Background and Study Aims: The aim of this study was to determine the relative contribution of previous endoscopic experience, case observation, and hands-on experience to skill acquisition in radial EUS.
Methods: In EUS trainees, four senior gastroenterology fellows, and a nurse endoscopist, the ability to reproduce set views from the mediastinum, stomach, and duodenum was assessed. Points were ascribed to static and dynamic stations and to the use of console controls.
Results: Trainees observed 55 - 170 cases and conducted 25 - 124 examinations. Competence was demonstrated after performing approximately 25 examinations in the mediastinum, 35 examinations in the stomach, and 78 examinations in the duodenum. The number of previous examinations conducted correlated with the ability to scan the duodenum (P < 0.01). Observation of 100 or more further procedures early in training did not accelerate learning. The nurse endoscopist showed a comparable degree of competence in mediastinal scanning to that of the other trainees after performing a similar number of examinations.
Conclusions: Proficiency in radial endosonography is greatly influenced by the numbers of examinations performed. Observing large numbers of cases early in training does not appear to translate into competence. A background in advanced therapeutic endoscopy is not a prerequisite for acquiring endoscopic ultrasound skills. Nurse endoscopists may be expected to train successfully in mediastinal imaging at the same pace as senior gastroenterology fellows.
References
-
1
Parada K S, Peng R, Erickson R A. et al .
A resource utilization projection study of EUS.
Gastrointest Endosc.
2002;
55
328-334
-
2
Meenan J, Wong T, Rottenberg G.
Substitution of EUS for ERCP: implications for training and service development [abstract].
Gut.
2000;
48
A12
-
3
Eisen G M, Dominitz J A, Faigel D O. et al .
Guidelines for advanced endoscopic training.
Gastrointest Endosc.
2001;
53
846-48
-
4
Van Dam J, Brady P G, Freeman F. et al .
Guidelines for training in endoscopic ultrasound.
Gastrointest Endosc.
1999;
49
829-833
-
5
Eisen G M, Dominitz J A, Faigel D O. et al .
Guidelines for credentialing and granting privileges for endoscopic ultrasound.
Gastrointest Endosc.
2001;
54
679-682
-
6
Fockens P, Van den Brande J H, van Dullemen H M. et al .
Endosonographic T-staging of esophageal carcinoma: a learning curve.
Gastrointest Endosc.
1996;
44
58-62
-
7
Catalano M F, Sivak M V Jr, Bedford R A. et al .
Observer variation and reproducibility of endoscopic ultrasonography.
Gastrointest Endosc.
1995;
41
115-120
-
8
Hoffman B J, Wallace M B, Eloubeidi M A. et al .
How many supervised procedures does it take to become competent in EUS? Results of a multicenter three year study [abstract].
Gastrointest Endosc.
2000;
51
AB139
-
9
Gress F, Schmitt C, Savides T. et al .
Interobserver agreement for EUS in the evaluation and diagnosis of sub-mucosal masses.
Gastrointest Endosc.
2001;
53
71-76
-
10
Conference of United Kingdom Medical Royal College. Joint Advisory Group on Gastrointestinal Endoscopy .
Guidelines for the training, appraisal and assessment of trainees in GI endoscopy, London:.
Joint Advisory Group on Gastrointestinal.
Endoscopy;
2001
11-12
-
11
Meining A, Dittler H J, Wolf A. et al .
You get what you expect? A critical appraisal of imaging methodology in endosonographic cancer staging.
Gut.
2002;
50
599-603
-
12
Sivak M V Jr..
EUS: past, present and the future of endoscopy.
Gastrointest Endosc.
2002;
55
446-448
J. Meenan, M. D.
Dept. of Gastroenterology
St. Thomas's Hospital · London SE1 7EH · United Kingdom ·
Fax: + 44-20-960-5543
Email: john.meenan@gstt.sthames.nhs.uk
