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Clin Gastroenterol Hepatol. 2017 Jun 15. pii: S1542-3565(17)30718-8. doi: 10.1016/j.cgh.2017.06.012. [Epub ahead of print]

A Prospective Multicenter Study Evaluating Learning Curves and Competence in Endoscopic Ultrasound and Endoscopic Retrograde Cholangiopancreatography Among Advanced Endoscopy Trainees: The Rapid Assessment of Trainee Endoscopy Skills (RATES) Study.

Author information

1
University of Colorado Anschutz Medical Campus, Aurora, CO. Electronic address: sachinwani10@yahoo.com.
2
Northwestern University, Chicago, IL.
3
University of Colorado Anschutz Medical Campus, Aurora, CO.
4
University Hospitals Cleveland Medical Center, Cleveland, OH.
5
Colorado Clinical and Translational Sciences Institute, Aurora, CO; University of Colorado Anschutz Medical Campus, Aurora, CO.
6
Carolinas Medical Center, Charlotte, NC.
7
Medical University of South Carolina, Charleston, SC.
8
Geisinger Medical Center, Danville, PA.
9
Icahn School of Medicine at Mount Sinai, New York, NY.
10
Indiana University, Indianapolis, IN.
11
Washington University School of Medicine, St. Louis, MO.
12
Virginia Mason Medical Center, Seattle, WA.
13
University of Virginia Health System, Charlottesville, VA.
14
Moffitt Cancer Center, Tampa, FL.
15
Dartmouth Hitchcock Medical Center, Lebanon, NH.
16
University of California, Los Angeles, Los Angeles, CA.
17
Brigham and Women's Hospital, Boston, MA.
18
University of Kansas, Kansas City, KS.
19
University of Wisconsin, Madison, WI.
20
Henry Ford Hospital, Detroit, MI.
21
University of Texas, San Antonio, TX.
22
Vanderbilt University, Nashville, TN.
23
University of Texas Southwestern, Dallas, TX.

Abstract

BACKGROUND AND AIMS:

Based on the Next Accreditation System, trainee assessment should occur on a continuous basis with individualized feedback. We aimed to validate endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) learning curves among advanced endoscopy trainees (AETs) using a large national sample of training programs and to develop a centralized database that allows assessment of performance in relation to peers.

METHODS:

ASGE recognized training programs were invited to participate and AETs were graded on ERCP and EUS exams using a validated competency assessment tool that assesses technical and cognitive competence in a continuous fashion. Grading for each skill was done using a 4-point scoring system and a comprehensive data collection and reporting system was built to create learning curves using cumulative sum analysis. Individual results and benchmarking to peers were shared with AETs and trainers quarterly.

RESULTS:

Of the 62 programs invited, 20 programs and 22 AETs participated in this study. At the end of training, median number of EUS and ERCP performed/AET was 300 (range 155-650) and 350 (125-500). Overall, 3786 exams were graded (EUS:1137; ERCP-biliary 2280, pancreatic 369). Learning curves for individual endpoints, and overall technical/cognitive aspects in EUS and ERCP demonstrated substantial variability and were successfully shared with all programs. The majority of trainees achieved overall technical (EUS: 82%; ERCP: 60%) and cognitive (EUS: 76%; ERCP: 100%) competence at conclusion of training.

CONCLUSIONS:

These results demonstrate the feasibility of establishing a centralized database to report individualized learning curves and confirm the substantial variability in time to achieve competence among AETs in EUS and ERCP. (Clinicaltrials.gov:NCT02509416).

KEYWORDS:

Competence; ERCP; EUS; advanced endoscopy training; competency-based medical education; learning curves

PMID:
28625816
DOI:
10.1016/j.cgh.2017.06.012
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