Competence in Endoscopic Ultrasound and Endoscopic Retrograde Cholangiopancreatography, From Training Through Independent Practice

Sachin Wani; Rajesh N. Keswani; Samuel Han; Eva M. Aagaard; Matthew Hall; Violette Simon; Wasif M. Abidi; Subhas Banerjee; Todd H. Baron; Michael Bartel; Erik Bowman; Brian C. Brauer; Jonathan M. Buscaglia; Linda Carlin; Amitabh Chak; Hemant Chatrath; Abhishek Choudhary; Bradley Confer; Gregory A. Coté; Koushik K. Das; Christopher J. DiMaio; Andrew M. Dries; Steven A. Edmundowicz; Abdul Hamid El Chafic; Ihab El Hajj; Swan Ellert; Jason Ferreira; Anthony Gamboa; Ian S. Gan; Lisa M. Gangarosa; Bhargava Gannavarapu; Stuart R. Gordon; Nalini M. Guda; Hazem T. Hammad; Cynthia Harris; Sujai Jalaj; Paul S. Jowell; Sana Kenshil; Jason Klapman; Michael L. Kochman; Srinadh Komanduri; Gabriel Lang; Linda S. Lee; David E. Loren; Frank J. Lukens; Daniel Mullady; V. Raman Muthusamy; Andrew S. Nett; Mojtaba S. Olyaee; Kavous Pakseresht; Pranith Perera; Patrick Pfau; Cyrus Piraka; John M. Poneros; Amit Rastogi; Anthony Razzak; Brian Riff; Shreyas Saligram; James M. Scheiman; Isaiah Schuster; Raj J. Shah; Rishi Sharma; Joshua P. Spaete; Ajaypal Singh; Muhammad Sohail; Jayaprakash Sreenarasimhaiah; Tyler Stevens; James H. Tabibian; Demetrios Tzimas; Dushant S. Uppal; Shiro Urayama; Domenico Vitterbo; Andrew Y. Wang; Wahid Wassef; Patrick Yachimski; Sergio Zepeda-Gomez; Tobias Zuchelli; Dayna Early

doi:10.1053/j.gastro.2018.07.024

Competence in Endoscopic Ultrasound and Endoscopic Retrograde Cholangiopancreatography, From Training Through Independent Practice

Sachin Wani, Rajesh N. Keswani, Samuel Han, Eva M. Aagaard, Matthew Hall, Violette Simon, Wasif M. Abidi, Subhas Banerjee, Todd H. Baron, Michael Bartel, Erik Bowman, Brian C. Brauer, Jonathan M. Buscaglia, Linda Carlin, Amitabh Chak, Hemant Chatrath, Abhishek Choudhary, Bradley Confer, Gregory A. Coté, Koushik K. DasChristopher J. DiMaio, Andrew M. Dries, Steven A. Edmundowicz, Abdul Hamid El Chafic, Ihab El Hajj, Swan Ellert, Jason Ferreira, Anthony Gamboa, Ian S. Gan, Lisa M. Gangarosa, Bhargava Gannavarapu, Stuart R. Gordon, Nalini M. Guda, Hazem T. Hammad, Cynthia Harris, Sujai Jalaj, Paul S. Jowell, Sana Kenshil, Jason Klapman, Michael L. Kochman, Srinadh Komanduri, Gabriel Lang, Linda S. Lee, David E. Loren, Frank J. Lukens, Daniel Mullady, V. Raman Muthusamy, Andrew S. Nett, Mojtaba S. Olyaee, Kavous Pakseresht, Pranith Perera, Patrick Pfau, Cyrus Piraka, John M. Poneros, Amit Rastogi, Anthony Razzak, Brian Riff, Shreyas Saligram, James M. Scheiman, Isaiah Schuster, Raj J. Shah, Rishi Sharma, Joshua P. Spaete, Ajaypal Singh, Muhammad Sohail, Jayaprakash Sreenarasimhaiah, Tyler Stevens, James H. Tabibian, Demetrios Tzimas, Dushant S. Uppal, Shiro Urayama, Domenico Vitterbo, Andrew Y. Wang, Wahid Wassef, Patrick Yachimski, Sergio Zepeda-Gomez, Tobias Zuchelli, Dayna Early

Research output: Contribution to journal › Article › peer-review

55 Scopus citations

Abstract

Background & Aims: It is unclear whether participation in competency-based fellowship programs for endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) results in high-quality care in independent practice. We measured quality indicator (QI) adherence during the first year of independent practice among physicians who completed endoscopic training with a systematic assessment of competence. Methods: We performed a prospective multicenter cohort study of invited participants from 62 training programs. In phase 1, 24 advanced endoscopy trainees (AETs), from 20 programs, were assessed using a validated competence assessment tool. We used a comprehensive data collection and reporting system to create learning curves using cumulative sum analysis that were shared with AETs and trainers quarterly. In phase 2, participating AETs entered data into a database pertaining to every EUS and ERCP examination during their first year of independent practice, anchored by key QIs. Results: By the end of training, most AETs had achieved overall technical competence (EUS 91.7%, ERCP 73.9%) and cognitive competence (EUS 91.7%, ERCP 94.1%). In phase 2 of the study, 22 AETs (91.6%) participated and completed a median of 136 EUS examinations per AET and 116 ERCP examinations per AET. Most AETs met the performance thresholds for QIs in EUS (including 94.4% diagnostic rate of adequate samples and 83.8% diagnostic yield of malignancy in pancreatic masses) and ERCP (94.9% overall cannulation rate). Conclusions: In this prospective multicenter study, we found that although competence cannot be confirmed for all AETs at the end of training, most meet QI thresholds for EUS and ERCP at the end of their first year of independent practice. This finding affirms the effectiveness of training programs. Clinicaltrials.gov ID NCT02509416.

Original language	English (US)
Pages (from-to)	1483-1494.e7
Journal	Gastroenterology
Volume	155
Issue number	5
DOIs	https://doi.org/10.1053/j.gastro.2018.07.024
State	Published - Nov 2018

Keywords

Advanced Endoscopy Training
Learning Curves
Quality Indicators
The EUS and ERCP Skills Assessment Tool (TEESAT)

ASJC Scopus subject areas

Hepatology
Gastroenterology

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10.1053/j.gastro.2018.07.024

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Wani, S., Keswani, R. N., Han, S., Aagaard, E. M., Hall, M., Simon, V., Abidi, W. M., Banerjee, S., Baron, T. H., Bartel, M., Bowman, E., Brauer, B. C., Buscaglia, J. M., Carlin, L., Chak, A., Chatrath, H., Choudhary, A., Confer, B., Coté, G. A., ... Early, D. (2018). Competence in Endoscopic Ultrasound and Endoscopic Retrograde Cholangiopancreatography, From Training Through Independent Practice. Gastroenterology, 155(5), 1483-1494.e7. https://doi.org/10.1053/j.gastro.2018.07.024

Wani, S, Keswani, RN, Han, S, Aagaard, EM, Hall, M, Simon, V, Abidi, WM, Banerjee, S, Baron, TH, Bartel, M, Bowman, E, Brauer, BC, Buscaglia, JM, Carlin, L, Chak, A, Chatrath, H, Choudhary, A, Confer, B, Coté, GA, Das, KK, DiMaio, CJ, Dries, AM, Edmundowicz, SA, El Chafic, AH, El Hajj, I, Ellert, S, Ferreira, J, Gamboa, A, Gan, IS, Gangarosa, LM, Gannavarapu, B, Gordon, SR, Guda, NM, Hammad, HT, Harris, C, Jalaj, S, Jowell, PS, Kenshil, S, Klapman, J, Kochman, ML, Komanduri, S, Lang, G, Lee, LS, Loren, DE, Lukens, FJ, Mullady, D, Muthusamy, VR, Nett, AS, Olyaee, MS, Pakseresht, K, Perera, P, Pfau, P, Piraka, C, Poneros, JM, Rastogi, A, Razzak, A, Riff, B, Saligram, S, Scheiman, JM, Schuster, I, Shah, RJ, Sharma, R, Spaete, JP, Singh, A, Sohail, M, Sreenarasimhaiah, J, Stevens, T, Tabibian, JH, Tzimas, D, Uppal, DS, Urayama, S, Vitterbo, D, Wang, AY, Wassef, W, Yachimski, P, Zepeda-Gomez, S, Zuchelli, T & Early, D 2018, 'Competence in Endoscopic Ultrasound and Endoscopic Retrograde Cholangiopancreatography, From Training Through Independent Practice', Gastroenterology, vol. 155, no. 5, pp. 1483-1494.e7. https://doi.org/10.1053/j.gastro.2018.07.024

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title = "Competence in Endoscopic Ultrasound and Endoscopic Retrograde Cholangiopancreatography, From Training Through Independent Practice",

abstract = "Background & Aims: It is unclear whether participation in competency-based fellowship programs for endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) results in high-quality care in independent practice. We measured quality indicator (QI) adherence during the first year of independent practice among physicians who completed endoscopic training with a systematic assessment of competence. Methods: We performed a prospective multicenter cohort study of invited participants from 62 training programs. In phase 1, 24 advanced endoscopy trainees (AETs), from 20 programs, were assessed using a validated competence assessment tool. We used a comprehensive data collection and reporting system to create learning curves using cumulative sum analysis that were shared with AETs and trainers quarterly. In phase 2, participating AETs entered data into a database pertaining to every EUS and ERCP examination during their first year of independent practice, anchored by key QIs. Results: By the end of training, most AETs had achieved overall technical competence (EUS 91.7%, ERCP 73.9%) and cognitive competence (EUS 91.7%, ERCP 94.1%). In phase 2 of the study, 22 AETs (91.6%) participated and completed a median of 136 EUS examinations per AET and 116 ERCP examinations per AET. Most AETs met the performance thresholds for QIs in EUS (including 94.4% diagnostic rate of adequate samples and 83.8% diagnostic yield of malignancy in pancreatic masses) and ERCP (94.9% overall cannulation rate). Conclusions: In this prospective multicenter study, we found that although competence cannot be confirmed for all AETs at the end of training, most meet QI thresholds for EUS and ERCP at the end of their first year of independent practice. This finding affirms the effectiveness of training programs. Clinicaltrials.gov ID NCT02509416.",

keywords = "Advanced Endoscopy Training, Learning Curves, Quality Indicators, The EUS and ERCP Skills Assessment Tool (TEESAT)",

author = "Sachin Wani and Keswani, {Rajesh N.} and Samuel Han and Aagaard, {Eva M.} and Matthew Hall and Violette Simon and Abidi, {Wasif M.} and Subhas Banerjee and Baron, {Todd H.} and Michael Bartel and Erik Bowman and Brauer, {Brian C.} and Buscaglia, {Jonathan M.} and Linda Carlin and Amitabh Chak and Hemant Chatrath and Abhishek Choudhary and Bradley Confer and Cot{\'e}, {Gregory A.} and Das, {Koushik K.} and DiMaio, {Christopher J.} and Dries, {Andrew M.} and Edmundowicz, {Steven A.} and {El Chafic}, {Abdul Hamid} and {El Hajj}, Ihab and Swan Ellert and Jason Ferreira and Anthony Gamboa and Gan, {Ian S.} and Gangarosa, {Lisa M.} and Bhargava Gannavarapu and Gordon, {Stuart R.} and Guda, {Nalini M.} and Hammad, {Hazem T.} and Cynthia Harris and Sujai Jalaj and Jowell, {Paul S.} and Sana Kenshil and Jason Klapman and Kochman, {Michael L.} and Srinadh Komanduri and Gabriel Lang and Lee, {Linda S.} and Loren, {David E.} and Lukens, {Frank J.} and Daniel Mullady and Muthusamy, {V. Raman} and Nett, {Andrew S.} and Olyaee, {Mojtaba S.} and Kavous Pakseresht and Pranith Perera and Patrick Pfau and Cyrus Piraka and Poneros, {John M.} and Amit Rastogi and Anthony Razzak and Brian Riff and Shreyas Saligram and Scheiman, {James M.} and Isaiah Schuster and Shah, {Raj J.} and Rishi Sharma and Spaete, {Joshua P.} and Ajaypal Singh and Muhammad Sohail and Jayaprakash Sreenarasimhaiah and Tyler Stevens and Tabibian, {James H.} and Demetrios Tzimas and Uppal, {Dushant S.} and Shiro Urayama and Domenico Vitterbo and Wang, {Andrew Y.} and Wahid Wassef and Patrick Yachimski and Sergio Zepeda-Gomez and Tobias Zuchelli and Dayna Early",

note = "Publisher Copyright: {\textcopyright} 2018 AGA Institute",

year = "2018",

month = nov,

doi = "10.1053/j.gastro.2018.07.024",

language = "English (US)",

volume = "155",

pages = "1483--1494.e7",

journal = "Gastroenterology",

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publisher = "W.B. Saunders Ltd",

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TY - JOUR

T1 - Competence in Endoscopic Ultrasound and Endoscopic Retrograde Cholangiopancreatography, From Training Through Independent Practice

AU - Wani, Sachin

AU - Keswani, Rajesh N.

AU - Han, Samuel

AU - Aagaard, Eva M.

AU - Hall, Matthew

AU - Simon, Violette

AU - Abidi, Wasif M.

AU - Banerjee, Subhas

AU - Baron, Todd H.

AU - Bartel, Michael

AU - Bowman, Erik

AU - Brauer, Brian C.

AU - Buscaglia, Jonathan M.

AU - Carlin, Linda

AU - Chak, Amitabh

AU - Chatrath, Hemant

AU - Choudhary, Abhishek

AU - Confer, Bradley

AU - Coté, Gregory A.

AU - Das, Koushik K.

AU - DiMaio, Christopher J.

AU - Dries, Andrew M.

AU - Edmundowicz, Steven A.

AU - El Chafic, Abdul Hamid

AU - El Hajj, Ihab

AU - Ellert, Swan

AU - Ferreira, Jason

AU - Gamboa, Anthony

AU - Gan, Ian S.

AU - Gangarosa, Lisa M.

AU - Gannavarapu, Bhargava

AU - Gordon, Stuart R.

AU - Guda, Nalini M.

AU - Hammad, Hazem T.

AU - Harris, Cynthia

AU - Jalaj, Sujai

AU - Jowell, Paul S.

AU - Kenshil, Sana

AU - Klapman, Jason

AU - Kochman, Michael L.

AU - Komanduri, Srinadh

AU - Lang, Gabriel

AU - Lee, Linda S.

AU - Loren, David E.

AU - Lukens, Frank J.

AU - Mullady, Daniel

AU - Muthusamy, V. Raman

AU - Nett, Andrew S.

AU - Olyaee, Mojtaba S.

AU - Pakseresht, Kavous

AU - Perera, Pranith

AU - Pfau, Patrick

AU - Piraka, Cyrus

AU - Poneros, John M.

AU - Rastogi, Amit

AU - Razzak, Anthony

AU - Riff, Brian

AU - Saligram, Shreyas

AU - Scheiman, James M.

AU - Schuster, Isaiah

AU - Shah, Raj J.

AU - Sharma, Rishi

AU - Spaete, Joshua P.

AU - Singh, Ajaypal

AU - Sohail, Muhammad

AU - Sreenarasimhaiah, Jayaprakash

AU - Stevens, Tyler

AU - Tabibian, James H.

AU - Tzimas, Demetrios

AU - Uppal, Dushant S.

AU - Urayama, Shiro

AU - Vitterbo, Domenico

AU - Wang, Andrew Y.

AU - Wassef, Wahid

AU - Yachimski, Patrick

AU - Zepeda-Gomez, Sergio

AU - Zuchelli, Tobias

AU - Early, Dayna

PY - 2018/11

Y1 - 2018/11

N2 - Background & Aims: It is unclear whether participation in competency-based fellowship programs for endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) results in high-quality care in independent practice. We measured quality indicator (QI) adherence during the first year of independent practice among physicians who completed endoscopic training with a systematic assessment of competence. Methods: We performed a prospective multicenter cohort study of invited participants from 62 training programs. In phase 1, 24 advanced endoscopy trainees (AETs), from 20 programs, were assessed using a validated competence assessment tool. We used a comprehensive data collection and reporting system to create learning curves using cumulative sum analysis that were shared with AETs and trainers quarterly. In phase 2, participating AETs entered data into a database pertaining to every EUS and ERCP examination during their first year of independent practice, anchored by key QIs. Results: By the end of training, most AETs had achieved overall technical competence (EUS 91.7%, ERCP 73.9%) and cognitive competence (EUS 91.7%, ERCP 94.1%). In phase 2 of the study, 22 AETs (91.6%) participated and completed a median of 136 EUS examinations per AET and 116 ERCP examinations per AET. Most AETs met the performance thresholds for QIs in EUS (including 94.4% diagnostic rate of adequate samples and 83.8% diagnostic yield of malignancy in pancreatic masses) and ERCP (94.9% overall cannulation rate). Conclusions: In this prospective multicenter study, we found that although competence cannot be confirmed for all AETs at the end of training, most meet QI thresholds for EUS and ERCP at the end of their first year of independent practice. This finding affirms the effectiveness of training programs. Clinicaltrials.gov ID NCT02509416.

AB - Background & Aims: It is unclear whether participation in competency-based fellowship programs for endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) results in high-quality care in independent practice. We measured quality indicator (QI) adherence during the first year of independent practice among physicians who completed endoscopic training with a systematic assessment of competence. Methods: We performed a prospective multicenter cohort study of invited participants from 62 training programs. In phase 1, 24 advanced endoscopy trainees (AETs), from 20 programs, were assessed using a validated competence assessment tool. We used a comprehensive data collection and reporting system to create learning curves using cumulative sum analysis that were shared with AETs and trainers quarterly. In phase 2, participating AETs entered data into a database pertaining to every EUS and ERCP examination during their first year of independent practice, anchored by key QIs. Results: By the end of training, most AETs had achieved overall technical competence (EUS 91.7%, ERCP 73.9%) and cognitive competence (EUS 91.7%, ERCP 94.1%). In phase 2 of the study, 22 AETs (91.6%) participated and completed a median of 136 EUS examinations per AET and 116 ERCP examinations per AET. Most AETs met the performance thresholds for QIs in EUS (including 94.4% diagnostic rate of adequate samples and 83.8% diagnostic yield of malignancy in pancreatic masses) and ERCP (94.9% overall cannulation rate). Conclusions: In this prospective multicenter study, we found that although competence cannot be confirmed for all AETs at the end of training, most meet QI thresholds for EUS and ERCP at the end of their first year of independent practice. This finding affirms the effectiveness of training programs. Clinicaltrials.gov ID NCT02509416.

KW - Advanced Endoscopy Training

KW - Learning Curves

KW - Quality Indicators

KW - The EUS and ERCP Skills Assessment Tool (TEESAT)

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Competence in Endoscopic Ultrasound and Endoscopic Retrograde Cholangiopancreatography, From Training Through Independent Practice

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