Setting minimum standards for training in EUS and ERCP: results from a prospective multicenter study evaluating learning curves and competence among advanced endoscopy trainees.

Autor: Wani S; University of Colorado Anschutz Medical Center, Aurora, Colorado, USA., Han S; University of Colorado Anschutz Medical Center, Aurora, Colorado, USA., Simon V; University of Colorado Anschutz Medical Center, Aurora, Colorado, USA., Hall M; Children's Hospital Association, Lenexa, Kansas, USA., Early D; Washington University in St. Louis, St. Louis, Missouri, USA., Aagaard E; Washington University in St. Louis, St. Louis, Missouri, USA., Abidi WM; Brigham and Women's Hospital, Boston, Massachusetts, USA., Banerjee S; Stanford University, Stanford, California, USA., Baron TH; University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA., Bartel M; Mayo Clinic school of Graduate Medical Education, Jacksonville, Florida, USA., Bowman E; University of Wisconsin, Madison, Wisconsin, USA., Brauer BC; University of Colorado Anschutz Medical Center, Aurora, Colorado, USA., Buscaglia JM; Stony Brook University, Stony Brook, New York, USA., Carlin L; University of Colorado Anschutz Medical Center, Aurora, Colorado, USA., Chak A; University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA., Chatrath H; University of California, Los Angeles, Los Angeles, California, USA., Choudhary A; Stanford University, Stanford, California, USA., Confer B; Cleveland Clinic Foundation, Cleveland, Ohio, USA., Coté GA; Medical University of South Carolina, Charleston, South Carolina, USA., Das KK; Washington University in St. Louis, St. Louis, Missouri, USA., DiMaio CJ; Icahn School of Medicine at Mount Sinai, New York, New York, USA., Dries AM; Carolinas Medical Center, Charlotte, North Carolina, USA., Edmundowicz SA; University of Colorado Anschutz Medical Center, Aurora, Colorado, USA., El Chafic AH; Thomas Jefferson University, Philadelphia, Pennsylvania, USA., El Hajj I; Indiana University, Indianapolis, Indiana, USA., Ellert S; University of Colorado Anschutz Medical Center, Aurora, Colorado, USA., Ferreira J; Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA., Gamboa A; Vanderbilt University, Nashville, Tennessee, USA., Gan IS; Virginia Mason Medical Center, Seattle, Washington, USA., Gangarosa L; University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA., Gannavarapu B; Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA., Gordon SR; Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA., Guda NM; Aurora Health Care, Milwaukee, Wisconsin, USA., Hammad HT; University of Colorado Anschutz Medical Center, Aurora, Colorado, USA., Harris C; Moffitt Cancer Center, Tampa, Florida, USA., Jalaj S; University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA., Jowell P; Duke University, Durham, North Carolina, USA., Kenshil S; University of Alberta, Edmonton, Edmonton, Alberta, Canada., Klapman J; Moffitt Cancer Center, Tampa, Florida, USA., Kochman ML; University of Pennsylvania, Philadelphia, Pennsylvania, USA., Komanduri S; Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA., Lang G; Washington University in St. Louis, St. Louis, Missouri, USA., Lee LS; Brigham and Women's Hospital, Boston, Massachusetts, USA., Loren DE; Thomas Jefferson University, Philadelphia, Pennsylvania, USA., Lukens FJ; Mayo Clinic school of Graduate Medical Education, Jacksonville, Florida, USA., Mullady D; Washington University in St. Louis, St. Louis, Missouri, USA., Muthusamy RV; University of California, Los Angeles, Los Angeles, California, USA., Nett AS; University of Michigan, Ann Arbor, Michigan, USA., Olyaee MS; University of Kansas, Kansas City, Kansas, USA., Pakseresht K; University of Kansas, Kansas City, Kansas, USA., Perera P; University of Michigan, Ann Arbor, Michigan, USA., Pfau P; University of Wisconsin, Madison, Wisconsin, USA., Piraka C; Henry Ford Hospital, Detroit, Michigan, USA., Poneros JM; Columbia University, New York, New York, USA., Rastogi A; University of Kansas, Kansas City, Kansas, USA., Razzak A; Virginia Mason Medical Center, Seattle, Washington, USA., Riff B; Icahn School of Medicine at Mount Sinai, New York, New York, USA., Saligram S; Moffitt Cancer Center, Tampa, Florida, USA., Scheiman JM; University of Michigan, Ann Arbor, Michigan, USA., Schuster I; Stony Brook University, Stony Brook, New York, USA., Shah RJ; University of Colorado Anschutz Medical Center, Aurora, Colorado, USA., Sharma R; University of California, Davis, Davis, California, USA., Spaete JP; Duke University, Durham, North Carolina, USA., Singh A; University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA., Sohail M; University of Massachusetts Medical Center, Worcester, Massachusetts, USA., Sreenarasimhaiah J; University of Texas Southwestern Medical Center, Dallas, Texas, USA., Stevens T; Cleveland Clinic Foundation, Cleveland, Ohio, USA., Tabibian JH; University of Pennsylvania, Philadelphia, Pennsylvania, USA., Tzimas D; Stony Brook University, Stony Brook, New York, USA., Uppal DS; University of Virginia, Charlottesville, Virginia, USA., Urayama S; University of California, Davis, Davis, California, USA., Vitterbo D; University of Texas Southwestern Medical Center, Dallas, Texas, USA., Wang AY; University of Virginia, Charlottesville, Virginia, USA., Wassef W; University of Massachusetts Medical Center, Worcester, Massachusetts, USA., Yachimski P; Vanderbilt University, Nashville, Tennessee, USA., Zepeda-Gomez S; University of Alberta, Edmonton, Edmonton, Alberta, Canada., Zuchelli T; Henry Ford Hospital, Detroit, Michigan, USA., Keswani RN; Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
Jazyk: angličtina
Zdroj: Gastrointestinal endoscopy [Gastrointest Endosc] 2019 Jun; Vol. 89 (6), pp. 1160-1168.e9. Date of Electronic Publication: 2019 Feb 07.
DOI: 10.1016/j.gie.2019.01.030
Abstrakt: 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.).
(Copyright © 2019 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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