Due to the lack of pediatric digestive endoscopists and the lack of training system for pediatric gastroendoscopy, the development of pediatric gastroendoscopy in China is urgent. The training mode "hand and hand" and "mouth and hand" proposed by Chinese digestive endoscopists had some limitation and was incompletely applicable to the training of pediatric digestive endoscopists. Thus, we proposed the "six-step method" (theoretical teaching, surgical observation, simulator training, in vitro animal experiment, "hand over hand" training and "hands-on" training) and achieved preferable effect. In this study, we explored the application effect of "six-step method" in the training of pediatric digestive endoscopist, in order to further improve the training mode.

Fifty-seven trainees who received the standardized training of pediatric digestive endoscopist in the Affiliated Children′s Hospital of Xi′an Jiaotong University from 2018 to 2021were enrolled. All of them were trained by pediatric gastroendoscopy based on "six-step method" for 3-6 months. The mastery of endoscopy technology, ability of endoscopy technology, personal operation of endoscopy, satisfaction evaluation of the training mode was collected through questionnaire survey.

The overall satisfaction evaluation of the trainees to the training mode was 100%. The satisfaction evaluation for theoretical teaching, surgical observation, "hand over hand" training and "hands-on" training were all 100%, the satisfaction evaluation for simulator training and in vitro animal experiment was 97% and 96%, respectively. The score of DOPS formative evaluation at the end of training was better than that of "hand over hand" training for 2 weeks, the difference was statistically significant (P<0.05).100% of the trainees could independently perform the basic operation of gastroscopy (13 trainees with basic gastroscopic operation were excluded), 96% of the trainees could independently perform the removal of gastrointestinal foreign bodies, 56% of the trainees could independently perform the colonoscopy (2 trainees with basic colonoscopy skills were excluded), and 20% of the trainees could independently perform the endoscopic treatment of colorectal polyps. In addition, balloon dilation of esophageal stenosis, endoscopic retrograde appendicitis therapy and endoscopic catheterization are feasible for individual trainees. In the application of endoscopic technology, 84% of the trainees could independently carry out the endoscopic training technology that they mastered in the original unit after the training. Moreover, for the trainees who had basic operation before training, 85% of them performed a significant decreased incidence of surgical complications.

The "six-step method" training mode has a reliable teaching effect in a limited training, and provides an effective way for the standardization, specialization and professionalism of the training of pediatric digestive endoscopists.