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Introduction. The objective of this study was to describe Do-Not-Resuscitate (DNR) practices in a tertiary-care intensive care unit (ICU) in Saudi Arabia, and determine the predictors and outcomes of patients who had DNR orders. Methods. This retrospective cohort study was based on a prospectively collected database for a medical-surgicalIntensive CareDepartment in a tertiary-care center in Riyadh, Saudi Arabia (1999–2017). We compared patients who had DNR orders during the ICU stay with those with “full code.” The primary outcome was hospital mortality. The secondary outcomes included ICU mortality, tracheostomy, duration of mechanical ventilation, and length of stay in the ICU and hospital. Results. Among 24790 patients admitted to the ICU over the 19-year study period, 3217 (13%) had DNR orders during the ICU stay. Compared to patients with “full code,” patients with DNR orders were older (median 67 years [Q1, Q3: 55, 76] versus 57 years [Q1, Q3: 33, 71], p

Abstract Background and Aims Despite the significant milestone of vaccine discovery, the spread of misinformation and pseudoscientific claims has resulted in an increasing number of people refusing vaccination in Syria. In this study, we aimed to explore fears and misconceptions towards COVID‐19 vaccines among the Syrian population. Methods We conducted a nationwide cross‐sectional study between January and May 2022, using a convenience sample of 10,006 participants aged at least 18 years and living in Syria. We administered a validated online/paper questionnaire and conducted face‐to‐face interviews. We used SPSS software (version 26) for statistical analysis, assessing our data using frequency and χ2 tests, with p

Background. Intravenous infusions of neuromuscular blocking agents (NMBAs) and prone positioning are recommended for acute respiratory distress syndrome (ARDS) due to COVID-19. The safety of enteral nutrition (EN) during these treatments is unclear. This study assessed EN tolerance and safety during NMBA infusion in proned and nonproned patients with ARDS due to COVID-19. Methods. This retrospective study evaluated patients who were admitted to a tertiary-care ICU between March and December 2020, had ARDS due to COVID-19, and received NMBA infusion. We assessed their EN data, gastrointestinal events, and clinical outcomes. The primary outcome was gastrointestinal intolerance, defined as a gastric residual volume (GRV) ≥500 ml or 200–500 ml with vomiting. We compared proned and nonproned patients. Results. We studied 181 patients (mean age 61.2 ± 13.7 years, males 71.1%, and median body mass index 31.4 kg/m2). Most (63.5%) patients were proned, and 94.3% received EN in the first 48 hours of NMBA infusion at a median dose

Background. Respiratory syncytial virus (RSV), a well-known cause of bronchiolitis in children, can cause community-acquired pneumonia (CAP) in adults, but this condition is not well studied. Hence, we described the characteristics and outcomes of patients hospitalized for CAP due to RSV. Methods. This was a retrospective study of patients admitted to a tertiary-care hospital between 2016 and 2019 with CAP due to RSV diagnosed by a respiratory multiplex PCR within 48 hours of admission. We compared patients who required ICU admission to those who did not. Results. Eighty adult patients were hospitalized with CAP due to RSV (median age 69.0 years, hypertension 65.0%, diabetes 58.8%, chronic respiratory disease 52.5%, and immunosuppression 17.5%); 19 (23.8%) patients required ICU admission. The median pneumonia severity index score was 120.5 (140.0 for ICU and 102.0 for non-ICU patients; p=0.09). Bacterial coinfection was rare (10.0%). Patients who required ICU admission had more hypotension (systolic blood pressure

Objective. Pulmonary barotrauma has been frequently observed in patients with COVID-19 who present with acute hypoxemic respiratory failure. This study evaluated the prevalence, risk factors, and outcomes of barotrauma in patients with COVID-19 requiring ICU admission. Methods. This retrospective cohort study included patients with confirmed COVID-19 who were admitted to an adult ICU between March and December 2020. We compared patients who had barotrauma with those who did not. A multivariable logistic regression analysis was performed to determine the predictors of barotrauma and hospital mortality. Results. Of 481 patients in the study cohort, 49 (10.2%, 95% confidence interval: 7.6–13.2%) developed barotrauma on a median of 4 days after ICU admission. Barotrauma manifested as pneumothorax (N = 21), pneumomediastinum (N = 25), and subcutaneous emphysema (N = 25) with frequent overlap. Chronic comorbidities and inflammatory markers were similar in both patient groups. Barotrauma occurred in 4/132 patients (3.0%) who received noninvasive ventilation without intubation, and in 43/280 patients (15.4%) who received invasive mechanical ventilation. Invasive mechanical ventilation was the only risk factor for barotrauma (odds ratio: 14.558, 95% confidence interval: 1.833–115.601). Patients with barotrauma had higher hospital mortality (69.4% versus 37.0%; p

Introduction. Human rhinovirus (HRV) can lead to a variety of respiratory illnesses; it is also an uncommon cause of community-acquired pneumonia (CAP). We described the characteristics and outcomes of patients hospitalized for CAP due to HRV. Methods. We retrospectively studied consecutive adult patients admitted to King Abdulaziz Medical City-Riyadh with CAP due to HRV between 2016 and 2019. The diagnosis was made by respiratory multiplex PCR within 48 hours of hospitalization. We compared patients requiring ICU admission to those who did not. Results. One-hundred-and-six patients were studied (peak hospitalization between November and January, median age 71.5 years, hypertension 59%, diabetes 50%, and chronic respiratory disease 44.3%); 16 (15.1%) patients required ICU admission. The median pneumonia severity index score (PSI) was 107, with no significant difference between ICU and nonICU patients. ICU patients had a higher prevalence of tachypnea (62.5% vs. 26.7%, p=0.005), hemoptysis (12.5% vs 0%, p=0.001), and lymphopenia (71.4% vs 26.3%, p=0.01). Chest X-ray on presentation showed bilateral infiltrates in 47/101 (46.5%) patients and unilateral infiltrates in 26/101 (25.7%) patients. Systemic corticosteroids were used in 54.7% of patients (the median initial dose was 120 mg of prednisone equivalent and was higher in nonICU patients). Most (69.2%) ICU patients received mechanical ventilation (median duration of 8 days). Bacterial coinfection (6.6%) and superinfection (3.8%) were rare. The overall hospital mortality was 9.4% (higher for ICU patients: 37.5% vs. 4.4%, p

Background and Objectives. Acute bronchiolitis is a common respiratory disease in children. C-reactive protein (CRP) is an indicator of bacterial coinfection. This study is aimed at assessing the frequency of elevated CRP in children with acute bronchiolitis and at comparing the clinical characteristics, laboratory and radiological findings, antibiotics use, and outcome according to CRP levels. Material and Methods. We retrospectively reviewed medical records of children with acute bronchiolitis admitted to Pediatric Department, Salmaniya Medical Complex, Bahrain, in 2019-2020. Demographic, clinical, laboratory and radiological data, and outcomes were collected. Patients with high CRP were compared with those with normal levels. Results. Of 287 patients, 229 (79.2%) were included. 132 (57.6%) were males. Median presentation age was 3.7 (interquartile range (IQR), 1.27-12.33) months. Median CRP level was 10.4 (IQR, 2.8-35.1) mg/L. CRP was high in 167 (72.9%) patients. 17.6% (33/187 patients) had confirmed bacterial coinfection. Respiratory syncytial virus (RSV) was detected in 84 (36.7%) patients. Mean CRP level was higher in RSV-negative compared to RSV-positive patients, 31.3±44.3 versus 21.5±27.7 mg/L, respectively (P=0.042). Respiratory viral serology profile was positive in 34.7% (17/49 patients). 66.9% (107/160 patients) had positive chest X-ray. Antibiotics were used in 78.1% (179/227 patients). Thirteen (5.7%) patients required intensive care, five (2.2%) had surgical intervention, four (1.8%) required endotracheal intubation, and four (1.8%) died. Patients with high CRP were older at presentation (P

Background and Objectives. Jaundice is a common cause of hospital admission in infants presenting within the first month of life. This study is aimed at determining neonatal and maternal risk factors of indirect hyperbilirubinemia, at comparing neonates with risk factors and those without, and at assessing the type of management according to hyperbilirubinemia severity. Material and Methods. In this retrospective cross-sectional study, medical records of neonates with indirect hyperbilirubinemia who were admitted to the Pediatric Department, Salmaniya Medical Complex, Bahrain, between January 2020 and December 2020 were reviewed. Neonatal demographic data, antenatal history, birth weight, feeding type, maternal and neonatal laboratory evaluations, management, and length of hospital stay were collected and compared. Results. Out of 555 records, 404 neonates were included. Among those, 209 (51%) were males and 275 (68.1%) were Bahraini. The median indirect bilirubin level at presentation was 218 (interquartile range, 174-270) μmol/L. ABO incompatibility was the commonest risk factor for neonatal indirect hyperbilirubinemia (n=152, 37.6%) followed by glucose-6-phosphate dehydrogenase (G6PD) deficiency (n=130/400, 32.5%). Age (>25 years) was the commonest maternal risk factor (n=331, 81.9%) followed by cesarean delivery (n=137, 33.9%). Neonates with ABO incompatibility had a significantly higher mean indirect bilirubin level compared to those with other risk factors (234.9±68.5 versus 225±82.2 mmol/L, respectively) (P=0.04). Phototherapy use significantly increased along with the rise of bilirubin level (P

Background and Objectives. Gastrointestinal (GI) endoscopy is a medical field that has been evolving in the last decades. Innovative advances in pediatric endoscopy led to more accurate diagnosis of various GI diseases. This study aimed to assess the appropriateness of endoscopic procedures’ indications and to evaluate the diagnostic and therapeutic yield of pediatric GI endoscopy, considering the limitations to access this facility. Material and Methods. Retrospective, cross-sectional, and analytical chart review was performed for children who underwent GI endoscopy at Salmaniya Medical Complex, Bahrain, from 1995 to 2020. Demographic data, endoscopic indications, and findings were collected and compared. Results. Of 1,111 patients, 1,101 (99.1%) were included in the study. 589 (53.6%) patients were males. Median age at the time of endoscopy was 8 (interquartile range 3, 11) years. 1534 endoscopies were performed (1193 upper GI endoscopies (UGIE) and 341 colonoscopies) in 1296 sessions. The mean number of endoscopies per year was 59±30.9 procedures with 81.4% reduction noted after coronavirus pandemic (P

Ectopia cordis is a rare type of malformation where the heart is not located normally. It may be partially or completely located outside the thoracic cavity and can be associated with other congenital abnormalities. It results from failure of maturation of midline mesoderm and ventral body formation during embryogenic formation. The exact etiology remains unknown. The literature review reveals the prognosis for infants with ectopia cordis is very poor. Here, we are reporting the first case of a fetus that was prenatally diagnosed with ectopia cordis that was associated with omphalocele documented in our country. Considering the poor prognosis for the fetus, conservative management during the prenatal period was chosen.

The performance of glomerular filtration rate- (GFR-) estimating equations was studied against creatinine clearance measured by 24-hour urine collection (CrCl24h-urine) in critically ill patients. Methods. In this substudy of the PermiT trial (https://clinicaltrials.gov/ct2/show/ISRCTN68144998), patients from King Abdulaziz Medical City-Riyadh who had CrCl24h-urine were included. We estimated GFR using Cockroft–Gault (CG), modification of diet in renal disease study (MDRD), chronic kidney disease epidemiology collaboration (CKD-EPI), and Jelliffe equations. For the CG equation, we entered the actual weight in one calculation (CGactual-wt), and if BMI ≥30 kg/m2, we entered the ideal body weight (CGideal-wt) and the adjusted body weight (CGadjusted-wt) in two calculations. We calculated the MDRD equation based on 4 (MDRD-4) and 6 variables (MDRD-6). The performance of these equations was assessed by different ways including Spearman correlation, bias (difference between estimated GFR and CrCl24h-urine), precision (standard deviation of bias), and Bland–Altman plot analysis. Results. The cohort consisted of 237 patients (age 45 ± 20 years, males 75%, mechanically ventilated 99% with serum creatinine 101 ± 94 µmol/L and CrCl24h-urine 108 ± 69 ml/min/1.73 m2). The correlations between the different equations and CrCl24h-urine were modest (r: 0.62 to 0.79; p

Background. Refractoriness to platelet transfusion is an understudied phenomenon in critically ill patients. Our objective was to evaluate the prevalence, risk factors, and clinical outcomes of platelet refractoriness among patients in a tertiary-care intensive care unit (ICU). Methods. A retrospective cohort study included all patients (age >14 years) who were admitted to a tertiary-care medical-surgical ICU between 2011 and 2016 and received ≥2 platelet transfusions during their ICU stay. We calculated platelet increment (PI) and corrected count increment (CCI). Results. A total of 267 patients were enrolled in the study, collectively receiving 1357 transfusions with a median of 4.0 (interquartile range: 2.0, 6.0) transfusions per patient. The median pretransfusion platelet count was 31000.0 × 106/L (interquartile range: 16000.0, 50000.0). The median PI was 6000 × 106/L. The prevalence of platelet transfusion refractoriness was 54.8% based on PI 50%) prevalent in ICU patients. However, it was not associated with increased mortality.

Background and Objectives. Benign strictures are the main cause of esophageal strictures in children. They can be managed by different modalities but endoscopic dilatation is the standard therapy. This study is aimed at reviewing the efficacy and safety of endoscopic dilatations in children with esophageal strictures. Materials and Methods. In this retrospective cross-sectional single center study, records of patients with esophageal strictures presented to the pediatric department, Salmaniya Medical Complex, Bahrain, in the period between 1995 and 2019 were reviewed. Demographic data, indications of endoscopic dilatations, the procedure success rate, and possible complications were assessed. Results. Forty-six children were found to have esophageal strictures. Twenty-five (54.3%) patients were males. Most patients presented during infancy (86.5%, 32/37 patients). Twenty-six (56.5%) patients required 88 dilatation sessions, while the remaining 20 (43.5%) patients did not require dilatations. The median number of dilatation sessions per patient was three (interquartile range=2–5). Savary-Gilliard bougienages were the main dilators used (80.8%, 21/26 patients). Anastomotic stricture (post esophageal atresia/tracheoesophageal fistula repair) was the main cause of esophageal strictures and was found in 35 (76.1%) patients. Patients with nonanastomotic strictures had more frequent dilatations compared to those with anastomotic strictures (P=0.007). The procedure success rate was 98.8%. Yet, it was operator dependent (P=0.047). Complete response to dilatation was found in 18 (69.2%) patients, satisfactory in seven (26.9%), and an inadequate response in one (3.9%). Those with satisfactory responses still require ongoing dilatations based on their symptoms and radiological and endoscopic findings. No perforation or mortality was reported. Patients with dilatations had more recurrent hospitalization (P

Objective. The purpose of this study is to determine whether (1) liposomal bupivacaine is chondrotoxic; (2) the chondrotoxicity of liposomal bupivacaine differs from standard bupivacaine; and (3) chondrotoxic effects are time dependent. Materials and Methods. We obtained 72 10 mm articular cartilage plugs from 12 fresh bovine distal femoral knee joints and exposed them to either saline, 0.5% bupivacaine, or liposomal bupivacaine for either 30 or 90 minutes. Twenty-four hours after treatment, chondrocyte viability was measured with the use of a fluorescent live/dead assay. An ANOVA test of variance was performed followed by a Holm–Sidak test to make pairwise comparisons across conditions. Student’s t-test was used to compare means. Results. Percent viability of cells exposed to liposomal bupivacaine for 30 minutes was less versus saline control (53.9% ± 21.5% vs. 73.7 ± 18.4%, p=0.035), and this remained significant at 90 minutes (49.1% ± 20.3% vs. 67.2% ± 25.6%, p

Although Schistosoma infection in humans commonly involves the intestines, megacolon is a rare finding. We report a 47-year-old patient who was found to have chronic megacolon. After failing conservative management, he underwent extended hemicolectomy with colorectal anastomosis. The colon pathology revealed chronic schistosomiasis and Schistosoma serology was positive.

Background. Filter clotting is frequent during continuous renal replacement therapy (CRRT), which increases anemia risk. We studied anemia and blood transfusion in critically ill patients requiring CRRT for acute kidney injury and assessed the relationship between CRRT filter life span and PRBC transfusion. Methods. A case-control study was conducted at a tertiary-care intensive care unit (ICU) where CRRT cases were matched with controls for age, gender, admission category, and severity of illness. Daily hemoglobin levels, blood transfusions, and life span of CRRT filter were noted. CCRT patients were categorized according to the median of the filter life span (20 hours). Results. Ninety-five cases and 102 controls were enrolled. The hemoglobin level on admission was similar in the two groups, yet cases had significantly lower hemoglobin levels than controls (72.8 ± 15.3 versus 82.5 ± 20.7 g/L, p

Sustainable pavements are pavements that meet the requirements of present generation without influencing the capability of the future generation to meet their needs. One of the problems of the warm mix asphalt is that it has low resistance to moisture damage; therefore, the aim of this research paper is to study the possibility of producing more durable warm mixes against the moisture damage with the use of recycled concrete aggregate (RCA) which has not been studied before. Six replacement rates (0, 20, 40, 60, 80, and 100%) for the coarse version aggregate (VA) with RCA were studied. The Marshall mix design method was used to determine the optimum asphalt cement content for each replacement rate. Thereafter, specimens with the optimum asphalt cement content were prepared and tested in the indirect tension test to evaluate their moisture susceptibility. The results revealed that the mixes with higher percentage of RCA possess higher optimum asphalt content. Moreover, an improvement of 13 and 28% in Marshall stability and tensile strength ratio (TSR), respectively, was obtained in case that the VA was entirely replaced by the RCA.

The purpose of this study was to clarify the role of pattern recognition receptors in Behçet’s disease (BD). The frequencies of several pattern recognition receptors (CD11b, CD11c, CD32, CD206, CD209, and dectin-1) were analyzed in patients with BD by flow cytometry, and cytokine levels, interleukin- (IL-) 18, IL-23, and IL-17A, were compared in plasma. The analysis was performed in active (n=13) and inactive (n=13) stages of BD patients. Rheumatoid arthritis patients (n=19), as a disease control, and healthy control (HC) (n=19) were enrolled. The frequencies of CD11b+ and CD32+ cells were significantly increased in active BD patients compared to HC. Disease severity score was correlated to CD11c+, CD206+, and CD209+ in whole leukocytes and CD11b+, CD11c+, CD206+, CD209+, and Dectin-1+ in granulocytes. The plasma levels of IL-17A were significantly different between HC and active BD. IL-18 showed significant difference between active and inactive BD patients. From this study, we concluded the expressions of several pattern recognition receptors were correlated to the joint symptoms of BD.

Rationale. By reducing cerebral oxygen delivery, anemia may aggravate traumatic brain injury (TBI) secondary insult. This study evaluated the impact of anemia and blood transfusion on TBI outcomes. Methods. This was a retrospective cohort study of adult patients with isolated TBI at a tertiary-care intensive care unit from 1/1/2000 to 31/12/2011. Daily hemoglobin level and packed red blood cell (PRBC) transfusion were recorded. Patients with hemoglobin < 10 g/dL during ICU stay (anemic group) were compared with other patients. Results. Anemia was present on admission in two (2%) patients and developed in 48% during the first week with hemoglobin < 7 g/dL occurring in 3.0%. Anemic patients had higher admission Injury Severity Score and underwent more craniotomy (50% versus 13%, p

Titanium dioxide (TiO2) films with dominant {001} facets coated on a titanium sheet (Ti) were synthesized with the simple hydrothermal method by using Ti as the precursor and substrate. The effect of addition of isopropanol into the hydrothermal solution on the structure, photocatalytic activity, and stability of as-synthesized TiO2 films was investigated. The presence of isopropanol obviously influenced the microstructure of as-synthesized TiO2 films, which was converted from microspheres into irregular close stack of truncated tetrahedrons. And the percentage of exposed {001} facets calculated from the Raman spectra increased from 48.2% to 57%. Accordingly, the TiO2 films prepared with addition of isopropanol showed high and stable photocatalytic activity, which is nearly 2.6 times as that of the conventional P25 TiO2 coated on Ti-substrate. In addition, the photocatalytic activity of as-synthesized TiO2 films was greatly enhanced after calcination treatment at 600°C, which can be attributed to removal of fluoride ions and organic residuals adsorbed on the surface of the catalyst. Photoluminescence (PL) technique was used for the detection of produced hydroxyl radicals (•OH) on the surface of UV-illuminated TiO2 using terephthalic acid as probe molecule. The photocatalytic degradation intermediates of bezafibrate were analyzed by an ultraperformance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS), and accordingly the degradation pathways were proposed.

Abstract A Lypunov‐based Adaptive Backstepping Control (ABSC) approach is designed for a power Buck converter. This strategy is an advanced version of the Backstepping method utilising Lyapunov stability function to reach a higher stability and a better disturbance rejection behaviour in the practical applications. In addition, to reduce the computational burden and increase ease of implantation, Black‐box technique is considered assuming no accurate mathematical model for the system. Nonetheless, in real‐time environments, disturbances with wider ranges including: supply voltage variation, parametric variation, and noise can negatively impact the operation of this method. To compensate for this problem, the gains of the controller should be tuned again for better adaptability with the working condition. Therefore, to satisfy this need and enhance the controller's performance, a metaheuristic algorithm is applied in the control scheme called Grey Wolf Optimisation (GWO) algorithm. GWO is a well‐behaved nature‐inspired algorithm with faster decision‐making dynamics along with more accuracy over different optimisation algorithms. To better elaborate the merits of this approach, conventional BSM and PSO‐based PID schemes are also designed and tested in different situations.

Abstract Propolis, a natural product with many biological activities, is a resinous material produced by honeybees. It contains not only valuable components but also some possible contaminants in varying amounts. Hence, this study aimed to examine how the process step of wax separation affects certain elements, pesticide residues, and phenolic compounds in propolis. Total phenolics, elements, and some pesticide residues were analyzed in the crude propolis (CP samples), wax portion (W samples), and remaining propolis fraction (PF samples) after wax separation. Total phenolics of the CP samples were determined in the range of 31.90–45.00 mg GAE g−1 sample, while those of the PF samples were in the range of 54.97–162.09 mg GAE g−1 sample. Loss/reduction values by means of wax separation for phenolics were calculated as 10.88% and 17.89%, respectively. Pb contents of all PF samples were low (0.232–1.520 mg kg−1), but it was also noteworthy that nearly 40% or even more of Cr, As, Cd, and Pb were removed by wax separation. Removal of significant amounts of carbendazim (38.09%–67.35%), metalaxyl (81.57%–72.67%), tebuconazole (65.99%–78.36%), and propargite (88.46%–83.05%) was also achieved. Wax separation enables the removal of toxic substances from crude propolis without causing huge losses in phenolic compounds.

Abstract Introduction Our simulation‐based mastery learning (SBML) curriculum, delivered in person, has been shown to successfully train novices in structured esophagogastroduodenoscopy (EGD). SBML with virtual coaching (VC) has the potential to improve the effectiveness and efficiency of endoscopy training and expand access to trainees from around the world. We share our observations conducting an EGD training course using SBML with VC. Methods We conducted a 1‐week virtual SBML course for novice trainees across seven academic centers in the USA and Asia. The cognitive component was delivered using an online learning platform. For technical skills, a virtual coach supervised hands‐on training and local coaches provided assistance when needed. At the end of training, an independent rater assessed simulation‐based performance using a validated assessment tool. We assessed the clinical performance of 30 EGDs using the ASGE Assessment of Competency in Endoscopy tool. We compared the trainees’ scores to our cohort trained using in‐person SBML training using non‐inferiority t‐tests. Results We enrolled 21 novice trainees (mean age: 30.8 ± 3.6 years; female: 52%). For tip deflection, the trainees reached the minimum passing standard after 31 ± 29 runs and mastery after 52 ± 37 runs. For structured EGD, the average score for the overall exam was 4.6 ± 0.6, similar to the in‐person cohort (4.7 ± 0.5, p = 0.49). The knowledge‐based assessment was also comparable (virtual coaching: 81.9 ± 0.1; direct coaching: 78.3 ± 0.1; p = 0.385). Over time, our novice trainees reached clinical competence at a similar rate to our historical in‐person control. Conclusions VC appears feasible and effective for training novice gastroenterology trainees. VC allowed us to scale our SBML course, expand access to experts, and administer SBML simultaneously across different sites at the highest standards.

Abstract Background and Aim Gastointestinal endoscopy is a complex practical skill, and training and experience are required to ensure the accuracy and safety of the procedures. Therefore, proper endoscopy training is needed to provide highly skilled endoscopists. This study explores the learning experience and assesses the need for endoscopy training in Indonesia from an endoscopy trainee's point of view. Limitations from the current training model and the trainees' suggestions hopefully will become a foundation for the future endoscopy training model in Indonesia. Methods A total of 132 current endoscopy trainees and graduates of endoscopy training from various centers in Indonesia completed an online qualitative survey regarding their endoscopy training experience, their satisfaction with the current training method, barriers to achieving competency, and their suggestions for future training. Data were subjected to descriptive and qualitative analysis using content analysis. Results We found variations in the trainee's learning experience regarding the training supervision, feedback, and assessment methods. The most common endoscopy training methods were observation and direct practice with supervision. There was only a low proportion of simulator use (25%). The most found concept in barriers to achieving competency was “insufficient number of patients.” Meanwhile, the most found concept in suggestions for future training methods was “increasing the variety of cases and procedures.” Conclusion Our findings suggest that there are still variations in endoscopy training methods in Indonesia. Therefore, we propose to design a standardized endoscopy training program to ensure the competence of endoscopy trainees and better care for endoscopic patients. Simulators might be used to increase the trainees' competence in settings with low numbers of patients or cases.