Development of American Society for Gastrointestinal Endoscopy standards for training in advanced endoscopy within dedicated advanced endoscopy fellowship programs

Sachin Wani, Division of Gastroenterology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
Gregory A. Cote, Division of Gastroenterology, Oregon Health & Science University, Portland, Oregon, USA.
Rajesh N. Keswani, Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Rena H. Yadlapati, UCSD Center for Esophageal Diseases, Division of Gastroenterology, University of California San Diego, La Jolla, California, USA.
Matt Hall, Children's Hospital Association, Lenexa, Kansas, USA.
Jack O'Hara, Division of Gastroenterology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
Tyler M. Berzin, Beth Israel Deaconess Medical Center, Division of Gastroenterology, Harvard Medical School, Boston, Massachusetts, USA.
Rebecca A. Burbridge, Division of Gastroenterology, Duke University Medical Center, Durham, North Carolina, USA.
Prabhleen Chahal, Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Jonathan Cohen, New York University Grossman School of Medicine, New York, New York, USA.
Walter J. Coyle, Division of Gastroenterology, Scripps Green Hospital, La Jolla, California, USA.
Dayna Early, Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USA.
Nalini M. Guda, Advocate Health - MidwestFollow
Sumant Inamdar, Division of Gastroenterology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
Lauren Khanna, Department of Medicine, New York University Langone Health, New York, New York, USA.
Abhijit Kulkarni, Division of Gastroenterology and Hepatology, Allegheny Health Network, Pittsburgh, Pennsylvania, USA.
Laura Rosenkranz, Division of Gastroenterology, Hepatology, and Nutrition, University of Texas Health, San Antonio, Texas, USA.
Neil Sharma, Division of Interventional Endoscopic Oncology and Surgical Endoscopy, Parkview Health, Fort Wayne, Indiana, USA.
Eun Ji Shin, Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
Uzma D. Siddiqui, Center for Endoscopic Research and Therapeutics (CERT), University of Chicago, Chicago, Illinois, USA; 20Division of Gastroenterology, Northwestern University, Chicago, Illinois, USA.
Jasmine Sinha, Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Hendrikus Vanderveldt, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Peter V. Draganov, Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Florida, Gainesville, Florida, USA.

Affiliations

Aurora St. Luke's Medical Center

Abstract

Background and aims:Training in interventional endoscopy is offered by nonaccredited advanced endoscopy fellowship programs (AEFPs). The number of these programs has increased dramatically with a concurrent increase in the breadth and complexity of interventional endoscopy procedures. Accreditation is governed by competency-based education, yet what constitutes a "high-quality" nonaccredited AEFP has not been defined. Using an evidence-based consensus process, we aimed to establish standards for AEFPs.

Methods:The RAND UCLA appropriateness method, a well-described modified Delphi process to develop quality indicators, was used. A task force established by the American Society for Gastrointestinal Endoscopy drafted potential quality indicators (structure, process, and outcome) in 6 categories: activity preceding training; structure of AEFPs; training in ERCP, EUS, and EMR; and luminal stent placement. Three rounds of iterative feedback from 20 experts were conducted. Round 0 involved discussion of project details. In round 1, experts independently ranked proposed quality indicators on a 9-point interval scale ranging from highly inappropriate (1) to highly appropriate (9). Next, proposed quality indicators were discussed and reworded in a group meeting followed by round 2, in which experts independently reranked proposed quality indicators and provided benchmarks (when applicable). The median score for each quality indicator was calculated. Mean absolute deviation from the median was calculated, and appropriateness of potential quality indicators was assessed using the BIOMED concerted action on appropriateness definition, P value method, and interpercentile range adjusted for symmetry definition. A quality indicator was deemed appropriate if the median score was ≥7 and met criteria for appropriateness using all 3 defined statistical methods.

Results:Of 89 proposed quality indicators, 37 statements met criteria as appropriate for a quality indicator (activity preceding training, 2; structure of AEFPs, 10; training in ERCP, 7; training in EUS, 8; training in EMR, 7; luminal stent placement, 3). Minimum thresholds were defined for 19 relevant quality indicators for number of trainers, procedures during fellowship, and procedures before assessment of competence. Among the final appropriate quality indicators were that all trainees should undergo qualitative and quantitative competence assessments using validated tools at least quarterly with documented feedback throughout the training period and that trainees should track outcomes and relevant quality metrics for specific procedures.

Conclusions:This consensus process using validated methodology established standards for an AEFP in an effort to ensure adequate training in the most commonly taught interventional endoscopic procedures (ERCP, EUS, EMR, and luminal stent placement) during fellowship. An important component of an AEFP is the use of competency-based assessments that are compliant with the Accreditation Council for Graduate Medical Education's Next Accreditation System, with the goal of ensuring that trainees achieve specific milestones in their progression to achieving cognitive and technical competency.

Type

Article

PubMed ID

38935016

Teammate Access


 

Share

COinS