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Multicenter Study
. 2017 Nov;15(11):1758-1767.e11.
doi: 10.1016/j.cgh.2017.06.012. Epub 2017 Jun 16.

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  1 , Rajesh Keswani  2 , Matt Hall  3 , Samuel Han  3 , Meer Akbar Ali  4 , Brian Brauer  3 , Linda Carlin  5 , Amitabh Chak  4 , Dan Collins  6 , Gregory A Cote  7 , David L Diehl  8 , Christopher J DiMaio  9 , Andrew Dries  6 , Ihab El-Hajj  10 , Swan Ellert  5 , Kimberley Fairley  8 , Ashley Faulx  4 , Larissa Fujii-Lau  11 , Srinivas Gaddam  11 , Seng-Ian Gan  12 , Jonathan P Gaspar  13 , Chitiki Gautamy  14 , Stuart Gordon  15 , Cynthia Harris  14 , Sarah Hyder  15 , Ross Jones  6 , Stephen Kim  16 , Srinadh Komanduri  2 , Ryan Law  2 , Linda Lee  17 , Rawad Mounzer  3 , Daniel Mullady  11 , V Raman Muthusamy  16 , Mojtaba Olyaee  18 , Patrick Pfau  19 , Shreyas Saligram  14 , Cyrus Piraka  20 , Amit Rastogi  18 , Laura Rosenkranz  21 , Fadi Rzouq  18 , Aditi Saxena  22 , Raj J Shah  3 , Violette C Simon  3 , Aaron Small  12 , Jayaprakash Sreenarasimhaiah  23 , Andrew Walker  19 , Andrew Y Wang  13 , Rabindra R Watson  16 , Robert H Wilson  3 , Patrick Yachimski  22 , Dennis Yang  9 , Steven Edmundowicz  3 , Dayna S Early  11
Affiliations
Multicenter Study

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 et al. Clin Gastroenterol Hepatol. 2017 Nov.

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.

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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.

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.
See this image and copyright information in PMC

References

    1. Elta GH, Jorgensen J, Coyle WJ. Training in interventional endoscopy: current and future state. Gastroenterology 2015; 148:488–490. - PubMed
    1. Wani S, Keswani R, Elta G, et al. Perceptions of training among program directors and trainees in complex endoscopic procedures (CEPs): a nationwide survey of US ACGME accredited gastroenterology training programs. Gastroenterology 2015; 148:S–150.
    1. Wani S, Hall M, Wang AY, et al. Variation in learning curves and competence for ERCP among advanced endoscopy trainees by using cumulative sum analysis. Gastrointest Endosc 2016; 83:711–719 e11. - PubMed
    1. Wani S, Hall M, Keswani RN, et al. Variation in aptitude of trainees in endoscopic ultrasonography, based on cumulative sum analysis. Clin Gastroenterol Hepatol 2015;13:1318–1325 e2. - PMC - PubMed
    1. Wani S, Cote GA, Keswani R, et al. Learning curves for EUS by using cumulative sum analysis: implications for American Society for Gastrointestinal Endoscopy recommendations for training. Gastrointest Endosc 2013;77:558–565. - PubMed

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