The learning curve for interpretation of oesophageal high‐resolution manometry: a prospective interventional cohort study

Abstract

SUMMARY Background High resolution manometry has become the preferred choice of esophagologists for esophageal motor assessment, but the learning curve among trainees remains unclear. Aim To determine the learning curve of high resolution manometry interpretation. Design A prospective interventional cohort study was performed on 18 gastroenterology trainees naïve to high resolution manometry (median age 32±4.0 years, 44.4% female). An intake questionnaire and a 1-hour standardized didactic were performed at baseline. Multiple1-hour interpretation sessions were then conducted periodically over 15 months where 10 studies were discussed; 5 additional test studies were provided for interpretation, and results were compared to gold-standard interpretation by the senior author. Hypothetical management decisions based on trainee interpretation were separately queried. Accuracy was compared across test interpretations and sessions to determine the learning curve, with a goal of 90% accuracy. Results Baseline accuracy was low for abnormal body motor patterns (53.3%), but higher for achalasia/outflow obstruction (65.9%). Recognition of achalasia reached 90% accuracy after 6 sessions (p=0.01) while overall accurate management decisions reached this threshold by the 4th session (p<0.001). Based on our data, the threshold of 90% accuracy for recognition of any abnormal from normal pattern was reached after 30 studies (3rd session) but fluctuated. Diagnosis of esophageal body motor patterns remained suboptimal; accuracy of advisability of fundoplication improved, but did not reach 90% accuracy. Conclusions High resolution manometry has a steep learning curve among trainees. Achalasia recognition is achieved early, but diagnosis of other abnormal motor patterns and management decisions require further supervised training.

Curriculum for neurogastroenterology and motility training: A report from the joint ANMS‐ESNM task force

“…The Tier 2 trainee could acquire skills and knowledge for interpretation of gut function and motility studies by participating in specialized training. In the US, such training can be achieved from fellowship training in a center of excellence with motility expertise, from participating in a Tier 2 CTP, or from a Tier 3 motility fellowship. In Europe, this is currently achieved by apprenticeship (3 months to 2 years) at a training center with motility expertise, but there are significant differences in duration and organization between countries, including other parts of the world such as Latin America and Asia.…”

“…Following endoscopic training paradigms, certain elements of NGM training involving interpretation of motility studies and function testing lend themselves to counting numbers of studies performed and reaching an arbitrary number . However, the study of learning curves for interpretation of motility studies, for instance, suggests that simple numeric thresholds do not establish competence in identification of all motor disorders, even though new analysis paradigms and software tools have made interpretation more accurate and less cumbersome . Instead, there are variations in learning patterns between trainees that cannot be overcome by case volume alone .…”