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A Prospective Multicenter Study Evaluating Endoscopy Competence Among Gastroenterology Trainees in the Era of the Next Accreditation System (NAS) - The EnCompAS Study
Ist Teil von
The American journal of gastroenterology, 2018-10, Vol.113, p.S300-S300
Ort / Verlag
New York: Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins
Erscheinungsjahr
2018
Link zum Volltext
Beschreibungen/Notizen
Introduction: With the launch of the NAS, GI fellowship programs (GIFPs) need to assess and document competence in EGD and colonoscopy among GI fellows (GIFs) in a continuous fashion and demonstrate readiness for independent practice. The primary aim of this study was to assess learning curves (LCs) in EGD and colonoscopy in GIFs enrolled in a 3-year GIFP The secondary aim was to demonstrate the feasibility of creating a centralized database to provide individualized feedback during training. Methods: Accredited GIFPs were invited to participate. GIFs were evaluated on 5 consecutive EGDs and colonoscopies after every 25 procedures using the Assessment of Competency in Endoscopy (ACE) tool, a validated tool assessing cognitive and hands-on skills. Grading for each skill and overall assessment was done using a 4-point scoring system. A comprehensive data collection and reporting system was used to create LCs using cumulative sum (CUSUM) analysis and shared with GIFs and trainers quarterly. Acceptable and unacceptable failure rates were set a priori; success was defined as a score of 3 or 4. In order to generate aggregate CUSUM LCs across GIFs, we used generalized linear mixed effects models with a random intercept for each GIF and an AR1 covariance structure allowing us to use data from all GIFs to estimate the average learning experience with 95% CIs. Results: A total of 147 GIFs (1st yr - 54.4%, 2nd yr - 27.2%, 3rd yr - 18.4%) from 14 GIFPs participated. In total, 1385 EGDs and 1293 colonoscopies were evaluated. Aggregate LCs, based on year of training, showed that 3rd yr GIFs achieved competence based on overall hands-on and cognitive skills assessment and nearly all individual hands-on and cognitive endpoints (Figures 1 and 2). 1st and 2nd yr GIFs demonstrated the need for ongoing supervision. GIF participation in therapeutic maneuvers such as dilations and snare polypectomy increased with year of training. GIFs also had increasing scores of 3 (advanced) or 4 (superior) on these maneuvers as training progressed. (Figure 3). Conclusion: The results of this study showed that GIFs participating in a competence-based GIFP with continuous feedback achieve competence at the end of their training affirming the effectiveness of current GIFPs. This study also demonstrates the feasibility of creating a centralized database that allows for individualized remediation and credentialing. Finally, these results provide construct validity for our data collection and reporting system.