Competence development in ERCP: the learning curve of novice trainees

被引:66
作者
Ekkelenkamp, Vivian E. [1 ]
Koch, Arjun D. [1 ]
Rauws, Erik A. J. [2 ]
Borsboom, Gerard J. J. M. [3 ]
de Man, Robert A. [1 ]
Kuipers, Ernst J. [1 ]
机构
[1] Erasmus MC Univ, Med Ctr Rotterdam, Dept Gastroenterol & Hepatol, NL-3000 CA Rotterdam, Netherlands
[2] Acad Med Ctr Amsterdam, Dept Gastroenterol & Hepatol, Amsterdam, Netherlands
[3] Erasmus MC Univ, Med Ctr Rotterdam, Dept Publ Hlth, NL-3000 CA Rotterdam, Netherlands
关键词
ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY; TECHNICAL COMPETENCE;
D O I
10.1055/s-0034-1377930
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background and study aim: Measures for competence in endoscopic retrograde cholangiopancreatography (ERCP) during training are poorly defined. Currently, various training and accreditation programs base verification of competence on performance of a minimum number of procedures. There is a general awareness that procedural competence certification should be based on objective performance criteria. Continuous self-assessment using a Rotterdam Assessment Form for ERCP (RAF-E) can provide insight into trainee performance. The study aim was to express development in ERCP competence as a learning curve. Methods: ERCP trainees at a tertiary referral center in the Netherlands were invited to participate. Performed procedures were appraised using RAF-E. Indication for each ERCP and presence of a virgin papilla were documented. Complexity was graded on a 3-point scale. The primary outcome parameter was common bile duct (CBD) cannulation success rate. Success of the intended therapeutic interventions was additionally expressed as a learning curve. Results: 15 trainees were included. 1541 ERCPs (624 procedures in native papillary anatomy) were assessed through RAF-E. Unassisted CBD cannulation success rate improved from 36% at baseline to 85% after 200 procedures (P<0.001), and in 624 patients with a virgin papilla from 22% at baseline to 68% after 180 procedures (P<0.001). Learning curves for therapeutic interventions showed significant improvements for successful sphincterotomy (P=0.01) and stent placement (P<0.001). Conclusions: Learning curves are a valuable means for assessing competence in ERCP. Differences in learning curves can be shown with RAF-E. Verification of competence should be based on actual performance, instead of minimum numbers.
引用
收藏
页码:949 / 955
页数:7
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