Exploration of an effective training system for the diagnosis of pancreatobiliary diseases with EUS: A prospective study

Abstract

Background and objective: There are limited data on multistage-based training programs focused on EUS. We aimed to explore an effective training system for diagnosing pancreaticobiliary diseases with EUS.

Materials and methods: Nine advanced endoscopy trainees (AETs) with less EUS experience from nine institutions were recruited. The training system consisted of multiple stages and multi-teaching methods, including biliopancreatic standard scanning, anatomy and imaging knowledge, simulator, hands-on operations, error correction, and case analysis over a 12-month training period. Grading for technical and cognitive skills was assessed using The EUS Skills Assessment Tool.

Results: After training, the overall scores for radial (4.16 ± 0.21 vs. 1.46 ± 0.16, P < 0.01) and linear (4.43 ± 0.20 vs. 1.63 ± 0.23, P < 0.01) scanning were significantly improved. The aortopulmonary window/mediastinum station can be learned more easily by AETs compared with other stations (P = 0023). The scanning of the descending part of the duodenum seemed to improve the slowest after training (P = 0.0072), indicating that the descending part of the duodenum can be more difficult and should be the focus of training. Every teaching method heightened EUS competence, especially case analysis and hands-on operations. AETs achieved equivalent EUS competence after training despite their initial experience. Through a poststudy questionnaire, it was found that all AETs strongly agreed they were satisfied with the training system, and their confidence was greatly enhanced when EUS was performed independently.

Conclusions: The current multistage and multi-methods training system showed efficient performance in the cognitive and technical competence of EUS. Descending part of duodenum scanning was difficult for beginners and should be the focus of training.

Keywords: EUS; biliopancreatic; education; training.

Conflict of interest statement

None

Figures

Figure 1

A systematic training program on EUS standard scanning was established

Figure 2

Training materials. (a) Typical pictures of stations for radial and linear scan; (b) Simulator for hands-on operation

Figure 3

The answers for questionnaire at study inception and the results of total training achievements. (a) AETs completed the questionnaire of twelve questions that assessed baseline characteristics and prior experience with EUS; (b) The number of cases for each trainee during the training; (c-e) The scores of advanced endoscopy trainees achieving competence for overall, technical and cognitive competence during training

Figure 4

Graphical representation of learning curves among the trainees by using each score station across all stages. (a)for AP window; (b) for cellac axis; (c) for pancreatic body (d) for panceatic tail (e) for portosplenic confluence (f) for pancreatic head/neck (g) for common bile duct/common hepatic duct (h) for gallbladder (i) for ampulla (j) uncinate process (k) for linear (l) for radial

Figure 5

Postquestionnaire results and comparison of scores between the less and more experienced group. (a) Postquestionnaire results about trainer's assessment of the effectiveness for different teaching methods; (b) Comparison of scores between the less and more experienced group during the training at radial and linear scan