Measuring trainee competence in performing endoscopic retrograde cholangiopancreatography: A systematic review of the literature

Voiosu, Theodor; Bălănescu, Paul; Voiosu, Andrei; Benguș, Andreea; Preda, Carmen Monica; Umans, Devica S; Mateescu, Bogdan; Hooft, Jeanin E. van

doi:10.1177/2050640618817110

Cited by 19 publications

(22 citation statements)

References 39 publications

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“…There have been calls by societies to shift emphasis away from minimum procedure counts in favor of competence assessment tools [20]. However, the outcome of competence is dependent on its definition, which may explain the heterogeneity in the ERCP training literature [21]. In our cohort, 20.3 % of assessed procedures were deemed complicated; these were significantly more likely to require trainer supervision compared with procedures of moderate (OR 2.30; P = 0.01) or easy (OR 4.82; P < 0.001) difficulty.…”

Section: Discussionmentioning

confidence: 99%

ERCP assessment tool: evidence of validity and competency development during training

et al. 2019

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Background The endoscopic retrograde cholangiopancreatography (ERCP) direct observation of procedural skills (DOPS) is a 27-item competency assessment tool that was developed to support UK ERCP training. We evaluated validity of ERCP DOPS and competency development during training. Methods This prospective study analyzed ERCP DOPS performed in the UK between July 2016 and October 2018. Reliability was measured using Cronbach’s alpha, and DOPS scores were benchmarked using the contrasting groups method. The percentage of competent scores was averaged for each item, domain, and overall rating, and stratified by lifetime procedure count to evaluate learning curves. Multivariable analyses were performed to identify predictors of DOPS competence. Results 818 DOPS (109 trainees, 80 UK centers) were analyzed. Overall Cronbach’s alpha was 0.961. Attaining competency in 87 % of assessed DOPS items provided the optimal competency benchmark. This was achieved in the domain sequence of: pre-procedure, post-procedure management, endoscopic non-technical skills, cannulation & imaging, and execution of selected therapy, and across all items after 200 – 249 procedures (89 %). After 300 procedures, the benchmark was reached for selective cannulation (89 %), but not for stenting (plastic 73 %; metal 70 %), sphincterotomy (80 %), and sphincteroplasty (56 %). On multivariable analysis, lifetime procedure count (P = 0.002), easier case difficulty (P < 0.001), trainee grade (P = 0.03), and higher lifetime DOPS count (P = 0.01) were predictors of DOPS competence. Conclusion This study provides novel validity, reliability, and learning curve data for ERCP DOPS. Trainees should have a minimum of 300 hands-on ERCP procedures before undertaking summative assessment for independent practice.

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Section: Discussionmentioning

confidence: 99%

ERCP assessment tool: evidence of validity and competency development during training

et al. 2019

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“…2 OR provided for increase in time to cannulation from < 5 to 5 -10 min (1) and from 5 -10 min to > 10 min (2), respectively. 3 OR reported for center number 4, which showed significantly higher technical success rates, using center number 1 as the reference category. 4 OR reported using common bile duct stones as the reference category for this variable; (1)benign bile duct stricture; (2)bile leak or trauma.…”

Section: Potential Risk Factorsmentioning

confidence: 95%

“…2 OR provided for increase in time to cannulation from < 5 to 5 -10 min (1) and from 5 -10 min to > 10 min (2), respectively. 3 OR provided for increase in difficulty level from 1 to 2 (1) and from 2 to 3…”

Section: Potential Risk Factorsmentioning

confidence: 99%

“…In order to address this issue, standards for training duration, procedure volume, and competence assessment have been proposed by several societies [1], and key performance measures for independent ERCP practice have been defined [2]. However, it has been widely recognized that many endoscopists in training fail to reach the required procedure volume or the predefined competence threshold during their training period [3,4]. To compound this issue, there are relatively limited and conflicting data pertaining to the safety of ERCP procedures with trainee involvement [5,6].…”

Section: Introductionmentioning

confidence: 99%

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Impact of trainee involvement on the outcome of ERCP procedures: results of a prospective multicenter observational trial

et al. 2019

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Background Training in advanced endoscopic techniques such as endoscopic retrograde cholangiopancreatography (ERCP) should be driven by key performance measures and standardized competence assessment in order to provide safe and high-quality interventions. We aimed to determine whether the involvement of trainees influences the outcome of the procedure and the incidence of ERCP-related adverse events. Methods This was an international, multicenter, prospective, observational study conducted at six high- and low-volume centers across Europe between October 2016 and October 2018, and included independent operators and their trainees. Standard report forms documenting indication, trainee involvement, technical outcome, and complications over a 30-day follow-up of consecutive ERCP procedures were included in the analysis. Technical success of the procedure and procedure-related adverse events were compared between procedures in the trainee group and the control group using bivariable and multivariable analysis. Results 21 trainees and 16 control endoscopists performed 1843 ERCPs during the study period. Trainee involvement in ERCP procedures did not decrease technical success (92.4 % vs. 93.7 %; P = 0.30) or increase the risk of adverse events (14.7 % vs. 14.6 %; P > 0.99). Conversely, there were significantly more moderate or severe adverse events in the control group compared with the trainee group (6.2 % vs. 3.4 %, P = 0.01). On multivariable analysis, only increased bilirubin levels, time to cannulation, and procedure difficulty level increased the risk of any procedure-related adverse event. Conclusion Trainee involvement in ERCP interventions within a proper teaching setting is safe and does not compromise the success of the procedure.

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“…Competency in ERCP is defined as the minimum skill level and experience required to perform the ERCP procedure safely and proficiently [27]. As in previously reported randomized controlled trials, biliary cannulation success was chosen as the primary outcome because most of the biliary pathologies require ERCP [22].…”

Section: Discussionmentioning

confidence: 99%

Impact of mechanical simulator practice on clinical ERCP performance by novice surgical trainees: a randomized controlled trial

et al. 2020

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Background Lack of forward-viewing endoscopy experience impairs training in endoscopic retrograde cholangiopancreatography (ERCP). We evaluated the effect of ERCP mechanical simulator (EMS) practice on ERCP performance by surgical trainees. Patients and methods 12 surgical trainees without endoscopy experience were randomly allocated to non-EMS (n = 6) programs or to EMS (n = 6) programs with coaching and 20 hours of supervised EMS practice. All trainees then received supervised hands-on clinical ERCP training. Trainers provided verbal instructions and hands-on assistance, and took over if cannulation was not achieved by 20 minutes. Blinded trainers rated clinical performance. Results Each group performed 150 clinical ERCPs. Biliary cannulation success was significantly higher in the EMS vs. the non-EMS group (P = 0.006), with shorter mean times (in minutes) for intubation, cannulation, and completion (all P < 0.001). EMS trainees showed a significantly better mean performance score (P = 0.006). In multivariate analysis, after adjusting for case sequence, CBD stone, complexity, and EMS training, the effect of EMS practice on odds for successful cannulation remained highly significant (odds ratio [OR] 2.10 [95 %CI 1.46 – 3.01]). At 6 months EMS trainees still had better cannulation success vs. non-EMS controls (P = 0.045); no difference was observed after 1 year. Conclusions EMS practice shortens the ERCP early learning curve of inexperienced surgical trainees, improves clinical success in selective biliary cannulation, and may reduce complications.

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Measuring trainee competence in performing endoscopic retrograde cholangiopancreatography: A systematic review of the literature

Cited by 19 publications

References 39 publications

ERCP assessment tool: evidence of validity and competency development during training

ERCP assessment tool: evidence of validity and competency development during training

Impact of trainee involvement on the outcome of ERCP procedures: results of a prospective multicenter observational trial

Impact of mechanical simulator practice on clinical ERCP performance by novice surgical trainees: a randomized controlled trial

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