Evaluating learning curves and competence in colorectal EMR among advanced endoscopy fellows: a pilot multicenter prospective trial using cumulative sum analysis.

Autor: Yang D; Division of Gastroenterology and Hepatology, University of Florida, Gainesville, Florida, USA., Perbtani YB; Division of Gastroenterology and Hepatology, University of Florida, Gainesville, Florida, USA., Wang Y; Division of Quantitative Sciences, University of Florida Cancer Center, University of Florida, Gainesville, Florida, USA., Rumman A; Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, Virginia, USA., Wang AY; Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, Virginia, USA., Kumta NA; Dr Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA., DiMaio CJ; Dr Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA., Antony A; Division of Gastroenterology, Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center, Northwell Health System, New Hyde Park, New York, USA., Trindade AJ; Division of Gastroenterology, Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center, Northwell Health System, New Hyde Park, New York, USA., Rolston VS; Division of Gastroenterology and Hepatology, Stony Brook University Hospital, Stony Brook, New York, USA., D'Souza LS; Division of Gastroenterology and Hepatology, Stony Brook University Hospital, Stony Brook, New York, USA., Corral Hurtado JE; Department of Gastroenterology, Mayo Clinic, Jacksonville, Florida, USA., Gomez V; Department of Gastroenterology, Mayo Clinic, Jacksonville, Florida, USA., Pohl H; Department of Gastroenterology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA; Department of Gastroenterology, Veterans Administration Medical Center, White River Junction, Vermont, USA., Draganov PV; Division of Gastroenterology and Hepatology, University of Florida, Gainesville, Florida, USA., Beyth RJ; Department of Medicine, University of Florida, Gainesville, Florida, USA., Lee JH; Division of Quantitative Sciences, University of Florida Cancer Center, University of Florida, Gainesville, Florida, USA; Department of Biostatistics, University of Florida, Gainesville, Florida, USA., Cheesman A; Dr Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA., Uppal DS; Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, Virginia, USA., Sejpal DV; Division of Gastroenterology, Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center, Northwell Health System, New Hyde Park, New York, USA., Bucobo JC; Division of Gastroenterology and Hepatology, Stony Brook University Hospital, Stony Brook, New York, USA., Wallace MB; Department of Gastroenterology, Mayo Clinic, Jacksonville, Florida, USA., Ngamruengphong S; Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, USA., Ajayeoba O; Department of Gastroenterology and Nutrition, Geisinger Medical Center, Danville, Pennsylvania, USA., Khara HS; Department of Gastroenterology and Nutrition, Geisinger Medical Center, Danville, Pennsylvania, USA., Diehl DL; Department of Gastroenterology and Nutrition, Geisinger Medical Center, Danville, Pennsylvania, USA., Jawaid S; Division of Gastroenterology and Hepatology, University of Florida, Gainesville, Florida, USA., Forsmark CE; Division of Gastroenterology and Hepatology, University of Florida, Gainesville, Florida, USA.
Jazyk: angličtina
Zdroj: Gastrointestinal endoscopy [Gastrointest Endosc] 2021 Mar; Vol. 93 (3), pp. 682-690.e4. Date of Electronic Publication: 2020 Sep 19.
DOI: 10.1016/j.gie.2020.09.023
Abstrakt: Background and Aims: Data on colorectal EMR (C-EMR) training are lacking. We aimed to evaluate C-EMR training among advanced endoscopy fellows (AEFs) by using a standardized assessment tool (STAT).
Methods: This multicenter prospective study used a STAT to grade AEF training in C-EMR during their 12-month fellowship. Cumulative sum analysis was used to establish learning curves and competence for cognitive and technical components of C-EMR and overall performance. Sensitivity analysis was performed by varying failure rates. AEFs completed a self-assessment questionnaire to assess their comfort level with performing C-EMR at the completion of their fellowship.
Results: Six AEFs (189 C-EMRs; mean per AEF, 31.5 ± 18.5) were included. Mean polyp size was 24.3 ± 12.6 mm, and mean procedure time was 22.6 ± 16.1 minutes. Learning curve analyses revealed that less than 50% of AEFs achieved competence for key cognitive and technical C-EMR endpoints. All 6 AEFs reported feeling comfortable performing C-EMR independently at the end of their training, although only 2 of them achieved competence in their overall performance. The minimum threshold to achieve competence in these 2 AEFs was 25 C-EMRs.
Conclusions: A relatively low proportion of AEFs achieved competence on key cognitive and technical aspects of C-EMR during their 12-month fellowship. The relatively low number of C-EMRs performed by AEFs may be insufficient to achieve competence, in spite of their self-reported readiness for independent practice. These pilot data serve as an initial framework for competence threshold, and suggest the need for validated tools for formal C-EMR training assessment.
(Copyright © 2021. Published by Elsevier Inc.)
Databáze: MEDLINE
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