Competence in endoscopic ultrasound and endoscopic retrograde cholangiopancreatography, from training through independent practice
Wani S, Keswani RN, Han S, et al. Competence in Endoscopic Ultrasound and Endoscopic Retrograde Cholangiopancreatography, from Training Through Independent Practice. Gastroenterology. 2018;155(5):1483-1494.e7. doi: 10.1053/j.gastro.2018.07.024.
BACKGROUND & AIMS: It is unclear whether participation in competency-based fellowship programs for endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) result in high-quality care in independent practice. We aimed to measure 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, inviting 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, the participating AETs entered data into a database pertaining to every EUS and ERCP 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% and ERCP, 73.9%) and cognitive competence (EUS, 91.7% and ERCP, 94.1%). In phase 2 of the study, 22 AETs (91.6%) participated and completed a median 136 EUS exams/AET and 116 ERCPs/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 a 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 no: NCT02509416.