Content area
Full text
Significance of this study What is already known on this subject?
The oesophago-gastro-duodenoscopy (OGD) completion rate of 95% is a key indicator of competency and an accepted quality indicator.
The number of OGDs required to achieve competency is not well established and there is a paucity of published data on OGD learning curves.
OGD training programmes around the world use the total number of OGDs performed as part of competency criteria. The number required in the UK is 200.
What are the new findings?
Our study interrogated the Joint Advisory Group (JAG) e-portfolio, which includes data from all training centres in the UK. This provided a unique opportunity to analyse OGD data submitted by 1255 trainees in the early stages of their training.
Two statistical methods were used to analyse the OGD learning curve. By moving average method, trainees attained an average 95% completion rate at 187 procedures. By learning curve cumulative summation (LC-Cusum) analysis, after 200 procedures, >90% trainees had attained a 95% completion rate.
OGD completion was associated with the total number of OGDs performed, trainee age and with lower GI endoscopy experience. In terms of patient factors, female gender, younger age and absence of sedation were associated with completion.
How might it impact on clinical practice in the foreseeable future?
Our study lends statistical support to the current UK and Australian requirement for 200 procedures.
Defining the OGD learning curve allows trainees to benchmark their progress against a UK national average.
LC-Cusum charts provide real-time feedback on individual learning curves. This information will be useful to trainees, trainers and training bodies.
Introduction
It is incumbent on endoscopy training programmes to assess the competency of trainees. Markers of technical competency in upper GI endoscopy (oesophago-gastro-duodenoscopy, OGD) include completion of procedures without physical assistance, successful J-manoeuvres and satisfactory scores in direct observation of procedural skills (DOPS) assessments.
In the UK, the Joint Advisory Group on GI endoscopy (JAG) require trainees to intubate the second part of the duodenum (D2) and perform a J-manoeuvre at least 95% of the time. 1 It is accepted that not all OGDs can be completed to D2 due to patient intolerance, stricture or previous gastric surgery. 2 3 Nevertheless, successful completion of OGDs is a prerequisite for competency. In...