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

• Published in: Clinical gastroenterology and hepatology Vol. 15; no. 11; pp. 1758 - 1767.e11
• Main Authors: Wani, Sachin, MD, Keswani, Rajesh, MD, Hall, Matt, PhD, Han, Samuel, MD, Ali, Meer Akbar, MD, Brauer, Brian, MD, Carlin, Linda, PhD, Chak, Amitabh, MD, Collins, Dan, MD, Cote, Gregory A., MD, Diehl, David L., MD, DiMaio, Christopher J., MD, Dries, Andrew, MD, El-Hajj, Ihab, MD, Ellert, Swan, MS, Fairley, Kimberley, MD, Faulx, Ashley, MD, Fujii-Lau, Larissa, MD, Gaddam, Srinivas, MD, Gan, Seng-Ian, MD, Gaspar, Jonathan P., MD, Gautamy, Chitiki, MD, Gordon, Stuart, MD, Harris, Cynthia, MD, Hyder, Sarah, MD, Jones, Ross, MD, Kim, Stephen, MD, Komanduri, Srinadh, MD, Law, Ryan, DO, Lee, Linda, MD, Mounzer, Rawad, MD, Mullady, Daniel, MD, Muthusamy, V. Raman, MD, Olyaee, Mojtaba, MD, Pfau, Patrick, MD, Saligram, Shreyas, MD, Piraka, Cyrus, MD, Rastogi, Amit, MD, Rosenkranz, Laura, MD, Rzouq, Fadi, MD, Saxena, Aditi, MD, Shah, Raj J., MD, Simon, Violette C., MS, Small, Aaron, MD, Sreenarasimhaiah, Jayaprakash, MD, Walker, Andrew, MD, Wang, Andrew Y., MD, Watson, Rabindra R., MD, Wilson, Robert H., BA, Yachimski, Patrick, MD, Yang, Dennis, MD, Edmundowicz, Steven, MD, Early, Dayna S., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2017
• Subjects: Advanced Endoscopy Training; Cholangiopancreatography, Endoscopic Retrograde - methods; Clinical Competence; Competence; Competency-based Medical Education; Endosonography - methods; ERCP; EUS; Gastroenterology - education; Gastroenterology and Hepatology; Gastrointestinal Diseases - diagnosis; Humans; Learning Curve; Learning Curves; Program Evaluation; Prospective Studies; NAS; Competence; The EUS and ERCP Skills Assessment Tool; interquartile range; advanced endoscopy trainees; ACGME; ASGE; EUS-FNA; endoscopic retrograde cholangiopancreatography; SD; endoscopic ultrasonography; TEESAT; American Society for Gastrointestinal Endoscopy; AETs; endoscopic ultrasound-guided fine needle aspiration; competency-based medical education; CUSUM; EUS; CI; CBME; ⱪ; IQR; cumulative sum analysis; learning curves; Next Accreditation System; ERCP; confidence interval; advanced endoscopy training; kappa value; Accreditation Council for Graduate Medical Education; standard deviation; Competency-based Medical Education; Learning Curves; CUSUM analysis; Advanced Endoscopy Training; FNA; κ
• ISSN: 1542-3565; 1542-7714
• DOI: 10.1016/j.cgh.2017.06.012

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)