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Analysis of variation in learning curves for achieving competency in convex endoscopic ultrasound training: A prospective cohort study using a standardized assessment tool

Published:November 04, 2022DOI:https://doi.org/10.1016/j.gie.2022.10.042
Analysis of variation in learning curves for achieving competency in convex endoscopic ultrasound training: A prospective cohort study using a standardized assessment tool
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      Abstract

      Background and Aims

      The need for mastering standard imaging techniques for convex endoscopic ultrasound (EUS) in the biliopancreatic regions has been increasing; however, large variations in the aptitude for achieving EUS competency hinder expert development. Therefore, we investigated the factors influencing the achievement of expert competency in EUS using a new assessment tool for multiple imaging items.

      Methods

      Between January 2018 and February 2022, 3,277 consecutive EUS procedures conducted by five beginners (EUS number < 250), seven intermediate trainees (250–749), and two experts (≥750) were prospectively evaluated. Immediately after each EUS procedure, the success or failure of imaging for each item was recorded using a newly developed EUS assessment tool that requires 17 items to be photographed. After correcting for missing values using multiple imputation, learning curves of EUS scores were created, and a competency was set based on expert scores. Finally, a comparative analysis between high and low performers was performed to extract factors influencing EUS scores.

      Results

      Although three of the seven intermediates (43%, mean of 317 cases) achieved competency, none of the beginners achieved competency. During a comparative analysis, although no significant difference in the number of EUS performed was observed between the high and low performers, the former had significantly higher scores in the written test (theoretical knowledge).

      Conclusions

      Our results showed that theoretical knowledge, rather than the number of EUS cases, may be a possible influencing factor for distinguishing high and low performers after treating 250 cases.

      Key words

      Acronyms and abbreviations:

      AETPs (advanced endoscopy training programs), AETs (average advanced endoscopy trainees), CA (celiac artery), CBD (common bile duct), CI (confidence interval), EUS (endoscopic ultrasound), EUS-FNA (EUS-guided fine needle aspiration), GB (gallbladder), IPMN (intraductal papillary mucinous neoplasm), IQR (interquartile range), MI (multiple imputation), MPD (main pancreatic duct), Pb (pancreas body), Ph (pancreas head), Pt (pancreas tail), PV (portal vein), SD (standard deviation), SMA (superior mesenteric artery), SMV (superior mesenteric vein), SV (splenic vein), TESAT (the EUS skills assessment tool)
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      Article info

      Publication history

      Accepted: October 31, 2022
      Received in revised form: October 29, 2022
      Received: July 28, 2022

      Publication stage

      In Press Journal Pre-Proof

      Footnotes

      Authors’ contributions:

      Conception and design: Masafumi Chiba, Masayuki Kato, Machi Suka, and Kazuki Sumiyama.

      Analysis and interpretation of the data: Masafumi Chiba, Masayuki Kato, Nana Shimamoto, Shintaro Tsukinaga, Yuichi Torisu, Hirobumi Toyoizumi, Machi Suka, and Kazuki Sumiyama.

      Acquisition of data: Masafumi Chiba, Masayuki Kato, Yuji Kinoshita, Takafumi Akasu, Hiroaki Matsui, Nana Shimamoto, Youichi Tomita, Takahiro Abe, Keisuke Kanazawa, Shintaro Tsukinaga, Masanori Nakano, Yuichi Torisu, and Hirobumi Toyoizumi.

      Drafting of the article: Masafumi Chiba, and Masayuki Kato.

      Critical revision of the article for important intellectual content: Masafumi Chiba, Masayuki Kato, Shintaro Tsukinaga, Masanori Nakano, and Yuichi Torisu.

      Final approval of the article: All authors.

      Disclosures:

      Drs. Masafumi Chiba, Masayuki Kato, Yuji Kinoshita, Takafumi Akasu, Hiroaki Matsui, Nana Shimamoto, Youichi Tomita, Takahiro Abe, Keisuke Kanazawa, Shintaro Tsukinaga, Masanori Nakano, Yuichi Torisu, Hirobumi Toyoizumi, Machi Suka, and Kazuki Sumiyama have no conflicts of interest or financial ties to disclose.

      Grant Support

      The authors declare that they have not received funding for this study.

      Acknowledgments

      The authors thank the Department of Surgery and the Division of Gastroenterology and Hepatology for patient recruitment. The authors also thank Enago for the English language editing of this paper.

      Identification

      DOI: https://doi.org/10.1016/j.gie.2022.10.042

      Copyright

      © 2022 by the American Society for Gastrointestinal Endoscopy

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