How should we establish the clinical case numbers required to achieve proficiency in flexible endoscopy?

Melina C. Vassiliou, Pepa A. Kaneva, Benjamin K. Poulose, Brian J. Dunkin, Jeffrey M. Marks, Riadh Sadik, Gideon Sroka, Mehran Anvari, Klaus Thaler, Gina Adrales, Jeffrey W. Hazey, Jenifer R. Lightdale, Vic Velanovich, Lee L. Swanstrom, John D. Mellinger, Gerald M. Fried

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)121-125
Number of pages5
JournalAmerican Journal of Surgery
Volume199
Issue number1
DOIs
StatePublished - Jan 2010
Externally publishedYes

Fingerprint

Endoscopy
Gastroenterology
Colonoscopy

Keywords

  • Flexible endoscopy
  • GAGES
  • Measuring performance
  • Objective assessment
  • Skills assessment

ASJC Scopus subject areas

  • Surgery

Cite this

Vassiliou, M. C., Kaneva, P. A., Poulose, B. K., Dunkin, B. J., Marks, J. M., Sadik, R., ... Fried, G. M. (2010). How should we establish the clinical case numbers required to achieve proficiency in flexible endoscopy? American Journal of Surgery, 199(1), 121-125. https://doi.org/10.1016/j.amjsurg.2009.10.004

How should we establish the clinical case numbers required to achieve proficiency in flexible endoscopy? / Vassiliou, Melina C.; Kaneva, Pepa A.; Poulose, Benjamin K.; Dunkin, Brian J.; Marks, Jeffrey M.; Sadik, Riadh; Sroka, Gideon; Anvari, Mehran; Thaler, Klaus; Adrales, Gina; Hazey, Jeffrey W.; Lightdale, Jenifer R.; Velanovich, Vic; Swanstrom, Lee L.; Mellinger, John D.; Fried, Gerald M.

In: American Journal of Surgery, Vol. 199, No. 1, 01.2010, p. 121-125.

Research output: Contribution to journalArticle

Vassiliou, MC, Kaneva, PA, Poulose, BK, Dunkin, BJ, Marks, JM, Sadik, R, Sroka, G, Anvari, M, Thaler, K, Adrales, G, Hazey, JW, Lightdale, JR, Velanovich, V, Swanstrom, LL, Mellinger, JD & Fried, GM 2010, 'How should we establish the clinical case numbers required to achieve proficiency in flexible endoscopy?', American Journal of Surgery, vol. 199, no. 1, pp. 121-125. https://doi.org/10.1016/j.amjsurg.2009.10.004
Vassiliou, Melina C. ; Kaneva, Pepa A. ; Poulose, Benjamin K. ; Dunkin, Brian J. ; Marks, Jeffrey M. ; Sadik, Riadh ; Sroka, Gideon ; Anvari, Mehran ; Thaler, Klaus ; Adrales, Gina ; Hazey, Jeffrey W. ; Lightdale, Jenifer R. ; Velanovich, Vic ; Swanstrom, Lee L. ; Mellinger, John D. ; Fried, Gerald M. / How should we establish the clinical case numbers required to achieve proficiency in flexible endoscopy?. In: American Journal of Surgery. 2010 ; Vol. 199, No. 1. pp. 121-125.
@article{3fdb300470004720beaf59fdc197b485,
title = "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. 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.",
keywords = "Flexible endoscopy, GAGES, Measuring performance, Objective assessment, Skills assessment",
author = "Vassiliou, {Melina C.} and Kaneva, {Pepa A.} and Poulose, {Benjamin K.} and Dunkin, {Brian J.} and Marks, {Jeffrey M.} and Riadh Sadik and Gideon Sroka and Mehran Anvari and Klaus Thaler and Gina Adrales and Hazey, {Jeffrey W.} and Lightdale, {Jenifer R.} and Vic Velanovich and Swanstrom, {Lee L.} and Mellinger, {John D.} and Fried, {Gerald M.}",
year = "2010",
month = "1",
doi = "10.1016/j.amjsurg.2009.10.004",
language = "English (US)",
volume = "199",
pages = "121--125",
journal = "American Journal of Surgery",
issn = "0002-9610",
publisher = "Elsevier Inc.",
number = "1",

}

TY - JOUR

T1 - How should we establish the clinical case numbers required to achieve proficiency in flexible endoscopy?

AU - Vassiliou, Melina C.

AU - Kaneva, Pepa A.

AU - Poulose, Benjamin K.

AU - Dunkin, Brian J.

AU - Marks, Jeffrey M.

AU - Sadik, Riadh

AU - Sroka, Gideon

AU - Anvari, Mehran

AU - Thaler, Klaus

AU - Adrales, Gina

AU - Hazey, Jeffrey W.

AU - Lightdale, Jenifer R.

AU - Velanovich, Vic

AU - Swanstrom, Lee L.

AU - Mellinger, John D.

AU - Fried, Gerald M.

PY - 2010/1

Y1 - 2010/1

N2 - 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.

AB - 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.

KW - Flexible endoscopy

KW - GAGES

KW - Measuring performance

KW - Objective assessment

KW - Skills assessment

UR - http://www.scopus.com/inward/record.url?scp=72049094515&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=72049094515&partnerID=8YFLogxK

U2 - 10.1016/j.amjsurg.2009.10.004

DO - 10.1016/j.amjsurg.2009.10.004

M3 - Article

C2 - 20103077

AN - SCOPUS:72049094515

VL - 199

SP - 121

EP - 125

JO - American Journal of Surgery

JF - American Journal of Surgery

SN - 0002-9610

IS - 1

ER -