Variation in learning curves and competence for ERCP among advanced endoscopy trainees by using cumulative sum...

Area of Science:

• Gastroenterology
• Medical Education
• Endoscopic Procedures

Background:

• Limited data exists on the learning curves and competence acquisition for Endoscopic Retrograde Cholangiopancreatography (ERCP).
• Standardized assessment tools are crucial for objectively evaluating proficiency in complex endoscopic procedures.

Purpose of the Study:

• To prospectively define ERCP learning curves among advanced endoscopy trainees (AETs).
• To measure AET competence using cumulative sum (CUSUM) analysis and a standardized assessment tool.

Main Methods:

• AETs were evaluated using a standardized ERCP competency assessment tool from their 26th case onwards.
• Cumulative sum (CUSUM) analysis was applied to track learning curves for technical and cognitive ERCP components.
• Sensitivity analyses were performed with varying definitions of success and failure rates.

Main Results:

• Five AETs underwent 1049 graded ERCPs, predominantly for biliary indications.
• Significant variability was observed in individual learning curves for ERCP technical and cognitive skills.
• While most AETs achieved competence in overall cannulation, none mastered native papilla cannulation.

Conclusions:

• ERCP learning curves exhibit substantial inter-trainee variability.
• Achieving competence in ERCP, especially native papilla cannulation, is not solely dependent on case volume.
• Standardized assessment and targeted training are essential for developing ERCP proficiency.