Setting minimum standards for training in EUS and ERCP

results from a prospective multicenter study evaluating learning curves and competence among advanced endoscopy trainees

Sachin Wani, Samuel Han, Violette Simon, Matthew Hall, Dayna Early, Eva Aagaard, 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 Gangarosa, Bhargava Gannavarapu, Stuart R. Gordon, Nalini M. Guda, Hazem T. Hammad, Cynthia Harris, Sujai Jalaj, Paul Jowell, Sana Kenshil, Jason Klapman, Michael L. Kochman, Sri Komanduri, Gabriel Lang, Linda S. Lee, David E. Loren, Frank J. Lukens, Daniel Mullady, Raman V. 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, Rajesh N. Keswani

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background and Aims: Minimum EUS and ERCP volumes that should be offered per trainee in “high quality” advanced endoscopy training programs (AETPs) are not established. We aimed to define the number of procedures required by an “average” advanced endoscopy trainee (AET) to achieve competence in technical and cognitive EUS and ERCP tasks to help structure AETPs. Methods: American Society for Gastrointestinal Endoscopy (ASGE)-recognized AETPs were invited to participate; AETs were graded on every fifth EUS and ERCP examination using a validated tool. Grading for each skill was done using a 4-point scoring system, and learning curves using cumulative sum analysis for overall, technical, and cognitive components of EUS and ERCP were shared with AETs and trainers quarterly. Generalized linear mixed-effects models with a random intercept for each AET were used to generate aggregate learning curves, allowing us to use data from all AETs to estimate the average learning experience for trainees. Results: Among 62 invited AETPs, 37 AETs from 32 AETPs participated. Most AETs reported hands-on EUS (52%, median 20 cases) and ERCP (68%, median 50 cases) experience before starting an AETP. The median number of EUS and ERCPs performed per AET was 400 (range, 200-750) and 361 (range, 250-650), respectively. Overall, 2616 examinations were graded (EUS, 1277; ERCP-biliary, 1143; pancreatic, 196). Most graded EUS examinations were performed for pancreatobiliary indications (69.9%) and ERCP examinations for ASGE biliary grade of difficulty 1 (72.1%). The average AET achieved competence in core EUS and ERCP skills at approximately 225 and 250 cases, respectively. However, overall technical competence was achieved for grade 2 ERCP at about 300 cases. Conclusion: The thresholds provided for an average AET to achieve competence in EUS and ERCP may be used by the ASGE and AETPs in establishing the minimal standards for case volume exposure for AETs during their training. (Clinical trial registration number: NCT02509416.)

Original languageEnglish (US)
Pages (from-to)1160-1168.e9
JournalGastrointestinal Endoscopy
Volume89
Issue number6
DOIs
StatePublished - Jun 1 2019

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Prospective Studies
Education
Gastrointestinal Endoscopy
Clinical Trials
Learning

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

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Setting minimum standards for training in EUS and ERCP : results from a prospective multicenter study evaluating learning curves and competence among advanced endoscopy trainees. / Wani, Sachin; Han, Samuel; Simon, Violette; Hall, Matthew; Early, Dayna; Aagaard, Eva; 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; Gannavarapu, Bhargava; Gordon, Stuart R.; Guda, Nalini M.; Hammad, Hazem T.; Harris, Cynthia; Jalaj, Sujai; Jowell, Paul; Kenshil, Sana; Klapman, Jason; Kochman, Michael L.; Komanduri, Sri; Lang, Gabriel; Lee, Linda S.; Loren, David E.; Lukens, Frank J.; Mullady, Daniel; Muthusamy, Raman V.; 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; Keswani, Rajesh N.

In: Gastrointestinal Endoscopy, Vol. 89, No. 6, 01.06.2019, p. 1160-1168.e9.

Research output: Contribution to journalArticle

Wani, S, Han, S, Simon, V, Hall, M, Early, D, Aagaard, E, 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, L, Gannavarapu, B, Gordon, SR, Guda, NM, Hammad, HT, Harris, C, Jalaj, S, Jowell, P, Kenshil, S, Klapman, J, Kochman, ML, Komanduri, S, Lang, G, Lee, LS, Loren, DE, Lukens, FJ, Mullady, D, Muthusamy, RV, 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 & Keswani, RN 2019, 'Setting minimum standards for training in EUS and ERCP: results from a prospective multicenter study evaluating learning curves and competence among advanced endoscopy trainees', Gastrointestinal Endoscopy, vol. 89, no. 6, pp. 1160-1168.e9. https://doi.org/10.1016/j.gie.2019.01.030
Wani, Sachin ; Han, Samuel ; Simon, Violette ; Hall, Matthew ; Early, Dayna ; Aagaard, Eva ; 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 ; Gannavarapu, Bhargava ; Gordon, Stuart R. ; Guda, Nalini M. ; Hammad, Hazem T. ; Harris, Cynthia ; Jalaj, Sujai ; Jowell, Paul ; Kenshil, Sana ; Klapman, Jason ; Kochman, Michael L. ; Komanduri, Sri ; Lang, Gabriel ; Lee, Linda S. ; Loren, David E. ; Lukens, Frank J. ; Mullady, Daniel ; Muthusamy, Raman V. ; 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 ; Keswani, Rajesh N. / Setting minimum standards for training in EUS and ERCP : results from a prospective multicenter study evaluating learning curves and competence among advanced endoscopy trainees. In: Gastrointestinal Endoscopy. 2019 ; Vol. 89, No. 6. pp. 1160-1168.e9.
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title = "Setting minimum standards for training in EUS and ERCP: results from a prospective multicenter study evaluating learning curves and competence among advanced endoscopy trainees",
abstract = "Background and Aims: Minimum EUS and ERCP volumes that should be offered per trainee in “high quality” advanced endoscopy training programs (AETPs) are not established. We aimed to define the number of procedures required by an “average” advanced endoscopy trainee (AET) to achieve competence in technical and cognitive EUS and ERCP tasks to help structure AETPs. Methods: American Society for Gastrointestinal Endoscopy (ASGE)-recognized AETPs were invited to participate; AETs were graded on every fifth EUS and ERCP examination using a validated tool. Grading for each skill was done using a 4-point scoring system, and learning curves using cumulative sum analysis for overall, technical, and cognitive components of EUS and ERCP were shared with AETs and trainers quarterly. Generalized linear mixed-effects models with a random intercept for each AET were used to generate aggregate learning curves, allowing us to use data from all AETs to estimate the average learning experience for trainees. Results: Among 62 invited AETPs, 37 AETs from 32 AETPs participated. Most AETs reported hands-on EUS (52{\%}, median 20 cases) and ERCP (68{\%}, median 50 cases) experience before starting an AETP. The median number of EUS and ERCPs performed per AET was 400 (range, 200-750) and 361 (range, 250-650), respectively. Overall, 2616 examinations were graded (EUS, 1277; ERCP-biliary, 1143; pancreatic, 196). Most graded EUS examinations were performed for pancreatobiliary indications (69.9{\%}) and ERCP examinations for ASGE biliary grade of difficulty 1 (72.1{\%}). The average AET achieved competence in core EUS and ERCP skills at approximately 225 and 250 cases, respectively. However, overall technical competence was achieved for grade 2 ERCP at about 300 cases. Conclusion: The thresholds provided for an average AET to achieve competence in EUS and ERCP may be used by the ASGE and AETPs in establishing the minimal standards for case volume exposure for AETs during their training. (Clinical trial registration number: NCT02509416.)",
author = "Sachin Wani and Samuel Han and Violette Simon and Matthew Hall and Dayna Early and Eva Aagaard 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 Lisa Gangarosa and Bhargava Gannavarapu and Gordon, {Stuart R.} and Guda, {Nalini M.} and Hammad, {Hazem T.} and Cynthia Harris and Sujai Jalaj and Paul Jowell and Sana Kenshil and Jason Klapman and Kochman, {Michael L.} and Sri Komanduri and Gabriel Lang and Lee, {Linda S.} and Loren, {David E.} and Lukens, {Frank J.} and Daniel Mullady and Muthusamy, {Raman V.} 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 Keswani, {Rajesh N.}",
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TY - JOUR

T1 - Setting minimum standards for training in EUS and ERCP

T2 - results from a prospective multicenter study evaluating learning curves and competence among advanced endoscopy trainees

AU - Wani, Sachin

AU - Han, Samuel

AU - Simon, Violette

AU - Hall, Matthew

AU - Early, Dayna

AU - Aagaard, Eva

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

AU - Gannavarapu, Bhargava

AU - Gordon, Stuart R.

AU - Guda, Nalini M.

AU - Hammad, Hazem T.

AU - Harris, Cynthia

AU - Jalaj, Sujai

AU - Jowell, Paul

AU - Kenshil, Sana

AU - Klapman, Jason

AU - Kochman, Michael L.

AU - Komanduri, Sri

AU - Lang, Gabriel

AU - Lee, Linda S.

AU - Loren, David E.

AU - Lukens, Frank J.

AU - Mullady, Daniel

AU - Muthusamy, Raman V.

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 - Keswani, Rajesh N.

PY - 2019/6/1

Y1 - 2019/6/1

N2 - Background and Aims: Minimum EUS and ERCP volumes that should be offered per trainee in “high quality” advanced endoscopy training programs (AETPs) are not established. We aimed to define the number of procedures required by an “average” advanced endoscopy trainee (AET) to achieve competence in technical and cognitive EUS and ERCP tasks to help structure AETPs. Methods: American Society for Gastrointestinal Endoscopy (ASGE)-recognized AETPs were invited to participate; AETs were graded on every fifth EUS and ERCP examination using a validated tool. Grading for each skill was done using a 4-point scoring system, and learning curves using cumulative sum analysis for overall, technical, and cognitive components of EUS and ERCP were shared with AETs and trainers quarterly. Generalized linear mixed-effects models with a random intercept for each AET were used to generate aggregate learning curves, allowing us to use data from all AETs to estimate the average learning experience for trainees. Results: Among 62 invited AETPs, 37 AETs from 32 AETPs participated. Most AETs reported hands-on EUS (52%, median 20 cases) and ERCP (68%, median 50 cases) experience before starting an AETP. The median number of EUS and ERCPs performed per AET was 400 (range, 200-750) and 361 (range, 250-650), respectively. Overall, 2616 examinations were graded (EUS, 1277; ERCP-biliary, 1143; pancreatic, 196). Most graded EUS examinations were performed for pancreatobiliary indications (69.9%) and ERCP examinations for ASGE biliary grade of difficulty 1 (72.1%). The average AET achieved competence in core EUS and ERCP skills at approximately 225 and 250 cases, respectively. However, overall technical competence was achieved for grade 2 ERCP at about 300 cases. Conclusion: The thresholds provided for an average AET to achieve competence in EUS and ERCP may be used by the ASGE and AETPs in establishing the minimal standards for case volume exposure for AETs during their training. (Clinical trial registration number: NCT02509416.)

AB - Background and Aims: Minimum EUS and ERCP volumes that should be offered per trainee in “high quality” advanced endoscopy training programs (AETPs) are not established. We aimed to define the number of procedures required by an “average” advanced endoscopy trainee (AET) to achieve competence in technical and cognitive EUS and ERCP tasks to help structure AETPs. Methods: American Society for Gastrointestinal Endoscopy (ASGE)-recognized AETPs were invited to participate; AETs were graded on every fifth EUS and ERCP examination using a validated tool. Grading for each skill was done using a 4-point scoring system, and learning curves using cumulative sum analysis for overall, technical, and cognitive components of EUS and ERCP were shared with AETs and trainers quarterly. Generalized linear mixed-effects models with a random intercept for each AET were used to generate aggregate learning curves, allowing us to use data from all AETs to estimate the average learning experience for trainees. Results: Among 62 invited AETPs, 37 AETs from 32 AETPs participated. Most AETs reported hands-on EUS (52%, median 20 cases) and ERCP (68%, median 50 cases) experience before starting an AETP. The median number of EUS and ERCPs performed per AET was 400 (range, 200-750) and 361 (range, 250-650), respectively. Overall, 2616 examinations were graded (EUS, 1277; ERCP-biliary, 1143; pancreatic, 196). Most graded EUS examinations were performed for pancreatobiliary indications (69.9%) and ERCP examinations for ASGE biliary grade of difficulty 1 (72.1%). The average AET achieved competence in core EUS and ERCP skills at approximately 225 and 250 cases, respectively. However, overall technical competence was achieved for grade 2 ERCP at about 300 cases. Conclusion: The thresholds provided for an average AET to achieve competence in EUS and ERCP may be used by the ASGE and AETPs in establishing the minimal standards for case volume exposure for AETs during their training. (Clinical trial registration number: NCT02509416.)

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U2 - 10.1016/j.gie.2019.01.030

DO - 10.1016/j.gie.2019.01.030

M3 - Article

VL - 89

SP - 1160-1168.e9

JO - Gastrointestinal Endoscopy

JF - Gastrointestinal Endoscopy

SN - 0016-5107

IS - 6

ER -