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 & 58 others 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

Research output: Contribution to journalArticle

5 Citations (Scopus)

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 languageEnglish (US)
Pages (from-to)1483-1494.e7
JournalGastroenterology
Volume155
Issue number5
DOIs
StatePublished - Nov 1 2018

Fingerprint

Endoscopic Retrograde Cholangiopancreatography
Mental Competency
Endoscopy
Multicenter Studies
Education
Practice (Psychology)
Learning Curve
Quality of Health Care
Catheterization
Cohort Studies
Research Design
Databases
Prospective Studies
Physicians

Keywords

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

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

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

In: Gastroenterology, Vol. 155, No. 5, 01.11.2018, p. 1483-1494.e7.

Research output: Contribution to journalArticle

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
Wani, Sachin ; Keswani, Rajesh N. ; Han, Samuel ; Aagaard, Eva M. ; Hall, Matthew ; Simon, Violette ; Abidi, Wasif M. ; Banerjee, Subhas ; Baron, Todd H. ; Bartel, Michael ; Bowman, Erik ; Brauer, Brian C. ; Buscaglia, Jonathan M. ; Carlin, Linda ; Chak, Amitabh ; Chatrath, Hemant ; Choudhary, Abhishek ; Confer, Bradley ; Coté, Gregory A. ; Das, Koushik K. ; DiMaio, Christopher J. ; Dries, Andrew M. ; Edmundowicz, Steven A. ; El Chafic, Abdul Hamid ; El Hajj, Ihab ; Ellert, Swan ; Ferreira, Jason ; Gamboa, Anthony ; Gan, Ian S. ; Gangarosa, Lisa M. ; Gannavarapu, Bhargava ; Gordon, Stuart R. ; Guda, Nalini M. ; Hammad, Hazem T. ; Harris, Cynthia ; Jalaj, Sujai ; Jowell, Paul S. ; Kenshil, Sana ; Klapman, Jason ; Kochman, Michael L. ; Komanduri, Srinadh ; Lang, Gabriel ; Lee, Linda S. ; Loren, David E. ; Lukens, Frank J. ; Mullady, Daniel ; Muthusamy, V. Raman ; Nett, Andrew S. ; Olyaee, Mojtaba S. ; Pakseresht, Kavous ; Perera, Pranith ; Pfau, Patrick ; Piraka, Cyrus ; Poneros, John M. ; Rastogi, Amit ; Razzak, Anthony ; Riff, Brian ; Saligram, Shreyas ; Scheiman, James M. ; Schuster, Isaiah ; Shah, Raj J. ; Sharma, Rishi ; Spaete, Joshua P. ; Singh, Ajaypal ; Sohail, Muhammad ; Sreenarasimhaiah, Jayaprakash ; Stevens, Tyler ; Tabibian, James H. ; Tzimas, Demetrios ; Uppal, Dushant S. ; Urayama, Shiro ; Vitterbo, Domenico ; Wang, Andrew Y. ; Wassef, Wahid ; Yachimski, Patrick ; Zepeda-Gomez, Sergio ; Zuchelli, Tobias ; Early, Dayna. / Competence in Endoscopic Ultrasound and Endoscopic Retrograde Cholangiopancreatography, From Training Through Independent Practice. In: Gastroenterology. 2018 ; Vol. 155, No. 5. pp. 1483-1494.e7.
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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.",
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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 - 2018/11/1

Y1 - 2018/11/1

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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DO - 10.1053/j.gastro.2018.07.024

M3 - Article

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SP - 1483-1494.e7

JO - Gastroenterology

JF - Gastroenterology

SN - 0016-5085

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ER -