Variation in learning curves and competence for ERCP among advanced endoscopy trainees by using cumulative sum analysis

Sachin Wani, Matthew Hall, Andrew Y. Wang, Christopher J. Dimaio, V. Raman Muthusamy, Rajesh N. Keswani, Brian C. Brauer, Jeffrey J. Easler, Roy D. Yen, Ihab El Hajj, Norio Fukami, Kourosh F. Ghassemi, Susana Gonzalez, Lindsay Hosford, Thomas G. Hollander, Robert Wilson, Vladimir M. Kushnir, Jawad Ahmad, Faris Murad, Anoop Prabhu & 8 others Rabindra R. Watson, Daniel S. Strand, Stuart K. Amateau, Augustin Attwell, Raj J. Shah, Dayna Early, Steven A. Edmundowicz, Daniel Mullady

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Background and Aims There are limited data on learning curves and competence in ERCP. By using a standardized data collection tool, we aimed to prospectively define learning curves and measure competence among advanced endoscopy trainees (AETs) by using cumulative sum (CUSUM) analysis. Methods AETs were evaluated by attending endoscopists starting with the 26th hands-on ERCP examination and then every ERCP examination during the 12-month training period. A standardized ERCP competency assessment tool (using a 4-point scoring system) was used to grade the examination. CUSUM analysis was applied to produce learning curves for individual technical and cognitive components of ERCP performance (success defined as a score of 1, acceptable and unacceptable failures [p1] of 10% and 20%, respectively). Sensitivity analyses varying p1 and by using a less-stringent definition of success were performed. Results Five AETs were included with a total of 1049 graded ERCPs (mean ± SD, 209.8 ± 91.6/AET). The majority of cases were performed for a biliary indication (80%). The overall and native papilla allowed cannulation times were 3.1 ± 3.6 and 5.7 ± 4, respectively. Overall learning curves demonstrated substantial variability for individual technical and cognitive endpoints. Although nearly all AETs achieved competence in overall cannulation, none achieved competence for cannulation in cases with a native papilla. Sensitivity analyses increased the proportion of AETs who achieved competence. Conclusion This study demonstrates that there is substantial variability in ERCP learning curves among AETs. A specific case volume does not ensure competence, especially for native papilla cannulation.

Original languageEnglish (US)
Pages (from-to)711-719.e11
JournalGastrointestinal Endoscopy
Volume83
Issue number4
DOIs
StatePublished - Apr 1 2016
Externally publishedYes

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Learning Curve
Endoscopic Retrograde Cholangiopancreatography
Mental Competency
Endoscopy
Catheterization

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

Cite this

Wani, S., Hall, M., Wang, A. Y., Dimaio, C. J., Muthusamy, V. R., Keswani, R. N., ... Mullady, D. (2016). Variation in learning curves and competence for ERCP among advanced endoscopy trainees by using cumulative sum analysis. Gastrointestinal Endoscopy, 83(4), 711-719.e11. https://doi.org/10.1016/j.gie.2015.10.022

Variation in learning curves and competence for ERCP among advanced endoscopy trainees by using cumulative sum analysis. / Wani, Sachin; Hall, Matthew; Wang, Andrew Y.; Dimaio, Christopher J.; Muthusamy, V. Raman; Keswani, Rajesh N.; Brauer, Brian C.; Easler, Jeffrey J.; Yen, Roy D.; El Hajj, Ihab; Fukami, Norio; Ghassemi, Kourosh F.; Gonzalez, Susana; Hosford, Lindsay; Hollander, Thomas G.; Wilson, Robert; Kushnir, Vladimir M.; Ahmad, Jawad; Murad, Faris; Prabhu, Anoop; Watson, Rabindra R.; Strand, Daniel S.; Amateau, Stuart K.; Attwell, Augustin; Shah, Raj J.; Early, Dayna; Edmundowicz, Steven A.; Mullady, Daniel.

In: Gastrointestinal Endoscopy, Vol. 83, No. 4, 01.04.2016, p. 711-719.e11.

Research output: Contribution to journalArticle

Wani, S, Hall, M, Wang, AY, Dimaio, CJ, Muthusamy, VR, Keswani, RN, Brauer, BC, Easler, JJ, Yen, RD, El Hajj, I, Fukami, N, Ghassemi, KF, Gonzalez, S, Hosford, L, Hollander, TG, Wilson, R, Kushnir, VM, Ahmad, J, Murad, F, Prabhu, A, Watson, RR, Strand, DS, Amateau, SK, Attwell, A, Shah, RJ, Early, D, Edmundowicz, SA & Mullady, D 2016, 'Variation in learning curves and competence for ERCP among advanced endoscopy trainees by using cumulative sum analysis', Gastrointestinal Endoscopy, vol. 83, no. 4, pp. 711-719.e11. https://doi.org/10.1016/j.gie.2015.10.022
Wani, Sachin ; Hall, Matthew ; Wang, Andrew Y. ; Dimaio, Christopher J. ; Muthusamy, V. Raman ; Keswani, Rajesh N. ; Brauer, Brian C. ; Easler, Jeffrey J. ; Yen, Roy D. ; El Hajj, Ihab ; Fukami, Norio ; Ghassemi, Kourosh F. ; Gonzalez, Susana ; Hosford, Lindsay ; Hollander, Thomas G. ; Wilson, Robert ; Kushnir, Vladimir M. ; Ahmad, Jawad ; Murad, Faris ; Prabhu, Anoop ; Watson, Rabindra R. ; Strand, Daniel S. ; Amateau, Stuart K. ; Attwell, Augustin ; Shah, Raj J. ; Early, Dayna ; Edmundowicz, Steven A. ; Mullady, Daniel. / Variation in learning curves and competence for ERCP among advanced endoscopy trainees by using cumulative sum analysis. In: Gastrointestinal Endoscopy. 2016 ; Vol. 83, No. 4. pp. 711-719.e11.
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abstract = "Background and Aims There are limited data on learning curves and competence in ERCP. By using a standardized data collection tool, we aimed to prospectively define learning curves and measure competence among advanced endoscopy trainees (AETs) by using cumulative sum (CUSUM) analysis. Methods AETs were evaluated by attending endoscopists starting with the 26th hands-on ERCP examination and then every ERCP examination during the 12-month training period. A standardized ERCP competency assessment tool (using a 4-point scoring system) was used to grade the examination. CUSUM analysis was applied to produce learning curves for individual technical and cognitive components of ERCP performance (success defined as a score of 1, acceptable and unacceptable failures [p1] of 10{\%} and 20{\%}, respectively). Sensitivity analyses varying p1 and by using a less-stringent definition of success were performed. Results Five AETs were included with a total of 1049 graded ERCPs (mean ± SD, 209.8 ± 91.6/AET). The majority of cases were performed for a biliary indication (80{\%}). The overall and native papilla allowed cannulation times were 3.1 ± 3.6 and 5.7 ± 4, respectively. Overall learning curves demonstrated substantial variability for individual technical and cognitive endpoints. Although nearly all AETs achieved competence in overall cannulation, none achieved competence for cannulation in cases with a native papilla. Sensitivity analyses increased the proportion of AETs who achieved competence. Conclusion This study demonstrates that there is substantial variability in ERCP learning curves among AETs. A specific case volume does not ensure competence, especially for native papilla cannulation.",
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T1 - Variation in learning curves and competence for ERCP among advanced endoscopy trainees by using cumulative sum analysis

AU - Wani, Sachin

AU - Hall, Matthew

AU - Wang, Andrew Y.

AU - Dimaio, Christopher J.

AU - Muthusamy, V. Raman

AU - Keswani, Rajesh N.

AU - Brauer, Brian C.

AU - Easler, Jeffrey J.

AU - Yen, Roy D.

AU - El Hajj, Ihab

AU - Fukami, Norio

AU - Ghassemi, Kourosh F.

AU - Gonzalez, Susana

AU - Hosford, Lindsay

AU - Hollander, Thomas G.

AU - Wilson, Robert

AU - Kushnir, Vladimir M.

AU - Ahmad, Jawad

AU - Murad, Faris

AU - Prabhu, Anoop

AU - Watson, Rabindra R.

AU - Strand, Daniel S.

AU - Amateau, Stuart K.

AU - Attwell, Augustin

AU - Shah, Raj J.

AU - Early, Dayna

AU - Edmundowicz, Steven A.

AU - Mullady, Daniel

PY - 2016/4/1

Y1 - 2016/4/1

N2 - Background and Aims There are limited data on learning curves and competence in ERCP. By using a standardized data collection tool, we aimed to prospectively define learning curves and measure competence among advanced endoscopy trainees (AETs) by using cumulative sum (CUSUM) analysis. Methods AETs were evaluated by attending endoscopists starting with the 26th hands-on ERCP examination and then every ERCP examination during the 12-month training period. A standardized ERCP competency assessment tool (using a 4-point scoring system) was used to grade the examination. CUSUM analysis was applied to produce learning curves for individual technical and cognitive components of ERCP performance (success defined as a score of 1, acceptable and unacceptable failures [p1] of 10% and 20%, respectively). Sensitivity analyses varying p1 and by using a less-stringent definition of success were performed. Results Five AETs were included with a total of 1049 graded ERCPs (mean ± SD, 209.8 ± 91.6/AET). The majority of cases were performed for a biliary indication (80%). The overall and native papilla allowed cannulation times were 3.1 ± 3.6 and 5.7 ± 4, respectively. Overall learning curves demonstrated substantial variability for individual technical and cognitive endpoints. Although nearly all AETs achieved competence in overall cannulation, none achieved competence for cannulation in cases with a native papilla. Sensitivity analyses increased the proportion of AETs who achieved competence. Conclusion This study demonstrates that there is substantial variability in ERCP learning curves among AETs. A specific case volume does not ensure competence, especially for native papilla cannulation.

AB - Background and Aims There are limited data on learning curves and competence in ERCP. By using a standardized data collection tool, we aimed to prospectively define learning curves and measure competence among advanced endoscopy trainees (AETs) by using cumulative sum (CUSUM) analysis. Methods AETs were evaluated by attending endoscopists starting with the 26th hands-on ERCP examination and then every ERCP examination during the 12-month training period. A standardized ERCP competency assessment tool (using a 4-point scoring system) was used to grade the examination. CUSUM analysis was applied to produce learning curves for individual technical and cognitive components of ERCP performance (success defined as a score of 1, acceptable and unacceptable failures [p1] of 10% and 20%, respectively). Sensitivity analyses varying p1 and by using a less-stringent definition of success were performed. Results Five AETs were included with a total of 1049 graded ERCPs (mean ± SD, 209.8 ± 91.6/AET). The majority of cases were performed for a biliary indication (80%). The overall and native papilla allowed cannulation times were 3.1 ± 3.6 and 5.7 ± 4, respectively. Overall learning curves demonstrated substantial variability for individual technical and cognitive endpoints. Although nearly all AETs achieved competence in overall cannulation, none achieved competence for cannulation in cases with a native papilla. Sensitivity analyses increased the proportion of AETs who achieved competence. Conclusion This study demonstrates that there is substantial variability in ERCP learning curves among AETs. A specific case volume does not ensure competence, especially for native papilla cannulation.

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