一项评估高级内镜培训学员在内镜超声和内镜逆行胰胆管造影中学习曲线和能力的前瞻性多中心研究：学员内镜技能快速评估研究。
A Prospective Multicenter Study Evaluating Learning Curves and Competence in Endoscopic Ultrasound and Endoscopic Retrograde Cholangiopancreatography Among Advanced Endoscopy Trainees: The Rapid Assessment of Trainee Endoscopy Skills Study.
机构信息
University of Colorado Anschutz Medical Campus, Aurora, Colorado.
Northwestern University, Chicago, Illinois.
出版信息
Clin Gastroenterol Hepatol. 2017 Nov;15(11):1758-1767.e11. doi: 10.1016/j.cgh.2017.06.012. Epub 2017 Jun 16.
BACKGROUND & AIMS: On the basis of the Next Accreditation System, trainee assessment should occur on a continuous basis with individualized feedback. We aimed to validate endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) learning curves among advanced endoscopy trainees (AETs) by using a large national sample of training programs and to develop a centralized database that allows assessment of performance in relation to peers.
METHODS
ASGE recognized training programs were invited to participate, and AETs were graded on ERCP and EUS exams by using a validated competency assessment tool that assesses technical and cognitive competence in a continuous fashion. Grading for each skill was done by using a 4-point scoring system, and a comprehensive data collection and reporting system was built to create learning curves by using cumulative sum analysis. Individual results and benchmarking to peers were shared with AETs and trainers quarterly.
RESULTS
Of the 62 programs invited, 20 programs and 22 AETs participated in this study. At the end of training, median number of EUS and ERCP performed/AET was 300 (range, 155-650) and 350 (125-500), respectively. Overall, 3786 exams were graded (EUS, 1137; ERCP-biliary, 2280; ERCP-pancreatic, 369). Learning curves for individual end points and overall technical/cognitive aspects in EUS and ERCP demonstrated substantial variability and were successfully shared with all programs. The majority of trainees achieved overall technical (EUS, 82%; ERCP, 60%) and cognitive (EUS, 76%; ERCP, 100%) competence at conclusion of training.
CONCLUSIONS
These results demonstrate the feasibility of establishing a centralized database to report individualized learning curves and confirm the substantial variability in time to achieve competence among AETs in EUS and ERCP. ClinicalTrials.gov: NCT02509416.
背景与目的
基于下一认证系统，学员评估应持续进行，并提供个性化反馈。我们旨在通过使用大型国家培训计划样本验证高级内镜培训生（AET）的内镜超声（EUS）和内镜逆行胰胆管造影（ERCP）学习曲线，并开发一个集中的数据库，以评估与同行相关的表现。
方法
邀请 ASGE 认可的培训计划参与，并使用经过验证的能力评估工具对 ERCP 和 EUS 考试中的 AET 进行分级，该工具以连续方式评估技术和认知能力。每项技能的评分均采用 4 分制，建立了一个全面的数据收集和报告系统，通过累积和分析来创建学习曲线。个体结果和与同行的基准测试每季度与 AET 和培训师共享。
结果
在受邀的 62 个项目中，有 20 个项目和 22 名 AET 参与了这项研究。培训结束时，每位 AET 完成的 EUS 和 ERCP 操作中位数分别为 300（范围 155-650）和 350（范围 125-500）。共有 3786 次考试进行了评分（EUS 1137 次，ERCP-胆道 2280 次，ERCP-胰腺 369 次）。EUS 和 ERCP 的各个终点和整体技术/认知方面的学习曲线表现出很大的可变性，并成功与所有项目共享。大多数学员在培训结束时达到了整体技术（EUS，82%；ERCP，60%）和认知（EUS，76%；ERCP，100%）能力。
结论
这些结果表明，建立一个集中的数据库来报告个体学习曲线并确认 AET 在 EUS 和 ERCP 中达到能力的时间存在很大差异是可行的。ClinicalTrials.gov：NCT02509416。
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