The status of training in new technologies in advanced endoscopy: from defining competence to credentialing and privileging

Dennis Yang, Mihir S Wagh, Peter V Draganov, Dennis Yang, Mihir S Wagh, Peter V Draganov

Abstract

The landscape of advanced endoscopy continues to evolve as new technologies and techniques become available. Although postgraduate advanced endoscopy fellowships have traditionally centered on ERCP and diagnostic EUS, the breadth of training has increased over the years in response to the ever-growing demand for therapeutic endoscopy. The increasing diversity and complexity of emerging endoscopic techniques accompanied by the shift in focus toward competency-based medical education requires innovative changes to the curriculum that will ensure adequate training yet without compromising best patient practices. The purpose of this review is to highlight the expansive array of advanced endoscopic procedures and the challenges of both defining and measuring competence during training. All authors are interventional endoscopists at their respective institutions performing these complex procedures, as well as training fellows in these techniques. We share our perspectives based on our experience navigating through these issues at our institutions and discuss strategies to standardize training and how to potentially incorporate these measures in the process of credentialing and privileging in endoscopy.

Copyright © 2020 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

Figures

Graphical abstract
Graphical abstract
Figure 1
Figure 1
Flow diagram for the creation of a structured training curriculum for novel endoscopic procedures using endoscopic submucosal dissection (ESD) as an example. ∗The ESD assessment tool in the diagram is used to illustrate potential core skills that could be graded using a numerical score. This is not a complete list or a validated tool.

References

    1. American College of Physicians. Clinical competence in diagnostic endoscopic retrograde cholangiopancreatography Health and Public Policy Committee, American College of Physicians. Ann Intern Med. 1988;108:142–144.
    1. Watkins J.L., Etzkorn K.P., Wiley T.E. Assessment of technical competence during ERCP training. Gastrointest Endosc. 1996;44:411–415.
    1. Jowell P.S., Baillie J., Branch M.S. Quantitative assessment of procedural competence: a prospective study of training in endoscopic retrograde cholangiopancreatography. Ann Intern Med. 1996;125:983–989.
    1. Garcia-Cano J. 200 supervised procedures: the minimum threshold number for competency in performing endoscopic retrograde cholangiopancreatography. Surg Endosc. 2007;21:1254–1255.
    1. Eisen G.M., Baron T.H., Dominitz J.A. Methods of granting hospital privileges to perform gastrointestinal endoscopy. Gastrointest Endosc. 2002;55:780–783.
    1. NIH state-of-the-science statement on endoscopic retrograde cholangiopancreatography (ERCP) for diagnosis and therapy. NIH Consens State Sci Statements. 2002;19:1–26.
    1. Verma D., Gostout C.J., Petersen B.T. Establishing a true assessment of endoscopic competence in ERCP during training and beyond: a single-operator learning curve for deep biliary cannulation in patients with native papillary anatomy. Gastrointest Endosc. 2007;65:394–400.
    1. Shahidi N., Ou G., Telford J. When trainees reach competency in performing ERCP: a systematic review. Gastrointest Endosc. 2015;81:1337–1342.
    1. ASGE Training Committee. Jorgensen J., Kubiliun N., Law J.K. Endoscopic retrograde cholangiopancreatography (ERCP): core curriculum. Gastrointest Endosc. 2016;83:279–289.
    1. ASGE Training Committee. DiMaio C.J., Mishra G., McHenry L. EUS core curriculum. Gastrointest Endosc. 2012;76:476–481.
    1. Nasca T.J., Philibert I., Brigham T. The next GME accreditation system—rationale and benefits. N Engl J Med. 2012;366:1051–1056.
    1. ASGE Standards of Practice Committee. Faulx A.L., Lightdale J.R., Acosta R.D. Guidelines for privileging, credentialing, and proctoring to perform GI endoscopy. Gastrointest Endosc. 2017;85:273–281.
    1. ASGE Guidelines for clinical application. Methods of privileging for new technology in gastrointestinal endoscopy. American Society for Gastrointestinal Endoscopy. Gastrointest Endosc. 1999;50:899–900.
    1. Wani S., Keswani R.N., Petersen B. Training in EUS and ERCP: standardizing methods to assess competence. Gastrointest Endosc. 2018;87:1371–1382.
    1. Siau K., Crossley J., Dunckley P. Direct observation of procedural skills (DOPS) assessment in diagnostic gastroscopy: nationwide evidence of validity and competency development during training. Surg Endosc. 2020;34:105–114.
    1. Siau K., Crossley J., Dunckley P. Colonoscopy direct observation of procedural skills assessment tool for evaluating competency during training. Am J Gastroenterol. 2019;115:234–243.
    1. Yang D., Othman M., Draganov P.V. Endoscopic mucosal resection vs. endoscopic submucosal dissection for Barrett’s esophagus and colorectal neoplasia. Clin Gastroenterol Hepatol. 2019;17:1019–1028.
    1. Kotzev A.I., Yang D., Draganov P.V. How to master endoscopic submucosal dissection in the USA. Dig Endosc. 2019;31:94–100.
    1. Pimentel-Nunes P., Pioche M., Albeniz E. Curriculum for endoscopic submucosal dissection training in Europe: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endoscopy. 2019;51:980–992.
    1. Draganov P.V., Coman R.M., Gotoda T. Training for complex endoscopic procedures: how to incorporate endoscopic submucosal dissection skills in the West? Expert Rev Gastroenterol Hepatol. 2014;8:119–121.
    1. Coman R.M., Gotoda T., Draganov P.V. Training in endoscopic submucosal dissection. World J Gastrointest Endosc. 2013;5:369–378.
    1. Gromski M.A., Cohen J., Saito K. Learning colorectal endoscopic submucosal dissection: a prospective learning curve study using a novel ex vivo simulator. Surg Endosc. 2017;31:4231–4237.
    1. Martinek J., Suchanek S., Stefanova M. Training on an ex vivo animal model improves endoscopic skills: a randomized, single-blind study. Gastrointest Endosc. 2011;74:367–373.
    1. Inoue H., Minami H., Kobayashi Y. Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy. 2010;42:265–271.
    1. Akintoye E., Kumar N., Obaitan I. Peroral endoscopic myotomy: a meta-analysis. Endoscopy. 2016;48:1059–1068.
    1. Crespin O.M., Liu L.W.C., Parmar A. Safety and efficacy of POEM for treatment of achalasia: a systematic review of the literature. Surg Endosc. 2017;31:2187–2201.
    1. NOSCAR POEM White Paper Committee. Stavropoulos S.N., Desilets D.J., Fuchs K.H. Per-oral endoscopic myotomy white paper summary. Gastrointest Endosc. 2014;80:1–15.
    1. Mittal C., Wagh M.S. Training pathways and competency assessment in peroral endoscopic myotomy (POEM) Techn Gastrointest Endosc. 2017;19:170–174.
    1. Inoue H., Shiwaku H., Iwakiri K. Clinical practice guidelines for peroral endoscopic myotomy. Dig Endosc. 2018;30:563–579.
    1. Hernandez Mondragon O.V., Rascon Martinez D.M., Muňoz Bautista A. The Per Oral Endoscopic Myotomy (POEM) technique: how many preclinical procedures are needed to master it? Endosc Int Open. 2015;3:E559–E565.
    1. Teitelbaum E.N., Soper J.N., Arafat F.O. Analysis of a learning curve and predictors of intraoperative difficulty for peroral esophageal myotomy (POEM) J Gastrointest Surg. 2014;18:92–98.
    1. El Zein M., Kumbhari V., Ngamruengphong S. Learning curve for peroral endoscopic myotomy. Endosc Int Open. 2016;4:E577–E582.
    1. Kurian A.A., Dunst C.M., Sharata A. Peroral endoscopic esophageal myotomy: defining the learning curve. Gastrointest Endosc. 2013;77:719–725.
    1. Patel K.S., Calixte R., Modayil R.J. The light at the end of the tunnel: a single-operator learning curve analysis for peroral endoscopic myotomy. Gastrointest Endosc. 2015;81:1181–1187.
    1. Liu Z., Zhang X., Zhang W. Comprehensive evaluation of the learning curve for peroral endoscopic myotomy. Clin Gastroenterol Hepatol. 2018;16:1420–1426.
    1. Goyal D., Watson R.R. Endoscopic bariatric therapies. Curr Gastroenterol Rep. 2016;18:26.
    1. Sullivan S., Edmundowicz S.A., Thompson C.C. Endosocpic bariatric and metabolic therapies: new and emerging technologies. Gastroenterology. 2017;152:1791–1801.
    1. ASGE Bariatric Endoscopy Task Force. Sullivan S., Kumar N., Edmundowicz S.A. ASGE position statement on endoscopic bariatric therapies in clinical practice. Gastrointest Endosc. 2015;82:767–772.
    1. ASGE/ASMBS Task Force on Endoscopic Bariatric Therapy. Ginsberg G.G., Chand B., Cote G.A. A pathway to endoscopic bariatric therapies. Gastrointest Endosc. 2011;74:943–953.
    1. Shahnazarian V., Ramai D., Sarkar A. Endoscopic bariatric therapies for treating obesity: a learning curve for gastroenterologists. Transl Gastroenterol Hepatol. 2019;4:16.
    1. Hill C., El Zein M., Agnihotri A. Endoscopic sleeve gastroplasty: the learning curve. Endosc Int Open. 2017;5:E900–E904.
    1. Saumoy M., Schneider Y., Zhou X.K. A single-operator learning curve analysis for the endoscopic sleeve gastroplasty. Gastrointest Endosc. 2018;87:442–447.
    1. Wani S., Hall M., Wang A.Y. Variation in learning curves and competence for ERCP among advanced endoscopy trainees by using cumulative sum analysis. Gastrointest Endosc. 2016;83:711–719.
    1. Wani S., Keswani R., Hall M. 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 (RATES) study. Clin Gastroenterol Hepatol. 2017;15:1758–1767.
    1. Wani S., Han S., Simon V. Setting minimum standards for training in EUS and ERCP: results from a prospective multicenter study evaluating learning curves and competence among advanced endoscopy trainees. Gastrointest Endosc. 2019;89:1160–1168.
    1. Gavin D.R., Valori R.M., Anderson J.T. The national colonoscopy audit: a nationwide assessment of the quality and safety of colonoscopy in the UK. Gut. 2013;62:242–249.
    1. Valori R. Quality improvements in endoscopy in England. Techn Gastrointest Endosc. 2012;14:63–72.
    1. Waschke K.A., Anderson J., Macintosh D. Training the gastrointestinal endoscopy trainer. Best Pract Res Clin Gastroenterol. 2016;30:409–419.
    1. Kaminski M.F., Anderson J.A., Valori R. Leadership training to improve adenoma detection rate in screening colonoscopy: a randomized trial. Gut. 2016;65:616–624.
    1. Waschke K.A., Anderson J., Valori M. ASGE principles of endoscopic training. Gastrointest Endosc. 2019;90:27–34.
    1. Khan R., Plahouras J., Johnston B.C. Virtual reality simulation training for health professions trainees in gastrointestinal endoscopy. Cochrane Database Syst Rev. 2018;8:CD008237.
    1. Mahmood T., Darzi A. The learning curve for a colonoscopy simulator in the absence of any feedback: no feedback, no learning. Surg Endosc. 2004;18:1224–1230.
    1. Cohen J., Bosworth B.P., Chak A. Preservation and incorporation of valuable endoscopic innovations (PIVI) on the use of endoscopy simulators for training and assessing skill. Gastrointest Endosc. 2012;76:471–475.
    1. Scaffidi M.A., Grover S.C., Carnahan H. A prospective comparison of live and video-based assessments of colonoscopy performance. Gastrointest Endosc. 2018;87:766–775.
    1. Huang R.J., Limsui D., Triadafilopoulos G. Video-based performance assessment in endoscopy: Moving beyond “see one, do one, teach one”? Gastrointest Endosc. 2018;87:776–777.
    1. Castro Filho E.C., Castro R., Fernandes F.F. Gastrointestinal endoscopy during the COVID-19 pandemic: an updated review of guidelines and statements from international and national societies. Gastrointest Endosc. 2020;92:440–445.e6.
    1. Yang D., Draganov P.V. Introducing POEM in your institution: the blueprint for launching a new program in the endoscopy suite. Pract Gastroenterol. 2016;32:52–56.
    1. Cappell M.S., Friedel D.M. Stricter national standards are required for credentialing of endoscopic-retrograde-cholangiopancreatography in the United States. World J Gastroenterol. 2019;25:3468–3483.

Source: PubMed

Patrocinadores e Colaboradores

Condições médicas

Intervenções de drogas

3
Se inscrever