• Sachin Wani, Samuel Han, Violette Simon, Matthew Hall, Dayna Early, Eva Aagaard, Wasif M Abidi, Subhas Banerjee, Todd H Baron, Michael Bartel, Erik Bowman, Brian C Brauer, Jonathan M Buscaglia, Linda Carlin, Amitabh Chak, Hemant Chatrath, Abhishek Choudhary, Bradley Confer, Gregory A Coté, Koushik K Das, Christopher J DiMaio, Andrew M Dries, Steven A Edmundowicz, Abdul Hamid El Chafic, Ihab El Hajj, Swan Ellert, Jason Ferreira, Anthony Gamboa, Ian S Gan, Lisa Gangarosa, Bhargava Gannavarapu, Stuart R Gordon, Nalini M Guda, Hazem T Hammad, Cynthia Harris, Sujai Jalaj, Paul Jowell, Sana Kenshil, Jason Klapman, Michael L Kochman, Sri Komanduri, Gabriel Lang, Linda S Lee, David E Loren, Frank J Lukens, Daniel Mullady, Raman V Muthusamy, Andrew S Nett, Mojtaba S Olyaee, Kavous Pakseresht, Pranith Perera, Patrick Pfau, Cyrus Piraka, John M Poneros, Amit Rastogi, Anthony Razzak, Brian Riff, Shreyas Saligram, James M Scheiman, Isaiah Schuster, Raj J Shah, Rishi Sharma, Joshua P Spaete, Ajaypal Singh, Muhammad Sohail, Jayaprakash Sreenarasimhaiah, Tyler Stevens, James H Tabibian, Demetrios Tzimas, Dushant S Uppal, Shiro Urayama, Domenico Vitterbo, Andrew Y Wang, Wahid Wassef, Patrick Yachimski, Sergio Zepeda-Gomez, Tobias Zuchelli, and Rajesh N Keswani.
• University of Colorado Anschutz Medical Center, Aurora, Colorado, USA.
• Gastrointest. Endosc. 2019 Jun 1; 89 (6): 1160-1168.e9.

Background And AimsMinimum EUS and ERCP volumes that should be offered per trainee in "high quality" advanced endoscopy training programs (AETPs) are not established. We aimed to define the number of procedures required by an "average" advanced endoscopy trainee (AET) to achieve competence in technical and cognitive EUS and ERCP tasks to help structure AETPs.MethodsAmerican Society for Gastrointestinal Endoscopy (ASGE)-recognized AETPs were invited to participate; AETs were graded on every fifth EUS and ERCP examination using a validated tool. Grading for each skill was done using a 4-point scoring system, and learning curves using cumulative sum analysis for overall, technical, and cognitive components of EUS and ERCP were shared with AETs and trainers quarterly. Generalized linear mixed-effects models with a random intercept for each AET were used to generate aggregate learning curves, allowing us to use data from all AETs to estimate the average learning experience for trainees.ResultsAmong 62 invited AETPs, 37 AETs from 32 AETPs participated. Most AETs reported hands-on EUS (52%, median 20 cases) and ERCP (68%, median 50 cases) experience before starting an AETP. The median number of EUS and ERCPs performed per AET was 400 (range, 200-750) and 361 (range, 250-650), respectively. Overall, 2616 examinations were graded (EUS, 1277; ERCP-biliary, 1143; pancreatic, 196). Most graded EUS examinations were performed for pancreatobiliary indications (69.9%) and ERCP examinations for ASGE biliary grade of difficulty 1 (72.1%). The average AET achieved competence in core EUS and ERCP skills at approximately 225 and 250 cases, respectively. However, overall technical competence was achieved for grade 2 ERCP at about 300 cases.ConclusionThe thresholds provided for an average AET to achieve competence in EUS and ERCP may be used by the ASGE and AETPs in establishing the minimal standards for case volume exposure for AETs during their training. (Clinical trial registration number: NCT02509416.).Copyright © 2019 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

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