TY - JOUR
T1 - Variation in learning curves and competence for ERCP among advanced endoscopy trainees by using cumulative sum analysis
AU - Wani, Sachin
AU - Hall, Matthew
AU - Wang, Andrew Y.
AU - Dimaio, Christopher J.
AU - Muthusamy, V. Raman
AU - Keswani, Rajesh N.
AU - Brauer, Brian C.
AU - Easler, Jeffrey J.
AU - Yen, Roy D.
AU - El Hajj, Ihab
AU - Fukami, Norio
AU - Ghassemi, Kourosh F.
AU - Gonzalez, Susana
AU - Hosford, Lindsay
AU - Hollander, Thomas G.
AU - Wilson, Robert
AU - Kushnir, Vladimir M.
AU - Ahmad, Jawad
AU - Murad, Faris
AU - Prabhu, Anoop
AU - Watson, Rabindra R.
AU - Strand, Daniel S.
AU - Amateau, Stuart K.
AU - Attwell, Augustin
AU - Shah, Raj J.
AU - Early, Dayna
AU - Edmundowicz, Steven A.
AU - Mullady, Daniel
N1 - Funding Information:
DISCLOSURE: Dr Wani is supported by the University of Colorado Outstanding Early Scholars Program. All other authors disclosed no financial relationships relevant to this publication.
Publisher Copyright:
© 2016 American Society for Gastrointestinal Endoscopy.
PY - 2016/4/1
Y1 - 2016/4/1
N2 - Background and Aims 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.
AB - Background and Aims 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.
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U2 - 10.1016/j.gie.2015.10.022
DO - 10.1016/j.gie.2015.10.022
M3 - Article
C2 - 26515957
AN - SCOPUS:84960316344
SN - 0016-5107
VL - 83
SP - 711-719.e11
JO - Gastrointestinal endoscopy
JF - Gastrointestinal endoscopy
IS - 4
ER -
