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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, Chafic AHE, Hajj IE, 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; 155:1483-1494.e7. [PMID: 30056094 PMCID: PMC6504935 DOI: 10.1053/j.gastro.2018.07.024] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 07/18/2018] [Accepted: 07/21/2018] [Indexed: 12/21/2022]
Abstract
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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Affiliation(s)
- Sachin Wani
- University of Colorado Anschutz Medical Center, Aurora, Colorado.
| | - Rajesh N. Keswani
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Samuel Han
- University of Colorado Anschutz Medical Center, Aurora, Colorado
| | | | | | - Violette Simon
- University of Colorado Anschutz Medical Center, Aurora, Colorado
| | | | | | - Todd H. Baron
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Michael Bartel
- Mayo Clinic School of Graduate Medical Education, Jacksonville, Florida
| | | | - Brian C. Brauer
- University of Colorado Anschutz Medical Center, Aurora, Colorado
| | | | - Linda Carlin
- University of Colorado Anschutz Medical Center, Aurora, Colorado
| | - Amitabh Chak
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Hemant Chatrath
- University of California-Los Angeles, Los Angeles, California
| | | | | | - Gregory A. Coté
- Medical University of South Carolina, Charleston, South Carolina
| | | | | | | | | | | | | | - Swan Ellert
- University of Colorado Anschutz Medical Center, Aurora, Colorado
| | - Jason Ferreira
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | | | - Ian S. Gan
- Virginia Mason Medical Center, Seattle, Washington
| | - Lisa M. Gangarosa
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | | | | | - Hazem T. Hammad
- University of Colorado Anschutz Medical Center, Aurora, Colorado
| | - Cynthia Harris
- Moffitt Cancer Center, University of South Florida, Tampa, Florida
| | - Sujai Jalaj
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | - Sana Kenshil
- University of Alberta, Edmonton, Alberta, Canada
| | - Jason Klapman
- Moffitt Cancer Center, University of South Florida, Tampa, Florida
| | | | - Srinadh Komanduri
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Gabriel Lang
- Washington University in St Louis, St Louis, Missouri
| | - Linda S. Lee
- Brigham and Women’s Hospital, Boston, Massachusetts
| | | | - Frank J. Lukens
- Mayo Clinic School of Graduate Medical Education, Jacksonville, Florida
| | | | | | | | | | | | | | | | | | | | | | | | - Brian Riff
- Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Shreyas Saligram
- Moffitt Cancer Center, University of South Florida, Tampa, Florida
| | | | | | - Raj J. Shah
- University of Colorado Anschutz Medical Center, Aurora, Colorado
| | - Rishi Sharma
- University of California-Davis, Davis, California
| | | | - Ajaypal Singh
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Muhammad Sohail
- University of Massachusetts Medical Center, Worcester, Massachusetts
| | | | | | | | | | - Dushant S. Uppal
- University of Virginia School of Medicine, Charlottesville, Virginia
| | | | | | - Andrew Y. Wang
- University of Virginia School of Medicine, Charlottesville, Virginia
| | - Wahid Wassef
- University of Massachusetts Medical Center, Worcester, Massachusetts
| | | | | | | | - Dayna Early
- Washington University in St Louis, St Louis, Missouri
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