A System to Assess the Competency for Interpretation of Esophageal Manometry Identifies Variation in Learning Curves

Rena Yadlapati, Rajesh N. Keswani, Jody D. Ciolino, David P. Grande, Zoe I. Listernick, Dustin A. Carlson, Donald O. Castell, Kerry B. Dunbar, Andrew J. Gawron, C. Prakash Gyawali, Philip O. Katz, David Katzka, Brian E. Lacy, Stuart J. Spechler, Roger Tatum, Marcelo F. Vela, John E. Pandolfino

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background & Aims: Quality esophageal high-resolution manometry (HRM) studies require competent interpretation of data. However, there is little understanding of learning curves, training requirements, or measures of competency for HRM. We aimed to develop and use a competency assessment system to examine learning curves for interpretation of HRM data. Methods: We conducted a prospective multicenter study of 20 gastroenterology trainees with no experience in HRM, from 8 centers, over an 8-month period (May through December 2015). We designed a web-based HRM training and competency assessment system. After reviewing the training module, participants interpreted 50 HRM studies and received answer keys at the fifth and then at every second interpretation. A cumulative sum procedure produced individual learning curves with preset acceptable failure rates of 10%; we classified competency status as competency not achieved, competency achieved, or competency likely achieved. Results: Five (25%) participants achieved competence, 4 (20%) likely achieved competence, and 11 (55%) failed to achieve competence. A minimum case volume to achieve competency was not identified. There was no significant agreement between diagnostic accuracy and accuracy for individual HRM skills. Conclusions: We developed a competency assessment system for HRM interpretation; using this system, we found significant variation in learning curves for HRM diagnosis and individual skills. Our system effectively distinguished trainee competency levels for HRM interpretation and contrary to current recommendations, found that competency for HRM is not case-volume specific.

Original languageEnglish (US)
JournalClinical Gastroenterology and Hepatology
DOIs
StateAccepted/In press - 2016

Fingerprint

Learning Curve
Manometry
Mental Competency
Gastroenterology
Multicenter Studies
Prospective Studies

Keywords

  • Competency-Based Medical Education
  • CUSUM
  • High-Resolution Manometry

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

Yadlapati, R., Keswani, R. N., Ciolino, J. D., Grande, D. P., Listernick, Z. I., Carlson, D. A., ... Pandolfino, J. E. (Accepted/In press). A System to Assess the Competency for Interpretation of Esophageal Manometry Identifies Variation in Learning Curves. Clinical Gastroenterology and Hepatology. https://doi.org/10.1016/j.cgh.2016.07.024

A System to Assess the Competency for Interpretation of Esophageal Manometry Identifies Variation in Learning Curves. / Yadlapati, Rena; Keswani, Rajesh N.; Ciolino, Jody D.; Grande, David P.; Listernick, Zoe I.; Carlson, Dustin A.; Castell, Donald O.; Dunbar, Kerry B.; Gawron, Andrew J.; Gyawali, C. Prakash; Katz, Philip O.; Katzka, David; Lacy, Brian E.; Spechler, Stuart J.; Tatum, Roger; Vela, Marcelo F.; Pandolfino, John E.

In: Clinical Gastroenterology and Hepatology, 2016.

Research output: Contribution to journalArticle

Yadlapati, R, Keswani, RN, Ciolino, JD, Grande, DP, Listernick, ZI, Carlson, DA, Castell, DO, Dunbar, KB, Gawron, AJ, Gyawali, CP, Katz, PO, Katzka, D, Lacy, BE, Spechler, SJ, Tatum, R, Vela, MF & Pandolfino, JE 2016, 'A System to Assess the Competency for Interpretation of Esophageal Manometry Identifies Variation in Learning Curves', Clinical Gastroenterology and Hepatology. https://doi.org/10.1016/j.cgh.2016.07.024
Yadlapati, Rena ; Keswani, Rajesh N. ; Ciolino, Jody D. ; Grande, David P. ; Listernick, Zoe I. ; Carlson, Dustin A. ; Castell, Donald O. ; Dunbar, Kerry B. ; Gawron, Andrew J. ; Gyawali, C. Prakash ; Katz, Philip O. ; Katzka, David ; Lacy, Brian E. ; Spechler, Stuart J. ; Tatum, Roger ; Vela, Marcelo F. ; Pandolfino, John E. / A System to Assess the Competency for Interpretation of Esophageal Manometry Identifies Variation in Learning Curves. In: Clinical Gastroenterology and Hepatology. 2016.
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abstract = "Background & Aims: Quality esophageal high-resolution manometry (HRM) studies require competent interpretation of data. However, there is little understanding of learning curves, training requirements, or measures of competency for HRM. We aimed to develop and use a competency assessment system to examine learning curves for interpretation of HRM data. Methods: We conducted a prospective multicenter study of 20 gastroenterology trainees with no experience in HRM, from 8 centers, over an 8-month period (May through December 2015). We designed a web-based HRM training and competency assessment system. After reviewing the training module, participants interpreted 50 HRM studies and received answer keys at the fifth and then at every second interpretation. A cumulative sum procedure produced individual learning curves with preset acceptable failure rates of 10{\%}; we classified competency status as competency not achieved, competency achieved, or competency likely achieved. Results: Five (25{\%}) participants achieved competence, 4 (20{\%}) likely achieved competence, and 11 (55{\%}) failed to achieve competence. A minimum case volume to achieve competency was not identified. There was no significant agreement between diagnostic accuracy and accuracy for individual HRM skills. Conclusions: We developed a competency assessment system for HRM interpretation; using this system, we found significant variation in learning curves for HRM diagnosis and individual skills. Our system effectively distinguished trainee competency levels for HRM interpretation and contrary to current recommendations, found that competency for HRM is not case-volume specific.",
keywords = "Competency-Based Medical Education, CUSUM, High-Resolution Manometry",
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AU - Yadlapati, Rena

AU - Keswani, Rajesh N.

AU - Ciolino, Jody D.

AU - Grande, David P.

AU - Listernick, Zoe I.

AU - Carlson, Dustin A.

AU - Castell, Donald O.

AU - Dunbar, Kerry B.

AU - Gawron, Andrew J.

AU - Gyawali, C. Prakash

AU - Katz, Philip O.

AU - Katzka, David

AU - Lacy, Brian E.

AU - Spechler, Stuart J.

AU - Tatum, Roger

AU - Vela, Marcelo F.

AU - Pandolfino, John E.

PY - 2016

Y1 - 2016

N2 - Background & Aims: Quality esophageal high-resolution manometry (HRM) studies require competent interpretation of data. However, there is little understanding of learning curves, training requirements, or measures of competency for HRM. We aimed to develop and use a competency assessment system to examine learning curves for interpretation of HRM data. Methods: We conducted a prospective multicenter study of 20 gastroenterology trainees with no experience in HRM, from 8 centers, over an 8-month period (May through December 2015). We designed a web-based HRM training and competency assessment system. After reviewing the training module, participants interpreted 50 HRM studies and received answer keys at the fifth and then at every second interpretation. A cumulative sum procedure produced individual learning curves with preset acceptable failure rates of 10%; we classified competency status as competency not achieved, competency achieved, or competency likely achieved. Results: Five (25%) participants achieved competence, 4 (20%) likely achieved competence, and 11 (55%) failed to achieve competence. A minimum case volume to achieve competency was not identified. There was no significant agreement between diagnostic accuracy and accuracy for individual HRM skills. Conclusions: We developed a competency assessment system for HRM interpretation; using this system, we found significant variation in learning curves for HRM diagnosis and individual skills. Our system effectively distinguished trainee competency levels for HRM interpretation and contrary to current recommendations, found that competency for HRM is not case-volume specific.

AB - Background & Aims: Quality esophageal high-resolution manometry (HRM) studies require competent interpretation of data. However, there is little understanding of learning curves, training requirements, or measures of competency for HRM. We aimed to develop and use a competency assessment system to examine learning curves for interpretation of HRM data. Methods: We conducted a prospective multicenter study of 20 gastroenterology trainees with no experience in HRM, from 8 centers, over an 8-month period (May through December 2015). We designed a web-based HRM training and competency assessment system. After reviewing the training module, participants interpreted 50 HRM studies and received answer keys at the fifth and then at every second interpretation. A cumulative sum procedure produced individual learning curves with preset acceptable failure rates of 10%; we classified competency status as competency not achieved, competency achieved, or competency likely achieved. Results: Five (25%) participants achieved competence, 4 (20%) likely achieved competence, and 11 (55%) failed to achieve competence. A minimum case volume to achieve competency was not identified. There was no significant agreement between diagnostic accuracy and accuracy for individual HRM skills. Conclusions: We developed a competency assessment system for HRM interpretation; using this system, we found significant variation in learning curves for HRM diagnosis and individual skills. Our system effectively distinguished trainee competency levels for HRM interpretation and contrary to current recommendations, found that competency for HRM is not case-volume specific.

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