How should we establish the clinical case numbers required to achieve proficiency in flexible endoscopy?
Abstract Background Recommended procedure numbers for upper endoscopy (UE) and colonoscopy (C) are 35 and 50 for surgical residents, and 130 and 140 for gastroenterology fellows, respectively. The purpose of this study was to challenge the methods used to determine proficiency in flexible endoscopy....
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| Veröffentlicht in: | The American journal of surgery 2010, Vol.199 (1), p.121-125 |
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| creator | Vassiliou, Melina C., M.D Kaneva, Pepa A., M.S Poulose, Benjamin K., M.D Dunkin, Brian J., M.D Marks, Jeffrey M., M.D Sadik, Riadh, M.D Sroka, Gideon, M.D Anvari, Mehran, M.D Thaler, Klaus, M.D Adrales, Gina L., M.D Hazey, Jeffrey W., M.D Lightdale, Jenifer R., M.D Velanovich, Vic, M.D Swanstrom, Lee L., M.D Mellinger, John D., M.D Fried, Gerald M., M.D |
| description | Abstract Background Recommended procedure numbers for upper endoscopy (UE) and colonoscopy (C) are 35 and 50 for surgical residents, and 130 and 140 for gastroenterology fellows, respectively. The purpose of this study was to challenge the methods used to determine proficiency in flexible endoscopy. Methods Global assessment of gastrointestinal endoscopic skills (GAGES) was used to evaluate 139 procedures. Scores for UE were compared using self-reported case numbers and grouped according to requirements for each discipline. C scores were compared using the requirements to define novice and experienced endoscopists. Procedure volumes were plotted against GAGES scores. Results Three groups were compared for UE based on case volumes: fewer than 35 cases (group 1), 35 to 130 cases (group 2), and more than 130 cases (group 3). There was no difference between group 2 (17.8 ± 1.8) and group 3 (19.1 ± 1.1), but both scored higher than group 1 (14.4 ± 3.7; P < .05). For C, the scores were 11.8 ± 3.8 (novices) and 18.8 ± 1.34 (experienced; P < .001) at a 50-case minimum and 12.4 ± 4.2 and 18.8 ± 1.3 ( P < .001) for a 140-case proficiency cut-off level, respectively. The curve of procedures versus GAGES plateaued at 50 (UE) and 75 (C). Conclusions The surgical and gastroenterology case recommendations may not represent the experience needed to achieve proficiency. GAGES scores could help define proficiency in basic endoscopy. |
| doi_str_mv | 10.1016/j.amjsurg.2009.10.004 |
| format | Article |
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The purpose of this study was to challenge the methods used to determine proficiency in flexible endoscopy. Methods Global assessment of gastrointestinal endoscopic skills (GAGES) was used to evaluate 139 procedures. Scores for UE were compared using self-reported case numbers and grouped according to requirements for each discipline. C scores were compared using the requirements to define novice and experienced endoscopists. Procedure volumes were plotted against GAGES scores. Results Three groups were compared for UE based on case volumes: fewer than 35 cases (group 1), 35 to 130 cases (group 2), and more than 130 cases (group 3). There was no difference between group 2 (17.8 ± 1.8) and group 3 (19.1 ± 1.1), but both scored higher than group 1 (14.4 ± 3.7; P < .05). For C, the scores were 11.8 ± 3.8 (novices) and 18.8 ± 1.34 (experienced; P < .001) at a 50-case minimum and 12.4 ± 4.2 and 18.8 ± 1.3 ( P < .001) for a 140-case proficiency cut-off level, respectively. The curve of procedures versus GAGES plateaued at 50 (UE) and 75 (C). Conclusions The surgical and gastroenterology case recommendations may not represent the experience needed to achieve proficiency. GAGES scores could help define proficiency in basic endoscopy.</description><identifier>ISSN: 0002-9610</identifier><identifier>EISSN: 1879-1883</identifier><identifier>DOI: 10.1016/j.amjsurg.2009.10.004</identifier><identifier>PMID: 20103077</identifier><identifier>CODEN: AJSUAB</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Analysis of Variance ; Biological and medical sciences ; Clinical Competence ; Colon ; Colonoscopy ; Colonoscopy - methods ; Colonoscopy - statistics & numerical data ; Competency-Based Education - methods ; Curricula ; Education, Medical, Graduate - methods ; Endoscopes, Gastrointestinal ; Endoscopy ; Endoscopy, Gastrointestinal - methods ; Endoscopy, Gastrointestinal - statistics & numerical data ; Female ; Flexible endoscopy ; GAGES ; Gastroenterology ; General aspects ; Humans ; Internship and Residency ; Intubation ; Male ; Measuring instruments ; Measuring performance ; Medical residencies ; Medical sciences ; Objective assessment ; Probability ; Quebec ; Reference Standards ; Skills ; Skills assessment ; Surgeons ; Surgery ; Task forces ; Task Performance and Analysis ; Workload - statistics & numerical data</subject><ispartof>The American journal of surgery, 2010, Vol.199 (1), p.121-125</ispartof><rights>Elsevier Inc.</rights><rights>2010 Elsevier Inc.</rights><rights>2015 INIST-CNRS</rights><rights>Copyright Elsevier Limited Jan 1, 2010</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c477t-e15592ad5816f9491a0fddf3ed908195ffb644511c5a43e5ead0291ebfc175153</citedby><cites>FETCH-LOGICAL-c477t-e15592ad5816f9491a0fddf3ed908195ffb644511c5a43e5ead0291ebfc175153</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0002961009006230$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,4010,27900,27901,27902,65306</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=22300002$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20103077$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Vassiliou, Melina C., M.D</creatorcontrib><creatorcontrib>Kaneva, Pepa A., M.S</creatorcontrib><creatorcontrib>Poulose, Benjamin K., M.D</creatorcontrib><creatorcontrib>Dunkin, Brian J., M.D</creatorcontrib><creatorcontrib>Marks, Jeffrey M., M.D</creatorcontrib><creatorcontrib>Sadik, Riadh, M.D</creatorcontrib><creatorcontrib>Sroka, Gideon, M.D</creatorcontrib><creatorcontrib>Anvari, Mehran, M.D</creatorcontrib><creatorcontrib>Thaler, Klaus, M.D</creatorcontrib><creatorcontrib>Adrales, Gina L., M.D</creatorcontrib><creatorcontrib>Hazey, Jeffrey W., M.D</creatorcontrib><creatorcontrib>Lightdale, Jenifer R., M.D</creatorcontrib><creatorcontrib>Velanovich, Vic, M.D</creatorcontrib><creatorcontrib>Swanstrom, Lee L., M.D</creatorcontrib><creatorcontrib>Mellinger, John D., M.D</creatorcontrib><creatorcontrib>Fried, Gerald M., M.D</creatorcontrib><title>How should we establish the clinical case numbers required to achieve proficiency in flexible endoscopy?</title><title>The American journal of surgery</title><addtitle>Am J Surg</addtitle><description>Abstract Background Recommended procedure numbers for upper endoscopy (UE) and colonoscopy (C) are 35 and 50 for surgical residents, and 130 and 140 for gastroenterology fellows, respectively. The purpose of this study was to challenge the methods used to determine proficiency in flexible endoscopy. Methods Global assessment of gastrointestinal endoscopic skills (GAGES) was used to evaluate 139 procedures. Scores for UE were compared using self-reported case numbers and grouped according to requirements for each discipline. C scores were compared using the requirements to define novice and experienced endoscopists. Procedure volumes were plotted against GAGES scores. Results Three groups were compared for UE based on case volumes: fewer than 35 cases (group 1), 35 to 130 cases (group 2), and more than 130 cases (group 3). There was no difference between group 2 (17.8 ± 1.8) and group 3 (19.1 ± 1.1), but both scored higher than group 1 (14.4 ± 3.7; P < .05). For C, the scores were 11.8 ± 3.8 (novices) and 18.8 ± 1.34 (experienced; P < .001) at a 50-case minimum and 12.4 ± 4.2 and 18.8 ± 1.3 ( P < .001) for a 140-case proficiency cut-off level, respectively. The curve of procedures versus GAGES plateaued at 50 (UE) and 75 (C). Conclusions The surgical and gastroenterology case recommendations may not represent the experience needed to achieve proficiency. GAGES scores could help define proficiency in basic endoscopy.</description><subject>Analysis of Variance</subject><subject>Biological and medical sciences</subject><subject>Clinical Competence</subject><subject>Colon</subject><subject>Colonoscopy</subject><subject>Colonoscopy - methods</subject><subject>Colonoscopy - statistics & numerical data</subject><subject>Competency-Based Education - methods</subject><subject>Curricula</subject><subject>Education, Medical, Graduate - methods</subject><subject>Endoscopes, Gastrointestinal</subject><subject>Endoscopy</subject><subject>Endoscopy, Gastrointestinal - methods</subject><subject>Endoscopy, Gastrointestinal - statistics & numerical data</subject><subject>Female</subject><subject>Flexible endoscopy</subject><subject>GAGES</subject><subject>Gastroenterology</subject><subject>General aspects</subject><subject>Humans</subject><subject>Internship and Residency</subject><subject>Intubation</subject><subject>Male</subject><subject>Measuring instruments</subject><subject>Measuring performance</subject><subject>Medical residencies</subject><subject>Medical sciences</subject><subject>Objective assessment</subject><subject>Probability</subject><subject>Quebec</subject><subject>Reference Standards</subject><subject>Skills</subject><subject>Skills assessment</subject><subject>Surgeons</subject><subject>Surgery</subject><subject>Task forces</subject><subject>Task Performance and Analysis</subject><subject>Workload - 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methods</topic><topic>Colonoscopy - statistics & numerical data</topic><topic>Competency-Based Education - methods</topic><topic>Curricula</topic><topic>Education, Medical, Graduate - methods</topic><topic>Endoscopes, Gastrointestinal</topic><topic>Endoscopy</topic><topic>Endoscopy, Gastrointestinal - methods</topic><topic>Endoscopy, Gastrointestinal - statistics & numerical data</topic><topic>Female</topic><topic>Flexible endoscopy</topic><topic>GAGES</topic><topic>Gastroenterology</topic><topic>General aspects</topic><topic>Humans</topic><topic>Internship and Residency</topic><topic>Intubation</topic><topic>Male</topic><topic>Measuring instruments</topic><topic>Measuring performance</topic><topic>Medical residencies</topic><topic>Medical sciences</topic><topic>Objective assessment</topic><topic>Probability</topic><topic>Quebec</topic><topic>Reference Standards</topic><topic>Skills</topic><topic>Skills assessment</topic><topic>Surgeons</topic><topic>Surgery</topic><topic>Task forces</topic><topic>Task Performance and Analysis</topic><topic>Workload - 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Academic</collection><jtitle>The American journal of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Vassiliou, Melina C., M.D</au><au>Kaneva, Pepa A., M.S</au><au>Poulose, Benjamin K., M.D</au><au>Dunkin, Brian J., M.D</au><au>Marks, Jeffrey M., M.D</au><au>Sadik, Riadh, M.D</au><au>Sroka, Gideon, M.D</au><au>Anvari, Mehran, M.D</au><au>Thaler, Klaus, M.D</au><au>Adrales, Gina L., M.D</au><au>Hazey, Jeffrey W., M.D</au><au>Lightdale, Jenifer R., M.D</au><au>Velanovich, Vic, M.D</au><au>Swanstrom, Lee L., M.D</au><au>Mellinger, John D., M.D</au><au>Fried, Gerald M., M.D</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>How should we establish the clinical case numbers required to achieve proficiency in flexible endoscopy?</atitle><jtitle>The American journal of surgery</jtitle><addtitle>Am J Surg</addtitle><date>2010</date><risdate>2010</risdate><volume>199</volume><issue>1</issue><spage>121</spage><epage>125</epage><pages>121-125</pages><issn>0002-9610</issn><eissn>1879-1883</eissn><coden>AJSUAB</coden><abstract>Abstract Background Recommended procedure numbers for upper endoscopy (UE) and colonoscopy (C) are 35 and 50 for surgical residents, and 130 and 140 for gastroenterology fellows, respectively. The purpose of this study was to challenge the methods used to determine proficiency in flexible endoscopy. Methods Global assessment of gastrointestinal endoscopic skills (GAGES) was used to evaluate 139 procedures. Scores for UE were compared using self-reported case numbers and grouped according to requirements for each discipline. C scores were compared using the requirements to define novice and experienced endoscopists. Procedure volumes were plotted against GAGES scores. Results Three groups were compared for UE based on case volumes: fewer than 35 cases (group 1), 35 to 130 cases (group 2), and more than 130 cases (group 3). There was no difference between group 2 (17.8 ± 1.8) and group 3 (19.1 ± 1.1), but both scored higher than group 1 (14.4 ± 3.7; P < .05). For C, the scores were 11.8 ± 3.8 (novices) and 18.8 ± 1.34 (experienced; P < .001) at a 50-case minimum and 12.4 ± 4.2 and 18.8 ± 1.3 ( P < .001) for a 140-case proficiency cut-off level, respectively. The curve of procedures versus GAGES plateaued at 50 (UE) and 75 (C). Conclusions The surgical and gastroenterology case recommendations may not represent the experience needed to achieve proficiency. GAGES scores could help define proficiency in basic endoscopy.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>20103077</pmid><doi>10.1016/j.amjsurg.2009.10.004</doi><tpages>5</tpages></addata></record> |
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| subjects | Analysis of Variance Biological and medical sciences Clinical Competence Colon Colonoscopy Colonoscopy - methods Colonoscopy - statistics & numerical data Competency-Based Education - methods Curricula Education, Medical, Graduate - methods Endoscopes, Gastrointestinal Endoscopy Endoscopy, Gastrointestinal - methods Endoscopy, Gastrointestinal - statistics & numerical data Female Flexible endoscopy GAGES Gastroenterology General aspects Humans Internship and Residency Intubation Male Measuring instruments Measuring performance Medical residencies Medical sciences Objective assessment Probability Quebec Reference Standards Skills Skills assessment Surgeons Surgery Task forces Task Performance and Analysis Workload - statistics & numerical data |
| title | How should we establish the clinical case numbers required to achieve proficiency in flexible endoscopy? |
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