Bethesda Endoscopic Retrograde Cholangiopancreatography Skill Assessment Tool (BESAT)‐Based Simulator Training Using a Novel Dry Endoscopic Retrograde Cholangiopancreatography Model Improves Technical Proficiency and Self‐Efficacy: A Prospective Stud

ABSTRACT Objectives 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. Methods 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. Results 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). Conclusions 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).