Supplemental Material for: A Structured, Repetitive Simulation Program for Endoscopic Coagulation Hemostasis with Hemostatic Forceps: An Assessor-Blinded Randomized Controlled Trial Using a Bleeding Ulcer Model

The analysis followed intention-to-treat principles.</p><p dir="ltr">Results</p><p dir="ltr">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.</p><p dir="ltr">Conclusion</p><p dir="ltr">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.</p>