title: A System to Assess the Competency for Interpretation of Esophageal Manometry Identifies Variation in Learning Curves.
abstract: OBJECTIVE
  Quality esophageal high-resolution manometry (HRM) studies require competent interpretation of data. However, there is little understanding of learning curves, training requirements, or measures of competency for HRM. We aimed to develop and use a competency assessment system to examine learning curves for interpretation of HRM data.
  
  
  METHODS
  We conducted a prospective multicenter study of 20 gastroenterology trainees with no experience in HRM, from 8 centers, over an 8-month period (May through December 2015). We designed a web-based HRM training and competency assessment system. After reviewing the training module, participants interpreted 50 HRM studies and received answer keys at the fifth and then at every second interpretation. A cumulative sum procedure produced individual learning curves with preset acceptable failure rates of 10%; we classified competency status as competency not achieved, competency achieved, or competency likely achieved.
  
  
  RESULTS
  Five (25%) participants achieved competence, 4 (20%) likely achieved competence, and 11 (55%) failed to achieve competence. A minimum case volume to achieve competency was not identified. There was no significant agreement between diagnostic accuracy and accuracy for individual HRM skills.
  
  
  CONCLUSIONS
  We developed a competency assessment system for HRM interpretation; using this system, we found significant variation in learning curves for HRM diagnosis and individual skills. Our system effectively distinguished trainee competency levels for HRM interpretation and contrary to current recommendations, found that competency for HRM is not case-volume specific.
authors.affiliation: Division of Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. Electronic address: rena.yadlapati@northwestern.edu.
authors.forename: Rena
authors.initials: R
authors.lastname: Yadlapati
authors.affiliation: Division of Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Rajesh N
authors.initials: RN
authors.lastname: Keswani
authors.affiliation: Department of Preventive Medicine-Division of Biostatistics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Jody D
authors.initials: JD
authors.lastname: Ciolino
authors.affiliation: Division of Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: David P
authors.initials: DP
authors.lastname: Grande
authors.affiliation: Division of Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Zoe I
authors.initials: ZI
authors.lastname: Listernick
authors.affiliation: Division of Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Dustin A
authors.initials: DA
authors.lastname: Carlson
authors.affiliation: Division of Gastroenterology & Hepatology, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Donald O
authors.initials: DO
authors.lastname: Castell
authors.affiliation: University of Texas Southwestern Medical Center and the Dallas VA Medical Center, Department of Internal Medicine, Division of Gastroenterology and Hepatology, Dallas, Texas.
authors.forename: Kerry B
authors.initials: KB
authors.lastname: Dunbar
authors.affiliation: Division of Gastroenterology, University of Utah, Salt Lake City, Utah.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Gawron
authors.affiliation: Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: C Prakash
authors.initials: CP
authors.lastname: Gyawali
authors.affiliation: Division of Gastroenterology, Albert Einstein Medical Center, Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Philip O
authors.initials: PO
authors.lastname: Katz
authors.affiliation: Division of Gastroenterology, Mayo Clinic, Rochester, Minnesota.
authors.forename: David
authors.initials: D
authors.lastname: Katzka
authors.affiliation: Division of Gastroenterology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire.
authors.forename: Brian E
authors.initials: BE
authors.lastname: Lacy
authors.affiliation: University of Texas Southwestern Medical Center and the Dallas VA Medical Center, Department of Internal Medicine, Division of Gastroenterology and Hepatology, Dallas, Texas.
authors.forename: Stuart J
authors.initials: SJ
authors.lastname: Spechler
authors.affiliation: Department of Surgery, University of Washington, Seattle, Washington.
authors.forename: Roger
authors.initials: R
authors.lastname: Tatum
authors.affiliation: Division of Gastroenterology, Mayo Clinic Arizona, Scottsdale, Arizona.
authors.forename: Marcelo F
authors.initials: MF
authors.lastname: Vela
authors.affiliation: Division of Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: John E
authors.initials: JE
authors.lastname: Pandolfino
mesh_terms: D000328:Adult; D002983:Clinical Competence; D005260:Female; D005762:Gastroenterology / Q000193:education*; D005764:Gastroesophageal Reflux / Q000175:diagnosis*; D006282:Health Personnel; D006801:Humans; D059032:Learning Curve; D008297:Male; D008365:Manometry / Q000379:methods*; D011446:Prospective Studies
keywords: CUSUM; Competency-Based Medical Education; High-Resolution Manometry