Challenges in meeting fellowship procedural guidelines in pediatric therapeutic endoscopy and liver biopsy

Diana G. Lerner, B. U. Li, Petar Mamula, Douglas S. Fishman, Robert Kramer, Vi Lier Goh, Khalil El-Chammas, Scott P. Pentiuk, Robert Rothbaum, Bhaskar Gurram, Riad M. Rahhal, Praveen S. Goday, Bernadette Vitola

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Objective: The aims of this study were to assess the opportunities for therapeutic endoscopy, liver biopsies, and percutaneous endoscopic gastrostomy (PEG) placements available to fellows during a 3-year pediatric gastroenterology fellowship, and to evaluate access to ancillary procedural-training opportunities. METHODS: Data were collected from 12 pediatric gastroenterology fellowship programs in the United States. Procedures completed in the years 2009-2011 were queried using CPT codes and endoscopy databases. The maximal opportunity for procedures was based on the total procedures performed by the institution in 3 years divided by the total number of fellows in the program. The centers completed a questionnaire regarding ancillary opportunities for endoscopic training. RESULTS: There is significant variability in pediatric endoscopic training opportunities in specialized gastrointestinal (GI) procedures. Under the 1999 guidelines, no centers were able to meet the thresholds for polypectomy and control of nonvariceal bleeding. The 2013 guidelines allowed the number of programs reaching polypectomy thresholds to increase by 67% but made no difference for control of bleeding despite a decrease in the threshold. Training in PEG placement was not available in 42% of the surveyed centers. Elective ancillary procedural training is offered by 92% of the surveyed centers. CONCLUSIONS: Most training programs do not have the volume of therapeutic endoscopy procedures for all of the fellows to meet the training guidelines. Training in therapeutic endoscopy, PEG placement, and liver biopsy in pediatric GI fellowships should be supplemented using all of the possible options including rotations with adult GI providers and hands-on endoscopy courses. A shift toward evaluating competency via quality measures may be more appropriate.

Original languageEnglish (US)
Pages (from-to)27-33
Number of pages7
JournalJournal of Pediatric Gastroenterology and Nutrition
Volume58
Issue number1
DOIs
StatePublished - Jan 1 2014

Fingerprint

Endoscopy
Gastrostomy
Guidelines
Pediatrics
Biopsy
Liver
Gastroenterology
Current Procedural Terminology
Hemorrhage
Therapeutics
Databases
Education

Keywords

  • competency
  • endoscopic procedures
  • fellowship
  • liver biopsy
  • pediatric gastroenterology training

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Gastroenterology

Cite this

Challenges in meeting fellowship procedural guidelines in pediatric therapeutic endoscopy and liver biopsy. / Lerner, Diana G.; Li, B. U.; Mamula, Petar; Fishman, Douglas S.; Kramer, Robert; Goh, Vi Lier; El-Chammas, Khalil; Pentiuk, Scott P.; Rothbaum, Robert; Gurram, Bhaskar; Rahhal, Riad M.; Goday, Praveen S.; Vitola, Bernadette.

In: Journal of Pediatric Gastroenterology and Nutrition, Vol. 58, No. 1, 01.01.2014, p. 27-33.

Research output: Contribution to journalArticle

Lerner, DG, Li, BU, Mamula, P, Fishman, DS, Kramer, R, Goh, VL, El-Chammas, K, Pentiuk, SP, Rothbaum, R, Gurram, B, Rahhal, RM, Goday, PS & Vitola, B 2014, 'Challenges in meeting fellowship procedural guidelines in pediatric therapeutic endoscopy and liver biopsy', Journal of Pediatric Gastroenterology and Nutrition, vol. 58, no. 1, pp. 27-33. https://doi.org/10.1097/MPG.0000000000000184
Lerner, Diana G. ; Li, B. U. ; Mamula, Petar ; Fishman, Douglas S. ; Kramer, Robert ; Goh, Vi Lier ; El-Chammas, Khalil ; Pentiuk, Scott P. ; Rothbaum, Robert ; Gurram, Bhaskar ; Rahhal, Riad M. ; Goday, Praveen S. ; Vitola, Bernadette. / Challenges in meeting fellowship procedural guidelines in pediatric therapeutic endoscopy and liver biopsy. In: Journal of Pediatric Gastroenterology and Nutrition. 2014 ; Vol. 58, No. 1. pp. 27-33.
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abstract = "Objective: The aims of this study were to assess the opportunities for therapeutic endoscopy, liver biopsies, and percutaneous endoscopic gastrostomy (PEG) placements available to fellows during a 3-year pediatric gastroenterology fellowship, and to evaluate access to ancillary procedural-training opportunities. METHODS: Data were collected from 12 pediatric gastroenterology fellowship programs in the United States. Procedures completed in the years 2009-2011 were queried using CPT codes and endoscopy databases. The maximal opportunity for procedures was based on the total procedures performed by the institution in 3 years divided by the total number of fellows in the program. The centers completed a questionnaire regarding ancillary opportunities for endoscopic training. RESULTS: There is significant variability in pediatric endoscopic training opportunities in specialized gastrointestinal (GI) procedures. Under the 1999 guidelines, no centers were able to meet the thresholds for polypectomy and control of nonvariceal bleeding. The 2013 guidelines allowed the number of programs reaching polypectomy thresholds to increase by 67{\%} but made no difference for control of bleeding despite a decrease in the threshold. Training in PEG placement was not available in 42{\%} of the surveyed centers. Elective ancillary procedural training is offered by 92{\%} of the surveyed centers. CONCLUSIONS: Most training programs do not have the volume of therapeutic endoscopy procedures for all of the fellows to meet the training guidelines. Training in therapeutic endoscopy, PEG placement, and liver biopsy in pediatric GI fellowships should be supplemented using all of the possible options including rotations with adult GI providers and hands-on endoscopy courses. A shift toward evaluating competency via quality measures may be more appropriate.",
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AU - Li, B. U.

AU - Mamula, Petar

AU - Fishman, Douglas S.

AU - Kramer, Robert

AU - Goh, Vi Lier

AU - El-Chammas, Khalil

AU - Pentiuk, Scott P.

AU - Rothbaum, Robert

AU - Gurram, Bhaskar

AU - Rahhal, Riad M.

AU - Goday, Praveen S.

AU - Vitola, Bernadette

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N2 - Objective: The aims of this study were to assess the opportunities for therapeutic endoscopy, liver biopsies, and percutaneous endoscopic gastrostomy (PEG) placements available to fellows during a 3-year pediatric gastroenterology fellowship, and to evaluate access to ancillary procedural-training opportunities. METHODS: Data were collected from 12 pediatric gastroenterology fellowship programs in the United States. Procedures completed in the years 2009-2011 were queried using CPT codes and endoscopy databases. The maximal opportunity for procedures was based on the total procedures performed by the institution in 3 years divided by the total number of fellows in the program. The centers completed a questionnaire regarding ancillary opportunities for endoscopic training. RESULTS: There is significant variability in pediatric endoscopic training opportunities in specialized gastrointestinal (GI) procedures. Under the 1999 guidelines, no centers were able to meet the thresholds for polypectomy and control of nonvariceal bleeding. The 2013 guidelines allowed the number of programs reaching polypectomy thresholds to increase by 67% but made no difference for control of bleeding despite a decrease in the threshold. Training in PEG placement was not available in 42% of the surveyed centers. Elective ancillary procedural training is offered by 92% of the surveyed centers. CONCLUSIONS: Most training programs do not have the volume of therapeutic endoscopy procedures for all of the fellows to meet the training guidelines. Training in therapeutic endoscopy, PEG placement, and liver biopsy in pediatric GI fellowships should be supplemented using all of the possible options including rotations with adult GI providers and hands-on endoscopy courses. A shift toward evaluating competency via quality measures may be more appropriate.

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