Very little is known about the process of acquisition of cognitive and technical skills in ERCP. AIM: To describe the learning curve for cognitive and technical skills in diagnostic and therapeutic ERCP in a variety of GI fellowship training programs. METHODS: Over a 2-year period, 16 attendings skilled in ERCP supervised and graded 38 GI trainees (6 advanced or ADV, 32 regular or REG) from 7 university medical centers. 4 centers had formal ADV training programs. Cognitive and technical skills for each component of diagnostic ERCP (precannulation, CBD and PD cannulation) and each therapeutic maneuver were graded immediately following ERCP using pretested standardized scales. To adjust the learning curves, the difficulty of each ERCP component was estimated using a standardized scale pretested against procedure time. Cognitive skills were also evaluated before and after the training period with a pretested written test. RESULTS: Mean difficulty scores for ERCP were highly correlated with actual times for precannulation and cannulation (Spearman corr coeff=.45-.57, p=.0001). All REG trainees and 1 ADV trainee had no prior ERCP experience. After adjusting for procedure difficulty, the CBD and PD cannulation learning curves for REG trainees had initial steep slopes and continued rise without a plateau at competent score levels. In contrast, those for ADV trainees showed early gradual rise then plateau at competent levels. Mean CBD cannulation scores were significantly higher for ADV trainees than for REG trainees(p<.0001). Successful PD cannulation scores were no different (p=.21). High cognitive scores were achieved very early in the learning process and continue to gradually rise. Mean trainee pretest scores were markedly lower than attending scores (p=.0001) but the differences decreased after the training period (p=.04). CONCLUSION: Trainees in advanced training programs achieve technical diagnostic and therapeutic ERCP skills more rapidly than REG trainees. Majority of REG trainees do not achieve technical competence at the end of their training. Cognitive skills in ERCP are more rapidly acquired than technical skills. They are significantly improved throughout the course of training but do not achieve attending levels.
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging