Dr Dunckley and colleagues determined the number of esophago-gastro-duodenoscopies trainees need to perform to acquire competency in terms of successful unassisted completion to the second part of the duodenum 95% of the time.
Esophago-gastro-duodenoscopies data were retrieved from the trainee e-portfolio developed by the Joint Advisory Group on GI Endoscopy (JAG) in the UK.
All trainees were included unless they were known to have a baseline experience of more than 20 procedures or had submitted data for less than 20 procedures.
The researchers' primary outcome measure was esophago-gastro-duodenoscopies completion, defined as passage of the endoscope to the second part of the duodenum without physical assistance.
The number of esophago-gastro-duodenoscopies required to achieve a 95% completion rate was calculated by the moving average method and learning curve cumulative summation (LC-Cusum) analysis.
|By moving average method, trainees attained a 95% completion rate at 187 procedures|
The team determined which factors were independently associated with esophago-gastro-duodenoscopies completion, a mixed effects logistic regression model was constructed with esophago-gastro-duodenoscopies completion as the outcome variable.
Data were analyzed for 1255 trainees over 288 centers, representing 243,555 esophago-gastro-duodenoscopies.
By moving average method, trainees attained a 95% completion rate at 187 procedures.
By learning curve cumulative summation analysis, after 200 procedures, more than 90% trainees had attained a 95% completion rate.
Total number of esophago-gastro-duodenoscopies performed, trainee age and experience in lower GI endoscopy were factors independently associated with esophago-gastro-duodenoscopy completion.
Dr Dunckley's team comments, "There are limited published data on the esophago-gastro-duodenoscopies learning curve."
"This is the largest study to date analyzing the learning curve for competency acquisition."
"The JAG competency requirement for 200 procedures appears appropriate."