A Structured, Repetitive Simulation Program for Endoscopic Coagulation Hemostasis with Hemostatic Forceps: An...

Introduction Prompt endoscopic hemostasis is required to control upper gastrointestinal bleeding. Current training relies on on-the-job exposure, with limited evidence supporting the use of dry-lab simulators. This study aimed to develop a structured, repeatable simulation-based training program for thermal coagulation hemostasis and evaluate its efficacy. Methods This single-center, assessor-blinded, randomized controlled trial was conducted at Tohoku University Hospital from December 2023 to June 2025. Non-expert endoscopists were randomized into either an intervention group (five simulation-based training sessions, including basic and hemostasis tasks, over two months) or a control group. Co-primary outcomes were procedure time and blinded video-based rubric scores for hemostasis at both low- and high-difficulty sites. Changes in self-efficacy were assessed using a visual analog scale. The analysis followed intention-to-treat principles. Results Twenty participants were enrolled, with nine in the intervention group and 11 in the control group. At the final assessment, the intervention group demonstrated shorter procedure times at both the antrum (43.6 vs. 51.3 seconds, P = 0.02) and the upper gastric body (32.6 vs. 59.7 seconds, P < 0.01). Significant within-group reductions were observed only in the intervention group (effect sizes of 0.62 in the antrum and 0.80 in the upper body). Rubric-based scores improved at high-difficulty sites (P = 0.03). All five visual analog scale domains improved significantly in the intervention group, whereas two domains increased in the control group. Conclusion Structured simulation-based training with a high-fidelity bleeding simulator improved technical performance, efficiency, and self-efficacy in coagulation hemostasis, representing a scalable framework for competency-based education.