A prospective multicenter study evaluating EUS and ERCP competence during advanced endoscopy training and subsequent independent practice: The rapid assessment of trainee endoscopy skills (rates2) study.
Wani SB, Keswani RN, Hall M, Han S, Aagaard E, Simon VC, Carlin L, Ellert S, Abidi WM, Baron TH, Brauer BC, Chatrath H, Cote GA, Das KK, DiMaio CJ, Edmundowicz SA, El Hajj II, Hammad HT, Jalaj S, Kochman ML, Komanduri S, Lee LS, Mullady D, Raman Muthusamy V, Nett AS, Olyaee MS, Pakseresht K, Perera P, Pfau P, Piraka C, Rastogi A, Shah RJ, Sharma R, Scheiman JM, Tabibian JH, Uppal D, Urayama S, Wang AY, Zuchelli T, Bowman E, Lang G, Loren DE, El Chafic AH, Yachimski P, Gamboa A, Poneros JM, Wassef W, Sohail M, Stevens T, Confer B, Guda NM, Ian Gan S, Razzak A, Gordon SR, Ferriera J, Banerjee S, Choudhary A, Dries AM, Buscaglia JM, Tzimas D, Zepeda-Gomez S, Kenshil S, Lukens F, Bartel M, Jowell P, Spaete JP, Riff B, Harris C, Saligram S, Gannavarapu B, Chak A, Singh A, and Early D. A prospective multicenter study evaluating EUS and ERCP competence during advanced endoscopy training and subsequent independent practice: The rapid assessment of trainee endoscopy skills (rates2) study. Gastrointest Endosc 2018; 87(6):AB46-AB48.
Background: We have shown that AETs achieve EUS and ERCP competence at varying rates, validating the shift from defining competence based on an absolute number of procedures to well-defined metrics. However, there are no data to confirm that advanced endoscopy trainees (AETs) who achieve competence during training subsequently perform high quality EUS and ERCP in their 1st year of independent practice. Aims: To report the outcomes of AETs during their 1st year of independent practice using ASGE established quality indicator (QI) thresholds To measure the relationship between achieving competence benchmarks during training and reported outcomes during independent practice. Methods: ASGE recognized advanced endoscopy training programs (AETPs) were invited to participate. In Phase I, AETs were graded on every 5th EUS and ERCP exam after completion of 25 hands-on EUS and ERCPs using the validated EUS and ERCP Skills Assessment Tool (TEESAT). Grading for each skill was done using a 4-point scoring system. A comprehensive data collection and reporting system was used to create learning curves using cumulative sum (CUSUM) analysis. Learning curves were created using CUSUM for overall and technical and cognitive components of EUS and ERCP and shared with AETs and trainers quarterly. Acceptable and unacceptable (Table presented) failures rates were set a priori and AETs with <20 evaluations were excluded. During Phase II, AETs provided QI performance data on all EUS and ERCP procedures during the 1st year of independent practice. Results: Of the 62 programs invited, 37 AETs from 32 AETPs participated in this study and 24 AETs were included in the final analysis (Phase I). At the end of training, median number of EUS and ERCPs performed/ AET was 400 (range 200-750) and 361 (250-650), respectively. Overall, 2616 exams were graded (EUS: 1277, ERCP-biliary 1143, pancreatic 196). Majority of graded EUS exams were performed for pancreatobiliary indications (70%) and ERCPs for ASGE biliary grade of difficulty 1 (72.1%). Majority of trainees achieved overall technical (EUS: 91.6%; ERCP: 73.9%) and cognitive (EUS: 91.6%, ERCP: 95.6%) competence at conclusion of training (Table 1). 22 of 24 AETs participated in (Phase II) and median EUS and ERCP procedures completed in independent practice/AET were 136 (IQR 102-204) and 116 (48-169), respectively. Table 2 highlights QI performance in EUS and ERCP during Phase II. Majority of AETs crossed the QI threshold for obtaining adequate samples (overall rate: 94.4%), diagnostic yield of malignancy (83.8%), and cannulation rates overall (94.9%) and native papilla cases (93.1%). Conclusions: Majority of AETs achieved EUS and ERCP competence by the end of training. Moreover, these AETs achieved QI thresholds for routine EUS and ERCP during their 1st year of independent practice, affirming the effectiveness of AETPs.