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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.


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.).

SUBMITTER: Wani S 

PROVIDER: S-EPMC6527477 | biostudies-literature | 2019 Jun

REPOSITORIES: biostudies-literature

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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.

Wani Sachin S   Han Samuel S   Simon Violette V   Hall Matthew M   Early Dayna D   Aagaard Eva E   Abidi Wasif M WM   Banerjee Subhas S   Baron Todd H TH   Bartel Michael M   Bowman Erik E   Brauer Brian C BC   Buscaglia Jonathan M JM   Carlin Linda L   Chak Amitabh A   Chatrath Hemant H   Choudhary Abhishek A   Confer Bradley B   Coté Gregory A GA   Das Koushik K KK   DiMaio Christopher J CJ   Dries Andrew M AM   Edmundowicz Steven A SA   El Chafic Abdul Hamid AH   El Hajj Ihab I   Ellert Swan S   Ferreira Jason J   Gamboa Anthony A   Gan Ian S IS   Gangarosa Lisa L   Gannavarapu Bhargava B   Gordon Stuart R SR   Guda Nalini M NM   Hammad Hazem T HT   Harris Cynthia C   Jalaj Sujai S   Jowell Paul P   Kenshil Sana S   Klapman Jason J   Kochman Michael L ML   Komanduri Sri S   Lang Gabriel G   Lee Linda S LS   Loren David E DE   Lukens Frank J FJ   Mullady Daniel D   Muthusamy Raman V RV   Nett Andrew S AS   Olyaee Mojtaba S MS   Pakseresht Kavous K   Perera Pranith P   Pfau Patrick P   Piraka Cyrus C   Poneros John M JM   Rastogi Amit A   Razzak Anthony A   Riff Brian B   Saligram Shreyas S   Scheiman James M JM   Schuster Isaiah I   Shah Raj J RJ   Sharma Rishi R   Spaete Joshua P JP   Singh Ajaypal A   Sohail Muhammad M   Sreenarasimhaiah Jayaprakash J   Stevens Tyler T   Tabibian James H JH   Tzimas Demetrios D   Uppal Dushant S DS   Urayama Shiro S   Vitterbo Domenico D   Wang Andrew Y AY   Wassef Wahid W   Yachimski Patrick P   Zepeda-Gomez Sergio S   Zuchelli Tobias T   Keswani Rajesh N RN  

Gastrointestinal endoscopy 20190207 6


<h4>Background and aims</h4>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.<h4>Methods</h4>American Society for Gastrointestinal Endoscopy (ASGE)-recognized AETPs were invited to participate; AETs were gra  ...[more]

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