A Prospective Multicenter Study Evaluating Learning Curves and Competence in Endoscopic Ultrasound and Endoscopic Retrograde Cholangiopancreatography Among Advanced Endoscopy Trainees: The Rapid Assessment of Trainee Endoscopy Skills Study

Sachin Wani, Rajesh Keswani, Matt Hall, Samuel Han, Meer Akbar Ali, Brian Brauer, Linda Carlin, Amitabh Chak, Dan Collins, Gregory A Cote, David L Diehl, Christopher J DiMaio, Andrew Dries, Ihab El-Hajj, Swan Ellert, Kimberley Fairley, Ashley Faulx, Larissa Fujii-Lau, Srinivas Gaddam, Seng-Ian Gan, Jonathan P Gaspar, Chitiki Gautamy, Stuart Gordon, Cynthia Harris, Sarah Hyder, Ross Jones, Stephen Kim, Srinadh Komanduri, Ryan Law, Linda Lee, Rawad Mounzer, Daniel Mullady, V Raman Muthusamy, Mojtaba Olyaee, Patrick Pfau, Shreyas Saligram, Cyrus Piraka, Amit Rastogi, Laura Rosenkranz, Fadi Rzouq, Aditi Saxena, Raj J Shah, Violette C Simon, Aaron Small, Jayaprakash Sreenarasimhaiah, Andrew Walker, Andrew Y Wang, Rabindra R Watson, Robert H Wilson, Patrick Yachimski, Dennis Yang, Steven Edmundowicz, Dayna S Early, Sachin Wani, Rajesh Keswani, Matt Hall, Samuel Han, Meer Akbar Ali, Brian Brauer, Linda Carlin, Amitabh Chak, Dan Collins, Gregory A Cote, David L Diehl, Christopher J DiMaio, Andrew Dries, Ihab El-Hajj, Swan Ellert, Kimberley Fairley, Ashley Faulx, Larissa Fujii-Lau, Srinivas Gaddam, Seng-Ian Gan, Jonathan P Gaspar, Chitiki Gautamy, Stuart Gordon, Cynthia Harris, Sarah Hyder, Ross Jones, Stephen Kim, Srinadh Komanduri, Ryan Law, Linda Lee, Rawad Mounzer, Daniel Mullady, V Raman Muthusamy, Mojtaba Olyaee, Patrick Pfau, Shreyas Saligram, Cyrus Piraka, Amit Rastogi, Laura Rosenkranz, Fadi Rzouq, Aditi Saxena, Raj J Shah, Violette C Simon, Aaron Small, Jayaprakash Sreenarasimhaiah, Andrew Walker, Andrew Y Wang, Rabindra R Watson, Robert H Wilson, Patrick Yachimski, Dennis Yang, Steven Edmundowicz, Dayna S Early

Abstract

Background & aims: On the basis of the Next Accreditation System, trainee assessment should occur on a continuous basis with individualized feedback. We aimed to validate endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) learning curves among advanced endoscopy trainees (AETs) by using a large national sample of training programs and to develop a centralized database that allows assessment of performance in relation to peers.

Methods: ASGE recognized training programs were invited to participate, and AETs were graded on ERCP and EUS exams by using a validated competency assessment tool that assesses technical and cognitive competence in a continuous fashion. Grading for each skill was done by using a 4-point scoring system, and a comprehensive data collection and reporting system was built to create learning curves by using cumulative sum analysis. Individual results and benchmarking to peers were shared with AETs and trainers quarterly.

Results: Of the 62 programs invited, 20 programs and 22 AETs participated in this study. At the end of training, median number of EUS and ERCP performed/AET was 300 (range, 155-650) and 350 (125-500), respectively. Overall, 3786 exams were graded (EUS, 1137; ERCP-biliary, 2280; ERCP-pancreatic, 369). Learning curves for individual end points and overall technical/cognitive aspects in EUS and ERCP demonstrated substantial variability and were successfully shared with all programs. The majority of trainees achieved overall technical (EUS, 82%; ERCP, 60%) and cognitive (EUS, 76%; ERCP, 100%) competence at conclusion of training.

Conclusions: These results demonstrate the feasibility of establishing a centralized database to report individualized learning curves and confirm the substantial variability in time to achieve competence among AETs in EUS and ERCP. ClinicalTrials.gov: NCT02509416.

Keywords: Advanced Endoscopy Training; Competence; Competency-based Medical Education; ERCP; EUS; Learning Curves.

Conflict of interest statement

Conflicts of interest

This author discloses the following: Sachin Wani is supported by the University of Colorado Department of Medicine Outstanding Early Scholars Program and educational grants from Boston Scientific and Cook Medical. The remaining authors disclose no conflicts.

Copyright © 2017 AGA Institute. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1.
Figure 1.
Example of graphic representation of learning curves provided to participating center on quarterly basis that includes individual learning curves for the participating AET (green) and in comparison with the national average (orange).
Figure 2.
Figure 2.
Graphic representation of learning curves among AETs by using CUSUM analysis for overall technical and cognitive aspects of EUS by using acceptable and unacceptable failure rates of 10% and 30%, respectively.
Figure 3.
Figure 3.
Graphic representation of learning curves for ERCP (overall technical and cognitive aspects).
Figure 4.
Figure 4.
Graphic representation of learning curves for cannulation of bile duct in native papilla cases and sphincterotomy.

Source: PubMed

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