Minimum standards for training in colorectal endoscopic mucosal resection among advanced endoscopy trainees

Area of Science:

• Gastroenterology
• Surgical Education
• Medical Training

Background:

• Limited data exists on colorectal endoscopic mucosal resection (C-EMR) training during advanced endoscopy fellowship.
• Assessing the required number of procedures for trainee competence in C-EMR is crucial.

Purpose of the Study:

• To determine the minimum number of C-EMR procedures an average advanced endoscopy trainee (AET) needs to achieve cognitive and technical competence.
• To establish benchmarks for C-EMR training programs.

Main Methods:

• AETs were assessed on C-EMR procedures using a standardized tool.
• Cumulative sum (CUSUM) analysis generated learning curves to estimate competence thresholds.
• Trainees completed self-assessment questionnaires.

Main Results:

• 22 AETs performed 637 C-EMRs (median 32 per trainee).
• Learning curves indicated a range of 19-39 procedures for competence across skills; 19 cases for overall competence.
• Despite self-reported comfort, only 14% of AETs achieved overall competence.

Conclusions:

• The current volume of C-EMRs in many training programs may be insufficient for achieving competence.
• Estimated competence thresholds offer a framework for setting minimal case volume standards in AETPs.