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

Gastrointest Endosc. 2016 Apr;83(4):711-9.e11. doi: 10.1016/j.gie.2015.10.022. Epub 2015 Oct 26.

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.

Publication types

  • Multicenter Study

MeSH terms

  • Catheterization / standards
  • Cholangiopancreatography, Endoscopic Retrograde / adverse effects
  • Cholangiopancreatography, Endoscopic Retrograde / standards*
  • Cholangiopancreatography, Endoscopic Retrograde / statistics & numerical data
  • Clinical Competence*
  • Education, Medical, Graduate
  • Gastroenterology / education*
  • Humans
  • Learning Curve*
  • Prospective Studies