Assistant performance is pivotal to endoscopy efficiency, yet nurse training is often informal. We evaluated whether structured simulation plus theory improves nurse-dependent workflow.

Prospective, parallel-group study of 20 endoscopy nurses allocated 1:1 to Simulation+Theory (training) or Control. Each nurse assisted 10 live procedures (5 gastroscopies, 5 colonoscopies; 200 observations) with the same endoscopist. The prespecified mix included diagnostic biopsies, dilation, cold-snare polypectomy (CSP), hot-snare polypectomy (HSP), endoscopic mucosal resection (EMR), and endoscopic submucosal dissection (ESD); EMR/ESD complexity used the Size-Morphology-Site-Access (SMSA) score. The primary outcome was device-to-field time (DTF; seconds). Secondary outcomes were micro-tasks (exchange, injection, balloon, hemostasis, generator change, retrieval). We summarized medians [range] and fit regression models on log DTF with nurse-clustered standard errors, adjusting for case index, procedure type, age, experience, mentor presence, and SMSA. Learning windows were cases 1–3, 4–6, and 7–10; a difference-in-differences contrast compared pre/post case 4.

Groups were similar at baseline (cases 1–3). From case 4 onward, the training group was faster and remained so through case 10. The adjusted post-training effect corresponded to a time ratio of 0.81 (95% CI 0.80–0.83; p<0.001). Improvements were consistent across procedures and largest for EMR/ESD; secondary micro-tasks showed similar patterns.

A brief Simulation+Theory program produced rapid, durable gains in nurse device readiness, independent of seniority. Embedding structured nurse training in endoscopy services may enhance efficiency and support expanding therapeutic workloads.