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

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• 作者：Sachin Wani ; MD¹ ; ; Matthew Hall ; PhD¹ ; Andrew Y. Wang ; MD² ; Christopher J. DiMaio ; MD³ ; V. Raman Muthusamy ; MD⁶ ; Rajesh N. Keswani ; MD⁴ ; Brian C. Brauer ; MD¹ ; Jeffrey J. Easler ; MD⁵ ; Roy D. Yen ; MD¹ ; Ihab El Hajj ; MD¹ ; Norio Fukami ; MD¹ ; Kourosh F. Ghassemi ; MD⁶ ; Susana Gonzalez ; MD³ ; Lindsay Hosford ; BA¹ ; Thomas G. Hollander ; MS⁵ ; Robert Wilson ; BA¹ ; Vladimir M. Kushnir ; MD³ ; Jawad Ahmad ; MD³ ; Faris Murad ; MD⁵ ; Anoop Prabhu ; MD³ ; Rabindra R. Watson ; MD⁶ ; Daniel S. Strand ; MD² ; Stuart K. Amateau ; MD¹ ; Augustin Attwell ; MD¹ ; Raj J. Shah ; MD¹ ; Dayna Early ; MD⁵ ; Steven A. Edmundowicz ; MD⁵ ; Daniel Mullady ; MD⁵
• 关键词：ACGME ; Accreditation Council for Graduate Medical Education ; AET ; advanced endoscopy trainee ; ASGE ; American Society for Gastrointestinal Endoscopy ; CUSUM ; cumulative sum ; CBME ; competency based medical education
• 刊名：Gastrointestinal Endoscopy
• 出版年：2016
• 出版时间：April 2016
• 年：2016
• 卷：83
• 期：4
• 页码：711-719.e11
• 全文大小：2580 K

文摘

There are limited data on learning curves and competence in ERCP. By using a standardized data collection tool, we aimed to prospectively define learning curves and measure competence among advanced endoscopy trainees (AETs) by using cumulative sum (CUSUM) analysis.

Methods

AETs were evaluated by attending endoscopists starting with the 26th hands-on ERCP examination and then every ERCP examination during the 12-month training period. A standardized ERCP competency assessment tool (using a 4-point scoring system) was used to grade the examination. CUSUM analysis was applied to produce learning curves for individual technical and cognitive components of ERCP performance (success defined as a score of 1, acceptable and unacceptable failures [p1] of 10% and 20%, respectively). Sensitivity analyses varying p1 and by using a less-stringent definition of success were performed.

Results

Five AETs were included with a total of 1049 graded ERCPs (mean ± SD, 209.8 ± 91.6/AET). The majority of cases were performed for a biliary indication (80%). The overall and native papilla allowed cannulation times were 3.1 ± 3.6 and 5.7 ± 4, respectively. Overall learning curves demonstrated substantial variability for individual technical and cognitive endpoints. Although nearly all AETs achieved competence in overall cannulation, none achieved competence for cannulation in cases with a native papilla. Sensitivity analyses increased the proportion of AETs who achieved competence.

Conclusion

This study demonstrates that there is substantial variability in ERCP learning curves among AETs. A specific case volume does not ensure competence, especially for native papilla cannulation.