title: Learning curves for EUS by using cumulative sum analysis: implications for American Society for Gastrointestinal Endoscopy recommendations for training.
abstract: BACKGROUND
  American Society for Gastrointestinal Endsocopy (ASGE) guidelines for assessing minimal competence in EUS are based on expert opinion and retrospective studies.
  
  
  OBJECTIVE
  To prospectively define learning curves in EUS among advanced endoscopy trainees (AETs).
  
  
  METHODS
  Prospective trial.
  
  
  METHODS
  Three tertiary-care referral centers.
  
  
  METHODS
  AETs with no prior EUS experience.
  
  
  METHODS
  AETs were evaluated by attending endosonographers at intervals of 10 EUS examinations (beginning at the 25th examination) during a 12-month training period. A standardized data collection form was used to grade examination of EUS anatomic stations and, when applicable, lesion of interest, accurate uTNM staging, wall layer origin of subepithelial lesions, and technical success with FNA.
  
  
  METHODS
  Cumulative sum analysis was applied to assess competency and produce a learning curve for each trainee for overall performance and for each anatomic station. Acceptable and unacceptable failure rates of 10% and 20%, respectively, were used.
  
  
  RESULTS
  Five AETs were included, with a total of 1412 EUS examinations (AET1-225, T2-175, T3-402, T4-315, T5-295). Two AETs crossed the threshold for acceptable performance at cases number 255 and 295, two AETs showed a trend toward acceptable performance after 225 and 196 cases but needed ongoing training, and 1 AET demonstrated the need for ongoing training after 402 cases. Similar variable results were noted for individual stations.
  
  
  CONCLUSIONS
  Results from this study may not be generalizable to other centers' AETs.
  
  
  CONCLUSIONS
  We observed substantial variability in achieving competency and a consistent need for more supervision in all AETs than current recommendations (150 cases). Future studies should focus on standardization of trainee performance, definition of competency, and widespread applicability of AET evaluation.
authors.affiliation: Division of Gastroenterology and Hepatology, University of Colorado and Veterans Affairs Medical Center, Denver, Colorado, USA.
authors.forename: Sachin
authors.initials: S
authors.lastname: Wani
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Coté
authors.forename: Rajesh
authors.initials: R
authors.lastname: Keswani
authors.forename: Daniel
authors.initials: D
authors.lastname: Mullady
authors.forename: Riad
authors.initials: R
authors.lastname: Azar
authors.forename: Faris
authors.initials: F
authors.lastname: Murad
authors.forename: Steve
authors.initials: S
authors.lastname: Edmundowicz
authors.forename: Srinadh
authors.initials: S
authors.lastname: Komanduri
authors.forename: Lee
authors.initials: L
authors.lastname: McHenry
authors.forename: Mohammad A
authors.initials: MA
authors.lastname: Al-Haddad
authors.forename: Matthew
authors.initials: M
authors.lastname: Hall
authors.forename: Christine E
authors.initials: CE
authors.lastname: Hovis
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Hollander
authors.forename: Dayna
authors.initials: D
authors.lastname: Early
mesh_terms: D002983:Clinical Competence; D016099:Endoscopy, Gastrointestinal / Q000193:education* / Q000379:methods*; D019160:Endosonography / Q000592:standards*; D017408:Guidelines as Topic; D006801:Humans; D059032:Learning Curve; D011446:Prospective Studies; D011996:Records