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

Publication ,  Journal Article
Wani, S; Keswani, RN; Han, S; Aagaard, EM; Hall, M; Simon, V; Abidi, WM; Banerjee, S; Baron, TH; Bartel, M; Bowman, E; Brauer, BC; Carlin, L ...
Published in: Gastroenterology
November 2018

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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Published In

Gastroenterology

DOI

EISSN

1528-0012

Publication Date

November 2018

Volume

155

Issue

5

Start / End Page

1483 / 1494.e7

Location

United States

Related Subject Headings

  • Quality Indicators, Health Care
  • Prospective Studies
  • Learning Curve
  • Humans
  • Gastroenterology & Hepatology
  • Endosonography
  • Clinical Competence
  • Cholangiopancreatography, Endoscopic Retrograde
  • 3210 Nutrition and dietetics
  • 3202 Clinical sciences
 

Citation

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Wani, S., Keswani, R. N., Han, S., Aagaard, E. M., Hall, M., Simon, V., … 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, Sachin, Rajesh N. Keswani, Samuel Han, Eva M. Aagaard, Matthew Hall, Violette Simon, Wasif M. Abidi, et al. “Competence in Endoscopic Ultrasound and Endoscopic Retrograde Cholangiopancreatography, From Training Through Independent Practice.Gastroenterology 155, no. 5 (November 2018): 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, et al. Competence in Endoscopic Ultrasound and Endoscopic Retrograde Cholangiopancreatography, From Training Through Independent Practice. Gastroenterology. 2018 Nov;155(5):1483-1494.e7.
Wani, Sachin, et al. “Competence in Endoscopic Ultrasound and Endoscopic Retrograde Cholangiopancreatography, From Training Through Independent Practice.Gastroenterology, vol. 155, no. 5, Nov. 2018, pp. 1483-1494.e7. Pubmed, doi: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. Competence in Endoscopic Ultrasound and Endoscopic Retrograde Cholangiopancreatography, From Training Through Independent Practice. Gastroenterology. 2018 Nov;155(5):1483-1494.e7.
Journal cover image

Published In

Gastroenterology

DOI

EISSN

1528-0012

Publication Date

November 2018

Volume

155

Issue

5

Start / End Page

1483 / 1494.e7

Location

United States

Related Subject Headings

  • Quality Indicators, Health Care
  • Prospective Studies
  • Learning Curve
  • Humans
  • Gastroenterology & Hepatology
  • Endosonography
  • Clinical Competence
  • Cholangiopancreatography, Endoscopic Retrograde
  • 3210 Nutrition and dietetics
  • 3202 Clinical sciences