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Setting minimum standards for training in EUS and ERCP: results from a prospective multicenter study evaluating learning curves and competence among advanced endoscopy trainees - 17/05/19

Doi : 10.1016/j.gie.2019.01.030 
Sachin Wani, MD 1, ⁎, Samuel Han, MD 1, Violette Simon, MS 1, Matthew Hall, PhD 2, Dayna Early, MD 3, Eva Aagaard, MD 3, Wasif M. Abidi, MD, PhD 4, Subhas Banerjee, MD 5, Todd H. Baron, MD 6, Michael Bartel, MD, PhD 7, Erik Bowman, MD 8, Brian C. Brauer, MD 1, Jonathan M. Buscaglia, MD 9, Linda Carlin, PhD 1, Amitabh Chak, MD 10, Hemant Chatrath, MD 11, Abhishek Choudhary, MD 5, Bradley Confer, DO 12, Gregory A. Coté, MD 13, Koushik K. Das, MD 3, Christopher J. DiMaio, MD 14, Andrew M. Dries, MD 15, Steven A. Edmundowicz, MD 1, Abdul Hamid El Chafic, MD 16, Ihab El Hajj, MD, MPH 17, Swan Ellert, PhD 1, Jason Ferreira, MD 18, Anthony Gamboa, MD 19, Ian S. Gan, MD 20, Lisa Gangarosa, MD 6, Bhargava Gannavarapu, MD 21, Stuart R. Gordon, MD 18, Nalini M. Guda, MD 22, Hazem T. Hammad, MD 1, Cynthia Harris, MD 23, Sujai Jalaj, MD 6, Paul Jowell, MD 24, Sana Kenshil, MD 25, Jason Klapman, MD 23, Michael L. Kochman, MD 26, Sri Komanduri, MD, MS 21, Gabriel Lang, MD 3, Linda S. Lee, MD 4, David E. Loren, MD 16, Frank J. Lukens, MD 7, Daniel Mullady, MD 3, Raman V. Muthusamy, MD 11, Andrew S. Nett, MD 27, Mojtaba S. Olyaee, MD 28, Kavous Pakseresht, MD 28, Pranith Perera, MD 27, Patrick Pfau, MD 8, Cyrus Piraka, MD 29, John M. Poneros, MD 30, Amit Rastogi, MD 28, Anthony Razzak, MD 20, Brian Riff, MD 14, Shreyas Saligram, MD 23, James M. Scheiman, MD 27, Isaiah Schuster, MD 9, Raj J. Shah, MD 1, Rishi Sharma, MD 31, Joshua P. Spaete, MD 24, Ajaypal Singh, MD 10, Muhammad Sohail, MD 32, Jayaprakash Sreenarasimhaiah, MD 33, Tyler Stevens, MD 12, James H. Tabibian, MD, PhD 26, Demetrios Tzimas, MD 9, Dushant S. Uppal, MD, MSc 34, Shiro Urayama, MD 31, Domenico Vitterbo, MD, PhD 33, Andrew Y. Wang, MD 34, Wahid Wassef, MD, MPH 32, Patrick Yachimski, MD 19, Sergio Zepeda-Gomez, MD 25, Tobias Zuchelli, MD 29, Rajesh N. Keswani, MD, MS 21
1 University of Colorado Anschutz Medical Center, Aurora, Colorado, USA 
2 Children’s Hospital Association, Lenexa, Kansas, USA 
3 Washington University in St. Louis, St. Louis, Missouri, USA 
4 Brigham and Women’s Hospital, Boston, Massachusetts, USA 
5 Stanford University, Stanford, California, USA 
6 University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA 
7 Mayo Clinic school of Graduate Medical Education, Jacksonville, Florida, USA 
8 University of Wisconsin, Madison, Wisconsin, USA 
9 Stony Brook University, Stony Brook, New York, USA 
10 University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA 
11 University of California, Los Angeles, Los Angeles, California, USA 
12 Cleveland Clinic Foundation, Cleveland, Ohio, USA 
13 Medical University of South Carolina, Charleston, South Carolina, USA 
14 Icahn School of Medicine at Mount Sinai, New York, New York, USA 
15 Carolinas Medical Center, Charlotte, North Carolina, USA 
16 Thomas Jefferson University, Philadelphia, Pennsylvania, USA 
17 Indiana University, Indianapolis, Indiana, USA 
18 Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA 
19 Vanderbilt University, Nashville, Tennessee, USA 
20 Virginia Mason Medical Center, Seattle, Washington, USA 
21 Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA 
22 Aurora Health Care, Milwaukee, Wisconsin, USA 
23 Moffitt Cancer Center, Tampa, Florida, USA 
24 Duke University, Durham, North Carolina, USA 
25 University of Alberta, Edmonton, Edmonton, Alberta, Canada 
26 University of Pennsylvania, Philadelphia, Pennsylvania, USA 
27 University of Michigan, Ann Arbor, Michigan, USA 
28 University of Kansas, Kansas City, Kansas, USA 
29 Henry Ford Hospital, Detroit, Michigan, USA 
30 Columbia University, New York, New York, USA 
31 University of California, Davis, Davis, California, USA 
32 University of Massachusetts Medical Center, Worcester, Massachusetts, USA 
33 University of Texas Southwestern Medical Center, Dallas, Texas, USA 
34 University of Virginia, Charlottesville, Virginia, USA 

∗Reprint requests: Sachin Wani, MD, Associate Professor of Medicine, Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Mail Stop F735, 1635 Aurora Court, Rm 2.031, Aurora, CO 80045.Division of Gastroenterology and HepatologyUniversity of Colorado Anschutz Medical CenterMail Stop F7351635 Aurora CourtRm 2.031AuroraCO80045

Abstract

Background and Aims

Minimum EUS and ERCP volumes that should be offered per trainee in “high quality” advanced endoscopy training programs (AETPs) are not established. We aimed to define the number of procedures required by an “average” advanced endoscopy trainee (AET) to achieve competence in technical and cognitive EUS and ERCP tasks to help structure AETPs.

Methods

American Society for Gastrointestinal Endoscopy (ASGE)-recognized AETPs were invited to participate; AETs were graded on every fifth EUS and ERCP examination using a validated tool. Grading for each skill was done using a 4-point scoring system, and learning curves using cumulative sum analysis for overall, technical, and cognitive components of EUS and ERCP were shared with AETs and trainers quarterly. Generalized linear mixed-effects models with a random intercept for each AET were used to generate aggregate learning curves, allowing us to use data from all AETs to estimate the average learning experience for trainees.

Results

Among 62 invited AETPs, 37 AETs from 32 AETPs participated. Most AETs reported hands-on EUS (52%, median 20 cases) and ERCP (68%, median 50 cases) experience before starting an AETP. The median number of EUS and ERCPs performed per AET was 400 (range, 200-750) and 361 (range, 250-650), respectively. Overall, 2616 examinations were graded (EUS, 1277; ERCP-biliary, 1143; pancreatic, 196). Most graded EUS examinations were performed for pancreatobiliary indications (69.9%) and ERCP examinations for ASGE biliary grade of difficulty 1 (72.1%). The average AET achieved competence in core EUS and ERCP skills at approximately 225 and 250 cases, respectively. However, overall technical competence was achieved for grade 2 ERCP at about 300 cases.

Conclusion

The thresholds provided for an average AET to achieve competence in EUS and ERCP may be used by the ASGE and AETPs in establishing the minimal standards for case volume exposure for AETs during their training. (Clinical trial registration number: NCT02509416.)

Il testo completo di questo articolo è disponibile in PDF.

Graphical abstract




Il testo completo di questo articolo è disponibile in PDF.

Abbreviations : ACGME, AET, AETP, ASGE, CUSUM


Mappa


 DISCLOSURE: The following author received research support for this study from the American Society for Gastrointestinal Endoscopy (ASGE) 2015 Endoscopy Research Award and the University of Colorado Department of Medicine Outstanding Early Scholars Program: S. Wani. In addition, the following authors disclosed financial relationships relevant to this publication: S. Wani: Consultant for Boston Scientific and Medtronic. J. M. Buscaglia, T. Stevens: Speaker and consultant for AbbVie and Boston Scientific. M. L. Kochman: Consultant for Boston Scientific, Dark Canyon Labs, Ferring, and Olympus. D. Mullady: Consultant for Boston Scientific; speaker for AbbVie. R. Shah, A. Rastogi: Consultant for Boston Scientific, Cook, and Olympus. P. Yachimski: Consultant for Boston Scientific. B.C. Brauer: Consultant for Boston Scientific and Medtronic; research grants from ERBE. M. Kochman: Consultant for BSC, Ferring, and Olympus; stock options from Dark Canyon Laboratory and Virgo Systems; Spouse, salary and stock options from Merck. All other authors disclosed no financial relationships relevant to this publication. Research support for REDCap was provided by the National Institutes of Health/National Center for Research Resources Colorado Clinical Translational Science Institute grant number UL1 TR001082. The ASGE had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or the decision to submit the manuscript for publication.
 See CME section; p. 1241.


© 2019  American Society for Gastrointestinal Endoscopy. Pubblicato da Elsevier Masson SAS. Tutti i diritti riservati.
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Vol 89 - N° 6

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