Bethesda Endoscopic Retrograde Cholangiopancreatography Skill Assessment Tool (BESAT)-Based Simulator Training Using a Novel Dry Endoscopic Retrograde Cholangiopancreatography Model Improves Technical Proficiency and Self-Efficacy: A Prospective Study.
Simulator-based training significantly boosts EST success rates and trainee confidence, but real-world applicability needs further validation.
Where it sits
this study against the rest of the igf-1 des (des(1-3) igf-1) corpusSummary and findings
This study evaluated a structured educational program using a novel dry simulator for endoscopic sphincterotomy (EST) training among gastroenterology trainees. The program included video learning, practical attempts, and expert feedback. EST success rates improved significantly post-training.
Abstract
<h4>Objectives</h4>Endoscopic sphincterotomy (EST) is a high-risk procedure with a steep learning curve. We previously developed a novel dry simulator capable of reproducing bleeding after an inappropriate incision. This study aimed to evaluate the effectiveness of a structured educational program using the simulator within the Bethesda Endoscopic retrograde cholangiopancreatography (ERCP) Skill Assessment Tool (BESAT) framework.<h4>Methods</h4>This prospective study implemented a standardized training sequence: (1) preliminary video-based learning; (2) an initial attempt at cannulation, EST, and biliary stone extraction; (3) BESAT-based expert feedback focusing on six key technical tips; (4) a second attempt. The primary outcome was the change in EST success, which is defined by an incision in the 11-12 o'clock direction with appropriate length and no bleeding, before and after feedback. Secondary outcomes were procedure completion, including stone removal within 15 min, and subjective self-assessments of procedural understanding and confidence.<h4>Results</h4>Thirty gastroenterology trainees were enrolled. The EST success rate increased from 43.3% to 76.7% (<i>p</i> < 0.05). The completion rate of the procedure tended to increase from 46.7% to 70.0% (<i>p</i> = 0.07). Subjective self-confidence improved from a median of 24.0-53.0 after training and remained at 53.5 at 3 months; other self-assessed domains also improved and were sustained. Post-hoc analysis showed that initial EST success was associated with >50 prior ERCP cases (odds ratio = 7.86, 95% confidence interval: 1.31-47.0, <i>p</i> < 0.05).<h4>Conclusions</h4>A structured simulator-based program enables trainees to experience failure and improves simulator-based EST performance with sustained gains in self-efficacy. <b>Trial Registration</b>: The trial was prospectively registered in the University Hospital Medical Information Network Clinical Trials Registry (UMIN000044823).
Background
Endoscopic sphincterotomy (EST) is a complex procedure with a high risk of complications, requiring significant training to master. Traditional training methods can be limited by availability and patient safety concerns. This study addresses the need for effective training tools by evaluating a novel dry simulator within a structured educational program.
Methods
This prospective study involved 30 gastroenterology trainees who underwent a standardized training sequence. The program included video-based learning, initial practical attempts, expert feedback using the BESAT framework, and a second attempt. The primary outcome was the change in EST success, defined by specific incision criteria. Secondary outcomes included procedure completion and self-assessed confidence.
Results
The primary outcome showed a significant increase in EST success rate from 43.3% to 76.7% (p < 0.05). The procedure completion rate increased from 46.7% to 70.0%, though this was not statistically significant (p = 0.07). Self-confidence improved significantly, with median scores rising from 24.0 to 53.0 post-training and remaining stable at 53.5 after three months. A post-hoc analysis indicated that initial EST success was more likely in trainees with over 50 prior ERCP cases.
Interpretation
The study demonstrates that a structured simulator-based training program can significantly improve technical proficiency and self-confidence in EST among trainees. While the improvement in success rates is statistically significant, the clinical significance in real-world settings remains to be fully validated. The association between prior experience and initial success highlights the importance of cumulative practice. Limitations include the small sample size and reliance on a simulator model.
Key findings
- EST success rate increased from 43.3% to 76.7% (p < 0.05).
- Procedure completion rate increased from 46.7% to 70.0% (p = 0.07).
- Self-confidence improved from a median of 24.0 to 53.0 after training.
- Initial EST success associated with >50 prior ERCP cases (odds ratio = 7.86, 95% CI: 1.31-47.0, p < 0.05).
Limitations
- small n=30
- simulator model may not replicate clinical conditions
- short follow-up for sustained skill assessment
- post-hoc analysis for prior experience association