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:
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      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.


      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.


      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).


      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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