Learning curves in ERCP during advanced endoscopy training: a Canadian multicenter prospective study

Area of Science:

• Medical Education
• Gastroenterology
• Surgical Skills Assessment

Background:

• Competency-based medical education is increasingly emphasized for advanced endoscopy trainees (AETs) to ensure quality and patient safety.
• The study addresses the need to evaluate the learning curves and competence achievement of Canadian AETs in Endoscopic Retrograde Cholangiopancreatography (ERCP).

Purpose of the Study:

• To examine the learning curves and competence acquisition of Canadian AETs in ERCP.
• To validate the use of the United Kingdom Joint Advisory Group on Gastrointestinal Endoscopy (JAG) ERCP Direct Observation of Procedural Skills (DOPS) tool for assessing ERCP competence.

Main Methods:

• A prospective study involving 11 Canadian AETs across five institutions from 2017-2018.
• Data collected on every fifth ERCP procedure using the JAG ERCP DOPS tool, featuring a 27-item, four-point rating scale.
• Cumulative sum (CUSUM) analysis applied to generate learning curves for overall supervision and individual ERCP DOPS items.

Main Results:

• A total of 261 ERCP procedures were evaluated.
• Trainees achieved an overall cannulation rate of 82% and a native papilla cannulation rate of 78%.
• All trainees attained competence in overall ERCP supervision, but gaps were noted in tissue sampling and sphincteroplasty.

Conclusions:

• Canadian AETs generally graduate with acceptable competence in overall ERCP performance and key procedural tasks.
• CUSUM learning curves effectively highlight specific areas, such as tissue sampling, that may require additional targeted training for trainees.