S1237 Enhancing Gastroenterology Fellow Competency in Through-the-Scope Clip Placement: A Simulation-Based Approach

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Introduction: Simulation-based education in gastrointestinal endoscopy improves procedural performance and patient safety. Despite the widespread use of through-the-scope (TTS) clips, gastroenterology (GI) fellows often learn clip placement informally or on ex-vivo models without direct clinical relevance. We developed and evaluated a simulation-based curriculum to improve GI fellows’ competency in TTS clip placement. Methods: We designed a 1.5-hour hands-on workshop for first- through third-year GI fellows at a high-volume academic center. The curriculum included (1) a baseline skills assessment where fellows placed a TTS clip on a linear defect cut into a synthetic tissue model mounted on a scope-holder device (Boston Scientific “Suture Stand”); (2) a 20-minute workshop covering clip characteristics, placement techniques, troubleshooting, and videos of optimal and suboptimal placements; and (3) a guided practice session on a complex simulated defect requiring multiple clips, with real-time faculty feedback. Pre- and post-intervention surveys administered at different dates assessed confidence, attitudes, and satisfaction. Fisher exact test compared survey responses. Results: Eight fellows participated; 37.5% had prior formal clip training from regional conferences. Most (75%) had performed 11–50 clip procedures, most common indications included hemostasis (100%) and polypectomy defect closure (75%). Pre-workshop challenges included positioning the target lesion (100%), limited scope maneuverability (100%), clip rotation/positioning (75%), and tissue grasping (75%). Post-intervention, confidence and self-assessed proficiency improved across all domains: comfort with clip selection increased from 50% to 100% (P = 0.08); clip positioning/maneuvering from 87.5% to 100% (P = 0.75); and “intermediate” proficiency rose from 50% to 85.7% (P = 0.45). Fellows rated the curriculum as relevant, realistic, and valuable, with 100% willing to participate in future simulation workshops. Conclusion: This pilot study demonstrates that a simulation-based curriculum for TTS clip placement is feasible, effective, and well-received by GI fellows. Integration of such training into fellowship programs can enhance procedural skills, and further studies are needed to assess long-term impact on clinical performance.

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