ERCP Knowledge, Practical Skills, and Training Needs of Endoscopic Nurses: A Cross-Sectional Study Based on Miller's Pyramid Theory.

Abstract

Aims/background: Endoscopic retrograde cholangiopancreatography (ERCP) is a high-risk invasive procedure that requires close cooperation between physicians and specialized nurses. Standardized systematic training for endoscopic nurses remains insufficient in many clinical settings in China. We aimed to investigate current levels of specialized knowledge and practical skills among endoscopic nurses in Zhejiang Province, China regarding ERCP, based on Miller's pyramid theory of abilities, and analyze their training willingness and needs, thereby providing a theoretical basis for establishing a systematic and standardized ERCP training system for acquiring specialized knowledge and operational skills.

Methods: We designed a questionnaire based on Miller's Pyramid of Clinical Competence and conducted a cross-sectional survey from August 2025 to September 2025 using convenience sampling among 230 endoscopy center nurses from 18 hospitals in Zhejiang. The questionnaire comprised three sections: general information, self-assessment of ERCP basic knowledge and practical skills, and training willingness and needs. The total survey score was 40 points, with 8-24 points indicating a low level, 25-34 points indicating a moderate level, and >34 points indicating a high level.

Results: In total, 230 valid questionnaires were returned. The overall score for endoscopic nurses' ERCP knowledge level was 23.55 ± 5.81 points and that for practical skills was 23.77 ± 6.98 points; thus, nurses' knowledge and practical skill scores were both at a low level. Male nurses, nurses in tertiary A hospitals, nurses aged >40 years, those with intermediate-level professional titles or above, and nurses with >10 years' working experience achieved higher scores in theoretical knowledge and practical abilities. Analysis of endoscopic nurses' training needs revealed that 99.57% of nurses were willing to participate in training. Regarding the most common responses, these were "once per quarter" for training frequency, "Monday to Friday noon" for training time, "31-45 minutes" for training duration, "learning new techniques" for training content, and "hands-on practice in the operating room" for training methods; and the most common responses regarding training resources were "operation video library".

Conclusion: The present findings indicated that endoscopic nurses' specialized knowledge and practical skills regarding ERCP require further improvement, and a clear demand for training exists. It is recommended that hospital administrators and nursing educators identify practical problems according to nurses' core demands and develop individualized hierarchical and staged training programs, with equal emphasis on theoretical knowledge and clinical practice. Teaching modalities including simulation training devices and hands-on workshops should be provided to foster professional specialization among ERCP nursing teams and improve patient safety outcomes.