Virtual reality (VR) technology is increasingly used in ERCP training to enable early acquisition of skills in a safe environment. While its role in developing technical skills in ERCP is recognised, evidence for its impact on generic non-technical skills (NTS) —including communication, teamwork, leadership, situational awareness, and emotional regulation—is limited. We evaluated the use of fully immersive VR to teach generic NTS during the Joint Advisory Group (JAG) approved Basic Skills ERCP course at University Hospital of North Tees. 

Three ERCP-based VR scenarios (complex stone disease, post-sphincterotomy bleeding, and oversedation during ERCP) were developed with support from a VR development team. Participants (consultants, trainees, and ERCP nurses) viewed the scenarios using immersive headsets (Red Box) and took part in facilitated group debriefs. A post-session electronic questionnaire assessed realism, usefulness for NTS, decision-making, emotional control, and overall value.

Seventeen delegates completed the questionnaire (7 doctors [4 consultants, 3 registrars] and 10 nurses). Thirty-five percent had prior exposure to more than 200 ERCP procedures. Perceptions of VR were highly positive: 76.5% strongly agreed and 23.5% agreed that sessions were realistic. VR improved understanding of NTS in ERCP (88.2% strongly agree, 11.2% agree), decision-making (58.8% strongly agree, 41.2% agree), confidence and emotional control in challenging cases (70.6% strongly agree, 29.4% agree) and the ability to manage unexpected limitations (70.6% strongly agree, 29.4% agree). Debrief discussions were rated useful by all participants (88.2% strongly agree, agree 11.2%). Overall session rating was excellent in 76.5% and very good in 23.5%. All participants recommended ongoing use of VR as an adjunct to ERCP training.

Fully immersive VR is a promising tool for teaching non-technical skills in ERCP, providing a realistic platform for developing situational awareness, communication, and confidence within a controlled environment.

Integrating VR into a standardised ERCP curriculum may accelerate the acquisition of both technical and non-technical skills. Further multi-centre studies are needed to determine its broader educational impact.