S2944 Educational Innovation: A Mentored Approach to Pediatric ERCP Skill Acquisition for Mid-Career Pediatric Gastroenterologist

Introduction: Pediatric gastroenterology (GI) training programs do not provide adequate procedural exposure to achieve clinical competency in endoscopic retrograde cholangiopancreatography (ERCP). Unlike adult GI, however, formal pediatric ERCP training programs are rare. As a result, pediatric gastroenterologists face significant barriers to ERCP training—competing for adult-focused fellowship positions or relocating to access one of the few pediatric ERCP opportunities nationwide. This gap has left most pediatric GI divisions without ERCP-capable providers. We describe and evaluate an innovative educational pathway developed to train a mid-career practicing pediatric gastroenterologist in ERCP, using a competency-based, mentored approach. Methods: This qualitative educational study utilized participant observation and semi-structured interviews through purposive sampling. Observations focused on teaching methods, and learning styles. Observational methods allowed in-depth insight into real-world training dynamics. Semi-structured interviews explored motivation, experiences, and challenges. Interviews were video-recorded, then transcribed and coded thematically using Atlas.ti. Visual thematic maps were created and illustrative quotes were formatted in a table. Results: Six major themes emerged. 1) Learner Motivation – The trainee was highly self-directed and driven by a desire for professional growth. Institutional need for pediatric ERCP, national shortage of pediatric advanced endoscopists 2) Unique Challenges for Mid-Career Learners - Balancing clinical responsibilities and training, mindset shift from expert to learner, accepting feedback, limited flexibility in training schedules 3) Supportive Environment – Leadership endorsed the training model, and the mentor demonstrated flexibility and commitment to individualized instruction. 4) Innovative Instructional Design – Training incorporated adult learning theory, educational scaffolding, progressive complexity, and frequent feedback. The learning remained within the trainee’s zone of maximal development and skill acquisition. 5) Learning Barriers - Time management. 6) Advice to Peers: Self-compassion and growth mindset. Conclusion: We present a novel, replicable pathway for developing ERCP competency among mid-career pediatric gastroenterologists. Grounded in adult learning principles and tailored mentorship, this model addresses a critical training gap and offers a sustainable approach to expanding advanced endoscopy capacity in pediatric GI practice.