'Four-position method' makes beginner endoscopists aware of spatial positioning of the left hand to master upper gastrointestinal endoscopy.

Background and study aims  We developed a novel "four-position method" for facilitating endoscopy of the upper gastrointestinal tract, and this study aimed to verify its usefulness for beginner endoscopists. Methods  Medical students (n = 121) were divided into three groups. A simulator subsequently was used to perform endoscopy. Group A was taught how to hold the endoscope and move the dial; Group B was taught the "four-position method"; and Group C, in addition to being taught the "four-position method," was permitted to use an endoscope before introduction to the simulator. In each group, the transit time to various parts of the upper digestive tract was recorded in addition to the time to grasp a clip in the stomach with the forceps. We also surveyed the groups with respect to their impression of the difficulty level of endoscopic operation before and after instructions. Results  Transit time to the cardia was no different among the groups; however, with regard to other targets, Group C reached the sites significantly more quickly than did Groups A and B. Time to clip grasping was significantly shorter in Groups B and C than in Group A. Regarding the impression of the difficulty level, significantly more students in Groups B and C compared to Group A felt that endoscopy was easier after instructions. Conclusion  Learning the "four-position method" made it possible to achieve stable endoscopic manipulation at an early stage and improve subsequent endoscopic procedures.