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

Background and Aims 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). Methods A SBT course was incorporated into seminars by the Japanese Society for Pediatric Gastroenterology, Hepatology, and Nutrition. Surveys with Visual Analog Scale (VAS, 0-100) completed by consenting pediatricians during four seminars from October 2021 to March 2023, were compared with the responses of adult gastrointestinal (GI) residents and junior residents. Results Fifty-two pediatric endoscopists (median age 31, PGY 7) were enrolled. A median VAS score of 47 (IQR 23.5-65) for understanding endoscopic hemostasis, significantly lower than adult GI residents (median 76, IQR 58-82, P<0.001) and comparable to 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), below adult GI residents (median 67, IQR 49-77, P<0.001) and junior residents (median 11.5, IQR 10-39, P=0.014). Regarding skill enhancement by SBT, a median score of 94.5 showed high and no significant difference from junior residents and adult GI residents. All pediatric endoscopists expressed interest in repeated SBT sessions. Discussion and Future Prospects Pediatric endoscopists were concerned about their competence in endoscopic hemostasis. The simplified SBT programs with the simulator, may potentially improve their skills and confidence.