Trial Evaluating Endoscopy Competence Among Gastroenterology Trainees in the Era of the Next Accreditation System.
Condition: Competency in General Endoscopic Surgical Procedures
Study type: Observational

Summary: 
      Hypothesis: ACE (The Assessment in Competency in Endoscopy Tool) tool for colonoscopy and EGD
      (Esophagogastroduodenoscopy) allows for reliable standardized learning curves, competency
      benchmarks, and creation of a centralized database that compares trainee performance amongst
      peers. Trainees receiving quarterly learning curves achieve competence in endoscopic
      procedures at a faster rate (ie less procedures) compared to trainees receiving usual
      feedback on endoscopic performance as established by their respective GI (gastrointestinal)
      fellowship program.

      Aims: To compare the number of procedures necessary to achieve competence in EGD and
      colonoscopy between trainees receiving learning curve performance feedback every three months
      in addition to standard feedback versus trainees receiving annual learning curve performance
      feedback in addition to standard feedback for these endoscopic procedures. To demonstrate the
      feasibility of development and adoption of a centralized database that would allow program
      directors and general GI trainees to generate performance reports in relation to national
      peers to provide real-time targeted performance feedback during training and evaluate trainee
      and GI fellowship program directors predictors of competence.
    

Detailed description: 
      There has been an increasing emphasis on standardizing competency assessment and
      demonstrating readiness for independent practice as medical training transitions from an
      apprenticeship model to competency based medical education (CBME). The Accreditation Council
      for Graduate Medical Education (ACGME) replaced their long-standing reporting system in 2014
      with the Next Accreditation System (NAS). For Gastroenterology (GI) fellowship programs
      (GIFPs), this includes assessing and documenting competence in basic endoscopic procedures
      [esophagogastroduodenoscopy (EGD)] in a continuous fashion. For colonoscopy, the prior
      minimum threshold of 140 procedures after which competence can be assessed was based on
      surrogates of competence such as cecal intubation rate, with limited assessment of technical
      and cognitive skills required to perform high-quality endoscopic examination. Recent data has
      demonstrated wide variability in trainee learning curves, hence emphasis needs to be shifted
      away from the volume of procedures performed to independent performance of well-defined
      metrics. Tools with comprehensive assessment of motor and cognitive abilities have been
      developed. The American Society for Gastrointestinal Endoscopy (ASGE) endorsed the assessment
      of competence in endoscopy tool (ACE) designed to help GIFPs facilitate implementation of the
      NAS requirements. While the ACE tool for EGD has yet to be validated, Sedlack and colleagues
      recently validated the ACE tool in colonoscopy. Multicenter prospective data are needed to
      help guide development of CBME that define learning curves in colonoscopy and EGD and
      generate a centralized database which will allow programs to provide individualized feedback
      and follow trainee performance longitudinally throughout training.
    

Intervention name(s): Quarterly Feedback
Intervention type(s): Other
Intervention description(s): Learning curves received quarterly vs. annually
Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Attendings and trainees in GI Fellowship Program
      
Keywords: esophagogastroduodenoscopy