Variation in learning curves and competence for ERCP among advanced endoscopy trainees by using cumulative sum analysis

Wani, Sachin; Hall, Matthew; Wang, Andrew Y.; DiMaio, Christopher J.; Muthusamy, V. Raman; Keswani, Rajesh N.; Brauer, Brian C.; Easler, Jeffrey J.; Yen, Roy D.; Hajj, Ihab El; Fukami, Norio; Ghassemi, Kourosh F.; Gonzalez, Susana; Hosford, Lindsay; Hollander, Thomas; Wilson, Robert H.; Kushnir, Vladimir; Ahmad, Jawad; Murad, Faris; Prabhu, Anoop; Watson, Rabindra R.; Strand, Daniel S.; Amateau, Stuart K.; Attwell, Augustin; Shah, Raj J.; Early, Dayna S.; Edmundowicz, Steven A.; Mullady, Daniel

doi:10.1016/j.gie.2015.10.022

Cited by 86 publications

(103 citation statements)

References 38 publications

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“…33,34 Although nearly all trainees pursuing ERCP training are expected to achieve competency in overall cannulation rates, at least 1 study suggests that consistent cannulation of native papilla may not occur before the end of a 3-year fellowship 35 or even after completion of a year of advanced endoscopy training. 34 At least 200 supervised independent ERCP procedures should be performed before learner competency is assessed. [36][37][38] In addition, a trainee should be expected to perform at least 80 independent sphincterotomies and 60 biliary stent placements.…”

Section: Flexible Sigmoidoscopymentioning

confidence: 99%

Guidelines for privileging, credentialing, and proctoring to perform GI endoscopy

Faulx¹,

Lightdale²,

Acosta³

et al. 2017

Gastrointestinal Endoscopy

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185

122

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Section: Flexible Sigmoidoscopymentioning

confidence: 99%

Guidelines for privileging, credentialing, and proctoring to perform GI endoscopy

Faulx¹,

Lightdale²,

Acosta³

et al. 2017

Gastrointestinal Endoscopy

Self Cite

185

122

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“…4-6, 17, 18 In colonoscopy training, assessments of individual skills (i.e., cecal intubation rate or insertion time) are not reliable indicators of overall competency, 19 and current studies are examining comprehensive tools to measure endoscopic skills. 20-23 Use of computer-based tools and virtual reality simulation with active feedback seem to be effective training methods for colonoscopy and provide reliable measures of competency.…”

Section: Discussionmentioning

confidence: 99%

A System to Assess the Competency for Interpretation of Esophageal Manometry Identifies Variation in Learning Curves

Yadlapati

Keswani

Ciolino

et al. 2017

Clinical Gastroenterology and Hepatology

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Background & Aims Quality esophageal high-resolution manometry (HRM) studies require competent interpretation of data. However, we have little understanding of learning curves, training requirements, or measures of competency for HRM. We aimed to develop and use a competency assessment system to examine learning curves for interpretation of HRM data. Methods We conducted a prospective multicenter study of 20 gastroenterology trainees with no experience in HRM, from 8 centers, over an 8 month period (May through December 2015). We designed a web-based HRM training and competency assessment system. After reviewing the training module, participants interpreted 50 HRM studies and received answer keys at the fifth and then at every second interpretation. A cumulative sum procedure produced individual learning curves with preset acceptable failure rates of 10%; we classified competency status as: competency not achieved, competency achieved, or competency likely achieved. Results Five (25%) participants achieved competence, 4 (20%) likely achieved competence, and 11 (55%) failed to achieve competence. A minimum case volume to achieve competency was not identified. There was no significant agreement between diagnostic accuracy and accuracy for individual HRM skills. Conclusion We developed a competency assessment system for HRM interpretation; using this system, we found significant variation in learning curves for HRM diagnosis and individual skills. Our system effectively distinguished trainee competency levels for HRM interpretation and contrary to current recommendations, found that competency for HRM is not case-volume specific.

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“…The recommendation for at least two therapeutic endoscopists is based on the practical need to ensure continued availability for management of urgent problems and complications. There is a learning curve to achieve technical and clinical success of both EUS and ERCP; however, there is substantial variability among trainees and a specific case volume does not ensure competency [39,40]. Similarly, complex therapeutic interventions with increased risks (such as transmural drainage of pancreatic pseudocysts) should likely only be performed by those with an exceptional endoscopic skillset and low complication rates.…”

Section: Guidance Statementsmentioning

confidence: 99%

Academic Pancreas Centers of Excellence: Guidance from a multidisciplinary chronic pancreatitis working group at PancreasFest

et al. 2017

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Chronic pancreatitis (CP) is a progressive inflammatory disease, which leads to loss of pancreatic function and other disease-related morbidities. A group of academic physicians and scientists developed comprehensive guidance statements regarding the management of CP that include its epidemiology, diagnosis, medical treatment, surgical treatment, and screening. The statements were developed through literature review, deliberation, and consensus opinion. These statements were ultimately used to develop a conceptual framework for the multidisciplinary management of chronic pancreatitis referred to as an academic pancreas center of excellence (APCOE).

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Variation in learning curves and competence for ERCP among advanced endoscopy trainees by using cumulative sum analysis

Cited by 86 publications

References 38 publications

Guidelines for privileging, credentialing, and proctoring to perform GI endoscopy

Guidelines for privileging, credentialing, and proctoring to perform GI endoscopy

A System to Assess the Competency for Interpretation of Esophageal Manometry Identifies Variation in Learning Curves

Academic Pancreas Centers of Excellence: Guidance from a multidisciplinary chronic pancreatitis working group at PancreasFest

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