{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T14:22:05Z","timestamp":1790950925942,"version":"4.1.0"},"reference-count":22,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T00:00:00Z","timestamp":1787270400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T00:00:00Z","timestamp":1787270400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Gastro and Hepatol"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Simulation\u2010based colonoscopy training may support early acquisition of insertion skills, but its clinical effect remains uncertain. We evaluated whether a self\u2010directed curriculum using the mikoto colonoscopy simulator improved insertion performance in gastroenterology trainees.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this multicenter cluster\u2010randomized trial, 12 gastroenterology trainees from 11 institutions in Japan and Taiwan were assigned 1:1 to mikoto simulator training or standard training, with the trainee as the unit of randomization. Each trainee performed 35 colonoscopies; intervention\u2010arm trainees additionally completed 100 self\u2010directed simulator sessions over 2\u2009weeks. The primary endpoint was post\u2010training cecal intubation rate (CIR), compared using mixed\u2010effects logistic regression with trainee as a random intercept and pre\u2010training CIR as a covariate.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 420 colonoscopies were analyzed. Post\u2010training CIR was 80.0% (72\/90) in the mikoto group versus 77.8% (70\/90) in controls (adjusted OR, 1.34; 95% confidence interval, 0.37\u20134.84;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.606). Within the mikoto group, CIR increased from 60.0% to 80.0% (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.003) and cecal intubation time decreased, but the group\u2010by\u2010period interaction was not significant. Detection outcomes were unchanged.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Although the between\u2010group difference in post\u2010training CIR did not reach statistical significance, self\u2010directed mikoto simulator training produced a significant within\u2010group improvement in CIR and a parallel reduction in cecal intubation time, supporting it as a feasible and educationally meaningful adjunct to conventional colonoscopy training for gastroenterology trainees.<\/jats:p>\n                    <jats:p>\n                      <jats:bold>Trial Registration:<\/jats:bold>\n                      UMIN Clinical Trials Registry: UMIN000054647\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jgh.70679","type":"journal-article","created":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T09:29:16Z","timestamp":1787304556000},"page":"3118-3127","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Self\u2010Directed Mikoto Simulator Training for Colonoscopy in Gastroenterology Trainees: An International Multicenter Randomized Trial"],"prefix":"10.1111","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9782-9998","authenticated-orcid":false,"given":"Daisuke","family":"Yamaguchi","sequence":"first","affiliation":[{"name":"Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine Saga University  Saga Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8290-2427","authenticated-orcid":false,"given":"Ryo","family":"Shimoda","sequence":"additional","affiliation":[{"name":"Department of Endoscopic Diagnostics and Therapeutics Saga University Hospital  Saga Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masashi","family":"Fujii","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Nephrology Tottori University Hospital  Tottori Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomohiko\u00a0Richard","family":"Ohya","sequence":"additional","affiliation":[{"name":"Department of Endoscopy The Jikei University School of Medicine  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2786-8056","authenticated-orcid":false,"given":"Han\u2010Mo","family":"Chiu","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine National Taiwan University Hospital  Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naoyuki","family":"Tominaga","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Saga\u2010Ken Medical Centre Koseikan  Saga Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hidenori","family":"Hidaka","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Saiseikai Karatsu Hospital  Saga Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroharu","family":"Kawakubo","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Imari\u2010Arita Kyouritsu Hospital  Saga Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yosuke","family":"Minoda","sequence":"additional","affiliation":[{"name":"Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences Kyushu University  Fukuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kosuke","family":"Maehara","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Kitakyushu Municipal Medical Center  Fukuoka 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