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The learning curve to achieve satisfactory completion rates in upper GI endoscopy: an analysis of a national training database
  1. S T Ward1,
  2. A Hancox2,
  3. M A Mohammed3,4,5,
  4. T Ismail6,
  5. E A Griffiths7,
  6. R Valori8,
  7. P Dunckley8
  1. 1Centre for Liver Research & NIHR Birmingham Biomedical Research Unit, Level 5 Institute for Biomedical Research, University of Birmingham, Birmingham, UK
  2. 2Department of Surgery, Birmingham Children's Hospital, Birmingham, UK
  3. 3Faculty of Health Studies, University of Bradford, Bradford, UK
  4. 4Bradford Institute for Health Research, Bradford, Yorkshire, UK
  5. 5Humberside Academic Health Sciences Network, Wakefield, UK
  6. 6Department of Colorectal Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
  7. 7Department of Upper Gastrointestinal Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
  8. 8Department of Gastroenterology, Gloucestershire Royal Hospital, Gloucester, UK
  1. Correspondence to ST Ward, Centre for Liver Research & NIHR Birmingham Biomedical Research Unit, Level 5 Institute for Biomedical Research, University of Birmingham, Vincent Drive, Birmingham B15 2TT, UK; drsteveward{at}yahoo.com

Abstract

Objective The aim of this study was to determine the number of OGDs (oesophago-gastro-duodenoscopies) trainees need to perform to acquire competency in terms of successful unassisted completion to the second part of the duodenum 95% of the time.

Design OGD data were retrieved from the trainee e-portfolio developed by the Joint Advisory Group on GI Endoscopy (JAG) in the UK. All trainees were included unless they were known to have a baseline experience of >20 procedures or had submitted data for <20 procedures. The primary outcome measure was OGD completion, defined as passage of the endoscope to the second part of the duodenum without physical assistance. The number of OGDs required to achieve a 95% completion rate was calculated by the moving average method and learning curve cumulative summation (LC-Cusum) analysis. To determine which factors were independently associated with OGD completion, a mixed effects logistic regression model was constructed with OGD completion as the outcome variable.

Results Data were analysed for 1255 trainees over 288 centres, representing 243 555 OGDs. By moving average method, trainees attained a 95% completion rate at 187 procedures. By LC-Cusum analysis, after 200 procedures, >90% trainees had attained a 95% completion rate. Total number of OGDs performed, trainee age and experience in lower GI endoscopy were factors independently associated with OGD completion.

Conclusions There are limited published data on the OGD learning curve. This is the largest study to date analysing the learning curve for competency acquisition. The JAG competency requirement for 200 procedures appears appropriate.

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