# Simulation-based training of endoscopic hemostasis for Japanese pediatric endoscopy learners: a pilot program

## TL;DR

This study introduces a simulation-based training program to help Japanese pediatric endoscopists improve their skills in endoscopic hemostasis, a critical procedure for managing bleeding during endoscopy.

## Contribution

The study introduces a novel clip hemostasis simulator and evaluates its potential for training pediatric endoscopists in Japan.

## Key findings

- Pediatric endoscopists had lower confidence in performing hemostasis compared to adult GI residents.
- Simulation-based training significantly improved perceived skill enhancement among participants.
- All pediatric endoscopists expressed interest in repeated simulator-based training sessions.

## Abstract

Endoscopic hemostasis training, often in emergencies, can be challenging for pediatric endoscopists. This study aimed to establish hands-on seminar sessions using the novel clip hemostasis simulator and to explore the underlying concerns about endoscopic hemostasis among pediatric endoscopists and the potential of simulator-based training (SBT).

An SBT course was incorporated into seminars by the Japanese Society for Pediatric Gastroenterology, Hepatology, and Nutrition. Surveys using the visual analog scale (VAS; 0-100) completed by consenting pediatricians during 4 seminars from October 2021 to March 2023 were compared with responses of adult GI residents and junior residents.

Fifty-two pediatric endoscopists (median age, 31 year; postgraduate year 7) were enrolled. A median VAS score of 47 (interquartile range [IQR], 23.5-65) for understanding endoscopic hemostasis was significantly lower than that of adult GI residents (median, 76; IQR, 58-82; P < .001) and comparable with junior residents (median, 54; IQR, 50-65). Pediatric endoscopists' confidence in independently performing hemostasis was low, with a median score of 0 (IQR, 0-16.5), which was below adult GI residents (median, 67; IQR, 49-77; P < .001) and junior residents (median, 11.5; IQR, 10-39; P = .014). Regarding skill enhancement by SBT, a median score of 94.5 showed high and no significant difference from junior residents and adult GI residents, respectively. All pediatric endoscopists expressed an interest in repeated SBT sessions.

Pediatric endoscopists were concerned about their competence in endoscopic hemostasis. The simplified SBT programs with the simulator may potentially improve their skills and confidence. (Clinical trial registration number: UMIN000035735.)