Reply to Konge et al.

We would like to thank Konge et al. for their interest in our recent publication addressing the development of competence in endoscopic retrograde cholangiopancreatography (ERCP) [1]. They raise some interesting points on the weakness of self-assessment.

We agree that self-assessment can never be a 100 % objective measure of performance. However, there is a difference between self-assessing individual performance on a qualitative scale and self-assessment or reporting of objective outcome measures, such as cannulation of the common bile duct (CBD).

In a previous study on ERCP quality, we cross-checked the self-reported cannulation success with the official endoscopy report; there was no significant difference in outcome of reported success rates [2]. Moreover, quality audits in endoscopy are also often based on self-reporting [3] [4] [5].

The purpose of self-assessing procedural outcome in ERCP or any other type of endoscopic procedure is first of all to monitor and report a set of objective outcome parameters in order to demonstrate progress over time. Secondly, the self-assessor is stimulated to evaluate this performance using a universal four-step approach to improvement employed by teachers in various fields, based on the Osborn – Parnes Creative Problem Solving process developed in the 1950 s [6]. It shows large similarities to the Plan – Do – Check – Act cycle of Deming and to the Kolb experiential learning cycle.

Our reported method of self-assessment is not designed to replace assessment by a supervising expert but can be used in parallel to evaluation by the mentor. Interestingly, in daily practice we have found the self-evaluated results from the trainee to be very useful for a better understanding of the trainee’s considerations and for providing structured feedback.

We believe that self-assessment is therefore an easy-to-use and reliable method to provide insight in the learning curve for ERCP.

The self-assessment form is currently being implemented in an electronic portfolio for all gastroenterology trainees in the Netherlands. This module can generate the group learning curve, based on the completed forms from all trainees, and can plot a real-time individual curve against the background of the group curve, based on the data available at that moment in the database. This can be considered to be real-time feedback on one’s learning curve and thus performance.

Moreover, we are currently working on integration of an endoscopy reporting system with the electronic portfolio. In this way, outcome parameters such as success of cannulation of the CBD are extracted directly from the endoscopy report. This will provide even more reliable data that is useful for competence and quality assessment, for both trainees and experienced endoscopists.

• References

• 1 Ekkelenkamp VE, Koch AD, Rauws EA et al. Competence development in ERCP: the learning curve of novice trainees. Endoscopy 2014; 46: 949-955
• 2 Ekkelenkamp VE, Koch AD, Haringsma J et al. Quality evaluation through self-assessment: a novel method to gain insight into ERCP performance. Frontline Gastroenterol 2014; 5: 10-16
• 3 Cotton PB, Romagnuolo J, Faigel DO et al. The ERCP quality network: a pilot study of benchmarking practice and performance. Am J Med Qual 2013; 28: 256-260
• 4 Kapral C, Muhlberger A, Wewalka F et al. Quality assessment of endoscopic retrograde cholangiopancreatography: results of a running nationwide Austrian benchmarking project after 5 years of implementation. Eur J Gastroenterol Hepatol 2012; 24: 1447-1454
• 5 Williams EJ, Ogollah R, Thomas P et al. What predicts failed cannulation and therapy at ERCP? Results of a large-scale multicenter analysis. . Endoscopy 2012; 44: 674-683
• 6 Osborn A, Parnes SJ. Osborn–Parnes approach to creative problem solving. Available at: www.cpsb.com 1960 Accessed 11 January 2012