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 L. Adrales; Jeffrey W. Hazey; Jenifer R. Lightdale; Vic Velanovich; Lee L. Swanstrom; John D. Mellinger; Gerald M. Fried

doi:10.1016/j.amjsurg.2009.10.004

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 L. Adrales, Jeffrey W. Hazey, Jenifer R. Lightdale, Vic Velanovich, Lee L. Swanstrom, John D. Mellinger, Gerald M. Fried

Research output: Contribution to journal › Article › peer-review

39 Scopus citations

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 language	English (US)
Pages (from-to)	121-125
Number of pages	5
Journal	American journal of surgery
Volume	199
Issue number	1
DOIs	https://doi.org/10.1016/j.amjsurg.2009.10.004
State	Published - Jan 2010
Externally published	Yes

Keywords

Flexible endoscopy
GAGES
Measuring performance
Objective assessment
Skills assessment

ASJC Scopus subject areas

Surgery

Access to Document

10.1016/j.amjsurg.2009.10.004

Cite this

Vassiliou, M. C., Kaneva, P. A., Poulose, B. K., Dunkin, B. J., Marks, J. M., Sadik, R., Sroka, G., Anvari, M., Thaler, K., Adrales, G. L., Hazey, J. W., Lightdale, J. R., Velanovich, V., Swanstrom, L. L., Mellinger, J. D., & 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

Vassiliou, MC, Kaneva, PA, Poulose, BK, Dunkin, BJ, Marks, JM, Sadik, R, Sroka, G, Anvari, M, Thaler, K, Adrales, GL, 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

@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 Adrales, {Gina L.} 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 = jan,

doi = "10.1016/j.amjsurg.2009.10.004",

language = "English (US)",

volume = "199",

pages = "121--125",

journal = "American journal of surgery",

issn = "0002-9610",