title: Variation in Aptitude of Trainees in Endoscopic Ultrasonography, Based on Cumulative Sum Analysis.
abstract: OBJECTIVE
  Studies have reported substantial variation in the competency of advanced endoscopy trainees, indicating a need for more supervised training in endoscopic ultrasound (EUS). We used a standardized, validated, data collection tool to evaluate learning curves and measure competency in EUS among trainees at multiple centers.
  
  
  METHODS
  In a prospective study performed at 15 centers, 17 trainees with no prior EUS experience were evaluated by experienced attending endosonographers at the 25th and then every 10th upper EUS examination, over a 12-month training period. A standardized data collection form was used (using a 5-point scoring system) to grade the EUS examination. Cumulative sum analysis was applied to produce a learning curve for each trainee; it tracked the overall performance based on median scores at different stations and also at each station. Competency was defined by a median score of 1, with acceptable and unacceptable failure rates of 10% and 20%, respectively.
  
  
  RESULTS
  Twelve trainees were included in the final analysis. Each of the trainees performed 265 to 540 EUS examinations (total, 4257 examinations). There was a large amount of variation in their learning curves: 2 trainees crossed the threshold for acceptable performance (at cases 225 and 245), 2 trainees had a trend toward acceptable performance (after 289 and 355 cases) but required continued observation, and 8 trainees needed additional training and observation. Similar results were observed at individual stations.
  
  
  CONCLUSIONS
  A specific case load does not ensure competency in EUS; 225 cases should be considered the minimum caseload for training because we found that no trainee achieved competency before this point. Ongoing training should be provided for trainees until competency is confirmed using objective measures.
authors.affiliation: Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, Colorado. Electronic address: sachinwani10@yahoo.com.
authors.forename: Sachin
authors.initials: S
authors.lastname: Wani
authors.affiliation: Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, Colorado.
authors.forename: Matthew
authors.initials: M
authors.lastname: Hall
authors.affiliation: Division of Gastroenterology and Hepatology, Northwestern University, Chicago, Illinois.
authors.forename: Rajesh N
authors.initials: RN
authors.lastname: Keswani
authors.affiliation: Division of Gastroenterology and Hepatology, Yale University, New Haven, Connecticut.
authors.forename: Harry R
authors.initials: HR
authors.lastname: Aslanian
authors.affiliation: Division of Gastroenterology and Hepatology, Massachusetts General Hospital and Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Brenna
authors.initials: B
authors.lastname: Casey
authors.affiliation: Division of Gastroenterology and Hepatology, Duke University, Durham, North Carolina.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Burbridge
authors.affiliation: Division of Gastroenterology and Hepatology, University Hospitals Case Medical Center, Cleveland, Ohio.
authors.forename: Amitabh
authors.initials: A
authors.lastname: Chak
authors.affiliation: Division of Gastroenterology and Hepatology, Stanford University, Stanford, California.
authors.forename: Ann M
authors.initials: AM
authors.lastname: Chen
authors.affiliation: Division of Gastroenterology and Hepatology, Indiana University Hospital, Indianapolis, Indiana.
authors.forename: Gregory
authors.initials: G
authors.lastname: Cote
authors.affiliation: Division of Gastroenterology and Hepatology, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Steven A
authors.initials: SA
authors.lastname: Edmundowicz
authors.affiliation: Division of Gastroenterology and Hepatology, University Hospitals Case Medical Center, Cleveland, Ohio.
authors.forename: Ashley L
authors.initials: AL
authors.lastname: Faulx
authors.affiliation: Division of Gastroenterology and Hepatology, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Hollander
authors.affiliation: Division of Gastroenterology and Hepatology, Massachusetts General Hospital and Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Linda S
authors.initials: LS
authors.lastname: Lee
authors.affiliation: Division of Gastroenterology and Hepatology, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Daniel
authors.initials: D
authors.lastname: Mullady
authors.affiliation: Division of Gastroenterology and Hepatology, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Faris
authors.initials: F
authors.lastname: Murad
authors.affiliation: Division of Gastroenterology and Hepatology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California.
authors.forename: V Raman
authors.initials: VR
authors.lastname: Muthusamy
authors.affiliation: Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine, Madison, Wisconsin.
authors.forename: Patrick R
authors.initials: PR
authors.lastname: Pfau
authors.affiliation: Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan.
authors.forename: James M
authors.initials: JM
authors.lastname: Scheiman
authors.affiliation: Division of Gastroenterology and Hepatology, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Tokar
authors.affiliation: Division of Gastroenterology and Hepatology, University of Florida, Gainesville, Florida.
authors.forename: Mihir S
authors.initials: MS
authors.lastname: Wagh
authors.affiliation: Division of Gastroenterology and Hepatology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California.
authors.forename: Rabindra
authors.initials: R
authors.lastname: Watson
authors.affiliation: Division of Gastroenterology and Hepatology, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Dayna
authors.initials: D
authors.lastname: Early
mesh_terms: D001076:Aptitude; D002983:Clinical Competence; D019160:Endosonography / Q000379:methods*; D005762:Gastroenterology / Q000193:education*; D005767:Gastrointestinal Diseases / Q000175:diagnosis*; D006801:Humans; D059032:Learning Curve; D011446:Prospective Studies
keywords: Competency; Cumulative Sum Analysis; RATE US Study; Training