Barraclough Harriet, Siau Keith, Ward Stephen T, Dunckley Paul, Hawkes Neil, Thomson Mike, Narula Priya
Sheffield Children's Hospital, Western Bank, Sheffield.
NIHR Biomedical Research Centre, University of Birmingham, Birmingham.
J Pediatr Gastroenterol Nutr. 2020 Mar;70(3):336-340. doi: 10.1097/MPG.0000000000002460.
The learning curve in paediatric oesophagogastroduodenoscopy (OGD) is unknown. Using ≥95% D2 (second part of the duodenum) intubation rates as a marker of technical competency, we conducted learning curve analyses to identify when trainees achieve competency in paediatric OGD. Factors associated with competency were also evaluated.
This nationwide study analysed data from paediatric OGD procedures prospectively entered into the UK endoscopy training e-portfolio between 2014 and 2018. Moving average and learning curve cumulative summation analyses were performed to determine procedural numbers required to achieve ≥95% D2 intubation rates. Factors associated with D2 intubation were assessed using a multivariable binary logistic regression approach.
A total of 8929 procedures performed by 61 trainees were identified. These 61 trainees had recorded a mean of 124.6 procedures (range 22-571, interquartile range 165). By moving average analysis, 95% D2 intubation was achieved after 79 procedures. By learning curve cumulative summation analysis, 81.6% of trainees were competent after 100 procedures. Multivariable factors associated with unassisted procedural completion included: lifetime procedure count (P < 0.001), higher trainee seniority (P < 0.001), patient age (P = 0.002), outpatient status (P < 0.001), and attendance at a national Basic Skills OGD course (P = 0.011).
This study demonstrates that, on average, 79 procedures in paediatric OGD are required to attain the competency outcome of ≥95% D2 intubation rates. By 100 procedures, 81.6% of our sample had achieved ≥95% D2 intubation. The minimum procedural count of 100 set by the UK and international training programmes can be used alongside existing objective assessment measures to safeguard competency within a training cohort.
小儿食管胃十二指肠镜检查（OGD）的学习曲线尚不清楚。我们以≥95%的十二指肠降部（D2）插管率作为技术能力的标志，进行了学习曲线分析，以确定学员在小儿OGD检查中何时达到能力标准。还评估了与能力相关的因素。
这项全国性研究分析了2014年至2018年期间前瞻性录入英国内镜培训电子档案的小儿OGD检查数据。进行移动平均和学习曲线累积总和分析，以确定达到≥95% D2插管率所需的操作次数。使用多变量二元逻辑回归方法评估与D2插管相关的因素。
共识别出61名学员进行的8929例操作。这61名学员记录的平均操作次数为124.6次（范围22 - 571次，四分位间距165次）。通过移动平均分析，79次操作后实现了95%的D2插管。通过学习曲线累积总和分析，100次操作后81.6%的学员达到了能力标准。与独立完成操作相关的多变量因素包括：终生操作次数（P<0.001）、学员资历较高（P<0.001）、患者年龄（P = 0.002）、门诊状态（P<0.001）以及参加全国基本技能OGD课程（P = 0.011）。
本研究表明，小儿OGD检查平均需要79次操作才能达到≥95% D2插管率的能力标准。到100次操作时，我们样本中的81.6%达到了≥95% D2插管。英国和国际培训计划设定的100次最低操作次数可与现有的客观评估措施一起用于保障培训队列中的能力水平。
