-choice pretest (16 questions) with photo identification (12 questions). Participants then interpreted a minimum of 10 teaching pediatric VCE cases (with option for 5 additional), providing free-text descriptions of landmarks and abnormal findings. Upon completion, participants took an identical posttest and exit survey. The curriculum required approximately 10–30 hours and had to be completed within 6 months. Mean scores were compared using t-tests; participant characteristics were compared using chi-square and Fisher's exact tests. The study was IRB-approved at Yale University (ID no. 2000022682).

**Key Results:** Of 143 pediatric GI fellows and attendings who expressed interest, 52 (36%) began the curriculum. Among those who began, 37 (71%) partially completed, 12 (23%) completed the entire curriculum, and 3 (6%) withdrew due to technological issues. Most participants were from North America (49/52). Significantly more females fully completed the curriculum (83% vs. 49%, P=0.0349). No significant differences were noted in age, region, institution type, level of training, or prior VCE experience between completers and partial completers. Among the 12 completers, significant improvement was seen in self-reported mean comfort level for: explaining indications (63.3 to 84.4, P=0.0097), contraindications (56.1 to 85.8, P=0.0036), managing complications (44.4 to 83.3, P=0.0048), using Rapid Reader software (44.4 to 90.4, P=0.00035), and interpreting/reporting VCE findings (33.7 to 82.3, P=0.00015). Knowledge improved significantly on the multiple-choice test (11 to 12.67 out of 16, P=0.041) and photo recognition test (9.75 to 10.75 out of 12, P=0.015). All 12 completers found the curriculum helpful and would recommend it. Main challenges included academic firewall security issues and inability to download Rapid Reader on Macintosh computers. All inquired about CME/MOC credits.

**Clinical Implications:** This pilot demonstrates that a standardized, web-based VCE curriculum can improve self-reported comfort and objective knowledge among pediatric gastroenterologists. The curriculum trained 12 new VCE endoscopists within 6 months with limited need for direct mentorship, addressing a key barrier to VCE training. However, the low completion rate (23%) highlights challenges of time commitment and technical barriers. Future iterations should address firewall issues, offer Mac compatibility, provide CME/MOC credits, and incorporate expert review to validate competence. The study supports the feasibility of broader implementation but larger studies with validated pediatric competency scoring tools are needed.