Bethesda Endoscopic Retrograde Cholangiopancreatography Skill Assessment Tool (BESAT)-Based Simulator Training Using...

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.

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.

Thirty gastroenterology trainees were enrolled. The EST success rate increased from 43.3% to 76.7% (p < 0.05). The completion rate of the procedure tended to increase from 46.7% to 70.0% (p = 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, p < 0.05).

A structured simulator-based program enables trainees to experience failure and improves simulator-based EST performance with sustained gains in self-efficacy. Trial Registration: The trial was prospectively registered in the University Hospital Medical Information Network Clinical Trials Registry (UMIN000044823).