Learning Curve Analyses for Achieving Satisfactory Procedural Completion Rates in Paediatric Oesophagogastroduodenoscopy.
Journal
Journal of pediatric gastroenterology and nutrition
ISSN: 1536-4801
Titre abrégé: J Pediatr Gastroenterol Nutr
Pays: United States
ID NLM: 8211545
Informations de publication
Date de publication:
03 2020
03 2020
Historique:
pubmed:
23
8
2019
medline:
22
6
2021
entrez:
23
8
2019
Statut:
ppublish
Résumé
The learning curve in paediatric oesophagogastroduodenoscopy (OGD) is unknown. Using ≥95% D2 (second part of the duodenum) intubation rates as a marker of technical competency, we conducted learning curve analyses to identify when trainees achieve competency in paediatric OGD. Factors associated with competency were also evaluated. This nationwide study analysed data from paediatric OGD procedures prospectively entered into the UK endoscopy training e-portfolio between 2014 and 2018. Moving average and learning curve cumulative summation analyses were performed to determine procedural numbers required to achieve ≥95% D2 intubation rates. Factors associated with D2 intubation were assessed using a multivariable binary logistic regression approach. A total of 8929 procedures performed by 61 trainees were identified. These 61 trainees had recorded a mean of 124.6 procedures (range 22-571, interquartile range 165). By moving average analysis, 95% D2 intubation was achieved after 79 procedures. By learning curve cumulative summation analysis, 81.6% of trainees were competent after 100 procedures. Multivariable factors associated with unassisted procedural completion included: lifetime procedure count (P < 0.001), higher trainee seniority (P < 0.001), patient age (P = 0.002), outpatient status (P < 0.001), and attendance at a national Basic Skills OGD course (P = 0.011). This study demonstrates that, on average, 79 procedures in paediatric OGD are required to attain the competency outcome of ≥95% D2 intubation rates. By 100 procedures, 81.6% of our sample had achieved ≥95% D2 intubation. The minimum procedural count of 100 set by the UK and international training programmes can be used alongside existing objective assessment measures to safeguard competency within a training cohort.
Sections du résumé
BACKGROUND
The learning curve in paediatric oesophagogastroduodenoscopy (OGD) is unknown. Using ≥95% D2 (second part of the duodenum) intubation rates as a marker of technical competency, we conducted learning curve analyses to identify when trainees achieve competency in paediatric OGD. Factors associated with competency were also evaluated.
METHODS
This nationwide study analysed data from paediatric OGD procedures prospectively entered into the UK endoscopy training e-portfolio between 2014 and 2018. Moving average and learning curve cumulative summation analyses were performed to determine procedural numbers required to achieve ≥95% D2 intubation rates. Factors associated with D2 intubation were assessed using a multivariable binary logistic regression approach.
RESULTS
A total of 8929 procedures performed by 61 trainees were identified. These 61 trainees had recorded a mean of 124.6 procedures (range 22-571, interquartile range 165). By moving average analysis, 95% D2 intubation was achieved after 79 procedures. By learning curve cumulative summation analysis, 81.6% of trainees were competent after 100 procedures. Multivariable factors associated with unassisted procedural completion included: lifetime procedure count (P < 0.001), higher trainee seniority (P < 0.001), patient age (P = 0.002), outpatient status (P < 0.001), and attendance at a national Basic Skills OGD course (P = 0.011).
CONCLUSIONS
This study demonstrates that, on average, 79 procedures in paediatric OGD are required to attain the competency outcome of ≥95% D2 intubation rates. By 100 procedures, 81.6% of our sample had achieved ≥95% D2 intubation. The minimum procedural count of 100 set by the UK and international training programmes can be used alongside existing objective assessment measures to safeguard competency within a training cohort.
Identifiants
pubmed: 31436700
doi: 10.1097/MPG.0000000000002460
pii: 00005176-202003000-00014
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
336-340Références
Leictner AM, Gillis LA, Gupta S, et al. NASPGHAN guidelines for training in pediatric gastroenterology. J Pediatr Gastroenterol Nutr 2013; 56: (suppl 1): S1–S8.
The Joint Advisory Group on Gastrointestinal Endoscopy. JAG trainee certification application criteria and process - Paediatric OGD/Upper GI. 2014. https://www.thejag.org.uk/Downloads/JAG%20certification%20for%20paediatric%20trainees/JAG%20trainee%20certification%20application%20criteria%20and%20process%20- %20Paediatric%20diagnostic%20colonoscopy%20v2.0.pdf. Accessed October 10, 2017.
Conjoint Committee for the Recognition of Training in Gastrointestinal Endoscopy. Information for applicants—requirements for CCRTGE Recognition. http://conjoint.org.au/applicants.php#procedural. Accessed January 2018.
Ward ST, Hancox A, Mohammed MA, et al. The learning curve to achieve satisfactory completion rates in upper GI endoscopy: an analysis of a national training database. Gut 2017; 66:1022–1033.
Siau K, Hawkes N, Dunkley P. Training in endoscopy. Curr Treat Options Gastroenterol 2018; 16:345–361.
Diggle P. Time Series: A Biostatistical Introduction. Oxford, UK: Oxford University Press on Demand; 1990.
Biau DJ, Williams SM, Schlup MM, et al. Quantitative and individualized assessment of the learning curve using LC-CUSUM. Br J Surg 2008; 95:925–929.
Beg S, Ragunath K, Wyman A, et al. Quality standards in upper gastrointestinal endoscopy: a position statement of the British Society of Gastroenterology (BSG) and Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland (AUGIS). Gut 2017; 66:2188.
Siau K, Levi R, Howarth L, et al. Validity evidence for direct observation of procedural skills in paediatric gastroscopy. J Pediatr Gastroenterol Nutr 2018; 67:e111–e116.
Broekaert IJ, Jahnel J, Moes N, et al. Evaluation of a European-wide survey on paediatric endoscopy training. Frontline Gastroenterol 2019; 10:188–193.