设定 EUS 和 ERCP 培训的最低标准：一项前瞻性多中心研究评估高级内镜培训学员学习曲线和能力的结果。
Setting minimum standards for training in EUS and ERCP: results from a prospective multicenter study evaluating learning curves and competence among advanced endoscopy trainees.
机构信息
University of Colorado Anschutz Medical Center, Aurora, Colorado, USA.
Children's Hospital Association, Lenexa, Kansas, USA.
出版信息
Gastrointest Endosc. 2019 Jun;89(6):1160-1168.e9. doi: 10.1016/j.gie.2019.01.030. Epub 2019 Feb 7.
BACKGROUND AND AIMS
Minimum EUS and ERCP volumes that should be offered per trainee in "high quality" advanced endoscopy training programs (AETPs) are not established. We aimed to define the number of procedures required by an "average" advanced endoscopy trainee (AET) to achieve competence in technical and cognitive EUS and ERCP tasks to help structure AETPs.
METHODS
American Society for Gastrointestinal Endoscopy (ASGE)-recognized AETPs were invited to participate; AETs were graded on every fifth EUS and ERCP examination using a validated tool. Grading for each skill was done using a 4-point scoring system, and learning curves using cumulative sum analysis for overall, technical, and cognitive components of EUS and ERCP were shared with AETs and trainers quarterly. Generalized linear mixed-effects models with a random intercept for each AET were used to generate aggregate learning curves, allowing us to use data from all AETs to estimate the average learning experience for trainees.
RESULTS
Among 62 invited AETPs, 37 AETs from 32 AETPs participated. Most AETs reported hands-on EUS (52%, median 20 cases) and ERCP (68%, median 50 cases) experience before starting an AETP. The median number of EUS and ERCPs performed per AET was 400 (range, 200-750) and 361 (range, 250-650), respectively. Overall, 2616 examinations were graded (EUS, 1277; ERCP-biliary, 1143; pancreatic, 196). Most graded EUS examinations were performed for pancreatobiliary indications (69.9%) and ERCP examinations for ASGE biliary grade of difficulty 1 (72.1%). The average AET achieved competence in core EUS and ERCP skills at approximately 225 and 250 cases, respectively. However, overall technical competence was achieved for grade 2 ERCP at about 300 cases.
CONCLUSION
The thresholds provided for an average AET to achieve competence in EUS and ERCP may be used by the ASGE and AETPs in establishing the minimal standards for case volume exposure for AETs during their training. (Clinical trial registration number: NCT02509416.).
背景与目的
在“高质量”高级内镜培训计划（AETP）中，每位学员应接受的最低 EUS 和 ERCP 量尚不确定。我们旨在确定“普通”高级内镜学员（AET）需要完成的操作数量，以实现 EUS 和 ERCP 技术和认知任务的能力，从而帮助构建 AETP。
方法
邀请美国胃肠内镜学会（ASGE）认可的 AETP 参与；每隔五次 EUS 和 ERCP 检查对 AET 进行评分，使用经过验证的工具。对每项技能的评分采用 4 分制，EUS 和 ERCP 的整体、技术和认知成分的学习曲线每季度与 AET 和培训师共享。使用具有每个 AET 的随机截距的广义线性混合效应模型生成综合学习曲线，允许我们使用所有 AET 的数据来估计学员的平均学习体验。
结果
在 62 个受邀的 AETP 中，有 32 个 AETP 的 37 名 AET 参与。大多数 AET 在开始 AETP 之前就有 EUS（52%，中位数 20 例）和 ERCP（68%，中位数 50 例）的实践经验。每位 AET 进行的 EUS 和 ERCP 中位数分别为 400（范围 200-750）和 361（范围 250-650）。共对 2616 次检查进行了评分（EUS 1277 次，ERCP-胆道 1143 次，胰腺 196 次）。大多数评分的 EUS 检查是为胰胆指征进行的（69.9%），而 ERCP 检查是为 ASGE 胆道难度 1 级（72.1%）进行的。平均 AET 在大约 225 次和 250 次 EUS 和 ERCP 操作中分别达到核心 EUS 和 ERCP 技能的熟练程度。然而，在大约 300 次 ERCP 操作中，整体技术能力达到了 ERCP 等级 2。
结论
ASGE 和 AETP 可以使用提供的平均 AET 达到 EUS 和 ERCP 能力的阈值，为 AET 在培训期间建立最低 EUS 和 ERCP 暴露量标准。（临床试验注册号：NCT02509416。）
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