Variation in learning curves and competence for ERCP among advanced endoscopy trainees by using cumulative sum analysis - 31/05/16

Doi : 10.1016/j.gie.2015.10.022

Sachin Wani, MD ^1,^⁎, Matthew Hall, PhD ¹, Andrew Y. Wang, MD ², Christopher J. DiMaio, MD ³, V. Raman Muthusamy, MD ⁶, Rajesh N. Keswani, MD ⁴, Brian C. Brauer, MD ¹, Jeffrey J. Easler, MD ⁵, Roy D. Yen, MD ¹, Ihab El Hajj, MD ¹, Norio Fukami, MD ¹, Kourosh F. Ghassemi, MD ⁶, Susana Gonzalez, MD ³, Lindsay Hosford, BA ¹, Thomas G. Hollander, MS ⁵, Robert Wilson, BA ¹, Vladimir M. Kushnir, MD ³, Jawad Ahmad, MD ³, Faris Murad, MD ⁵, Anoop Prabhu, MD ³, Rabindra R. Watson, MD ⁶, Daniel S. Strand, MD ², Stuart K. Amateau, MD ¹, Augustin Attwell, MD ¹, Raj J. Shah, MD ¹, Dayna Early, MD ⁵, Steven A. Edmundowicz, MD ⁵, Daniel Mullady, MD ⁵
¹ University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
² University of Virginia Health System, Charlottesville, Virginia, USA
³ Icahn School of Medicine at Mount Sinai, New York, New York, USA
⁴ Feinberg School of Medicine Northwestern University, Chicago, Illinois, USA
⁵ Washington University School of Medicine, St. Louis, Missouri, USA
⁶ University of California, Los Angeles, Los Angeles, California, USA

^∗Reprint requests: Sachin Wani, MD, Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Mail Stop F735, 1635 Aurora Court, Roo 2.01, Aurora, CO 80045.Division of Gastroenterology and HepatologyUniversity of Colorado Anschutz Medical CenterMail Stop F735, 1635 Aurora Court, Roo 2.01AuroraCO 80045

Abstract

Background and Aims

There are limited data on learning curves and competence in ERCP. By using a standardized data collection tool, we aimed to prospectively define learning curves and measure competence among advanced endoscopy trainees (AETs) by using cumulative sum (CUSUM) analysis.

Methods

AETs were evaluated by attending endoscopists starting with the 26th hands-on ERCP examination and then every ERCP examination during the 12-month training period. A standardized ERCP competency assessment tool (using a 4-point scoring system) was used to grade the examination. CUSUM analysis was applied to produce learning curves for individual technical and cognitive components of ERCP performance (success defined as a score of 1, acceptable and unacceptable failures [p1] of 10% and 20%, respectively). Sensitivity analyses varying p1 and by using a less-stringent definition of success were performed.

Results

Five AETs were included with a total of 1049 graded ERCPs (mean ± SD, 209.8 ± 91.6/AET). The majority of cases were performed for a biliary indication (80%). The overall and native papilla allowed cannulation times were 3.1 ± 3.6 and 5.7 ± 4, respectively. Overall learning curves demonstrated substantial variability for individual technical and cognitive endpoints. Although nearly all AETs achieved competence in overall cannulation, none achieved competence for cannulation in cases with a native papilla. Sensitivity analyses increased the proportion of AETs who achieved competence.

Conclusion

This study demonstrates that there is substantial variability in ERCP learning curves among AETs. A specific case volume does not ensure competence, especially for native papilla cannulation.

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Abbreviations : ACGME, AET, ASGE, CUSUM, CBME

Mappa

Methods

Study design

Study subjects

Evaluation tool and data collection

ERCP procedure

Study objectives

Statistical analysis and data management

Results

Overall learning curve analysis

Sensitivity analyses

Adverse events

Interobserver agreement

Discussion

	DISCLOSURE: Dr Wani is supported by the University of Colorado Outstanding Early Scholars Program. All other authors disclosed no financial relationships relevant to this publication.
	If you would like to chat with an author of this article, you may contact Dr Wani at sachinwani10@yahoo.com.

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Variation in learning curves and competence for ERCP among advanced endoscopy trainees by using cumulative sum analysis - 31/05/16

Abstract

Background and Aims

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Results

Conclusion

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