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Wani S , Hall M , Keswani RN , Aslanian HR , Casey B , Burbridge R , Chak A , Chen AM , Cote G , Edmundowicz SA , Faulx AL , Hollander TG , Lee LS , Mullady D , Murad F , Muthusamy VR , Pfau PR , Scheiman JM , Tokar J , Wagh MS , Watson R , Early D
Variation in Aptitude of Trainees in Endoscopic Ultrasonography, Based on Cumulative Sum Analysis
Clin Gastroenterol Hepatol. 2015 Jul;13(7) :1318-1325 e2
PMID: 25460557    PMCID: PMC5511035    URL: http://www.ncbi.nlm.nih.gov/pubmed/25460557
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BACKGROUND & AIMS: Studies have reported substantial variation in the competency of advanced endoscopy trainees, indicating a need for more supervised training in endoscopic ultrasound (EUS). We used a standardized, validated, data collection tool to evaluate learning curves and measure competency in EUS among trainees at multiple centers. METHODS: In a prospective study performed at 15 centers, 17 trainees with no prior EUS experience were evaluated by experienced attending endosonographers at the 25th and then every 10th upper EUS examination, over a 12-month training period. A standardized data collection form was used (using a 5-point scoring system) to grade the EUS examination. Cumulative sum analysis was applied to produce a learning curve for each trainee; it tracked the overall performance based on median scores at different stations and also at each station. Competency was defined by a median score of 1, with acceptable and unacceptable failure rates of 10% and 20%, respectively. RESULTS: Twelve trainees were included in the final analysis. Each of the trainees performed 265 to 540 EUS examinations (total, 4257 examinations). There was a large amount of variation in their learning curves: 2 trainees crossed the threshold for acceptable performance (at cases 225 and 245), 2 trainees had a trend toward acceptable performance (after 289 and 355 cases) but required continued observation, and 8 trainees needed additional training and observation. Similar results were observed at individual stations. CONCLUSIONS: A specific case load does not ensure competency in EUS; 225 cases should be considered the minimum caseload for training because we found that no trainee achieved competency before this point. Ongoing training should be provided for trainees until competency is confirmed using objective measures.
Wani, Sachin Hall, Matthew Keswani, Rajesh N Aslanian, Harry R Casey, Brenna Burbridge, Rebecca Chak, Amitabh Chen, Ann M Cote, Gregory Edmundowicz, Steven A Faulx, Ashley L Hollander, Thomas G Lee, Linda S Mullady, Daniel Murad, Faris Muthusamy, V Raman Pfau, Patrick R Scheiman, James M Tokar, Jeffrey Wagh, Mihir S Watson, Rabindra Early, Dayna eng P50 CA150964/CA/NCI NIH HHS/ U54 CA163060/CA/NCI NIH HHS/ 2014/12/03 06:00 Clin Gastroenterol Hepatol. 2015 Jul;13(7):1318-1325.e2. doi: 10.1016/j.cgh.2014.11.008. Epub 2014 Nov 14.