Quantitative Assessment of Procedural Competence: A Prospective Study of Training in Endoscopic Retrograde Cholangiopancreatography

Jowell, Paul S.; Baillie, John; Branch, Malcolm S.; Affronti, John; Browning, Carrie; Bute, Barbara Phillips

doi:10.7326/0003-4819-125-12-199612150-00009

Cited by 292 publications

(194 citation statements)

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“…Three papers used logistic regression (9;54;56) and two papers used multiple regression (25;58) to adjust for confounding factors before testing for a relationship between experience and operation time. Generalized linear mixed models were used once (30). Multivariate techniques of either type were reported increasingly from 1996.…”

Section: Multivariate (Trend)mentioning

confidence: 99%

ASSESSMENT OF THE LEARNING CURVE IN HEALTH TECHNOLOGIES A Systematic Review

Ramsay

Grant

Wallace

et al. 2000

J. of Inter. Tech. of Health Care

183

135

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Objective: We reviewed and appraised the methods by which the issue of the learning curve has been addressed during health technology assessment in the past. Method: We performed a systematic review of papers in clinical databases (BIOSIS, CINAHL, Cochrane Library, EMBASE, HealthSTAR, MEDLINE, Science Citation Index, and Social Science Citation Index) using the search term "learning curve." Results: The clinical search retrieved 4,571 abstracts for assessment, of which 559 (12%) published articles were eligible for review. Of these, 272 were judged to have formally assessed a learning curve. The procedures assessed were minimal access (51%), other surgical (41%), and diagnostic (8%). The majority of the studies were case series (95%). Some 47% of studies addressed only individual operator performance and 52% addressed institutional performance. The data were collected prospectively in 40%, retrospectively in 26%, and the method was unclear for 31%. The statistical methods used were simple graphs (44%), splitting the data chronologically and performing a t test or chi-squared test (60%), curve fitting (12%), and other model fitting (5%). Conclusions: Learning curves are rarely considered formally in health technology assessment. Where they are, the reporting of the studies and the statistical methods used are weak. As a minimum, reporting of learning should include the number and experience of the operators and a detailed description of data collection. Improved statistical methods would enhance the assessment of health technologies that require learning.

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Section: Multivariate (Trend)mentioning

confidence: 99%

ASSESSMENT OF THE LEARNING CURVE IN HEALTH TECHNOLOGIES A Systematic Review

Ramsay

Grant

Wallace

et al. 2000

J. of Inter. Tech. of Health Care

183

135

View full text Add to dashboard Cite

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“…This knowledge is generally acquired in the context of a multidisciplinary hepatobiliary-pancreatic academic fellowship training program. ERCP requires significant focused training and experience to maximize success and safety (11,37). A study (22) among surgery fellows found that an average of seven months of training in ERCP was required to reach the desired success level (85% cannulation rate).…”

Section: Trainingmentioning

confidence: 99%

ERCP Educational Guidelines for Fellows

Kim¹,

Park²,

Son³

et al. 2017

Korean J Pancreas Biliary Tract

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“…In this study, the minimum performance frequency of more than three per year was endorsed by the expert panel as the best estimate at the time of the study. Although models have been developed to predict the number of practice attempts required by a trainee to achieve clinical competence, 54 and various studies have been undertaken to define this value for specific procedures, 16,[55][56][57][58][59][60][61] the minimum frequency required to attain mastery may be specific to the procedure and to the individual learner. Published ''frequency of performance standards'' for procedural skill mastery or maintenance of competence were not found in the literature.…”

Section: Limitations and Future Questionsmentioning

confidence: 99%

“…The minimum frequency of performing or supervising a procedure to maintain competence was arbitrarily set by the investigators at three or more times per year, as suggested by the expert opinion panel and a review of the literature. 16,[54][55][56][57][58][59][60][61] A decision rule ( Fig. 2) was derived by the investigators as a tool to allow the assignment of each procedural skill to one of four training levels; 1) postgraduate certification (PG), 2) undergraduate certification (UG), 3) a skill where competency to perform was unnecessary but knowledge of the procedure was deemed important (PG knowledge only), or 4) an unnecessary skill with respect to clinical competency or acquisition of skill specific knowledge (unnecessary).…”

Section: -51mentioning

confidence: 99%

Redefining Emergency Medicine Procedures: Canadian Competence and Frequency Survey

Farion

Morrison

2001

Academic Emergency Medicine

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Abstract. Objective: To redefine the Royal College of Physicians and Surgeons (RCPS) procedural skills list for Canadian emergency medicine (EM) residents through a national survey of EM specialists to determine procedural performance frequency and self-assessment of competence. Methods: The survey instrument was developed in three phases: 1) an EM program directors survey identified inappropriate or dated procedures, endorsing 127 skills; 2) a search of EM literature added 98 skills; and 3) an expert panel designed the survey instrument and finalized a list of 150 skills. The survey instrument measured the frequency of procedure performance or supervision, selfreported competence (yes/no), and endorsement of one of four training levels for each skill: undergraduate (UG), postgraduate (PG), knowledge only, or unnecessary (i.e., too infrequently performed to maintain competence). Results: All 289 Canadian EM specialists were surveyed by mail; 231 (80%) responded, 221 completed surveys, and 10 were inactive. More than 60% reported competence in 125 (83%) procedures, and 55 procedures were performed at least three times a year. The mean competence score was 121 (SD Ϯ 17.7, median = 122) procedures. Competence score correlation with patient volume was r = 0.16 (p = 0.02) and with hours worked was r = 0.19 (p = 0.01). Competence score was not associated with year or route (residency vs grandfather) of certification. Each procedure was assigned to a training level using response consensus and decision rules (UG: 1%; PG: 82%; unnecessary: 17%). Conclusions: A survey of EM clinicians reporting competence and frequency of skill performance defined 127 procedural skills appropriate for Canadian RCPS postgraduate training and EM certification.

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Quantitative Assessment of Procedural Competence: A Prospective Study of Training in Endoscopic Retrograde Cholangiopancreatography

Cited by 292 publications

References 0 publications

ASSESSMENT OF THE LEARNING CURVE IN HEALTH TECHNOLOGIES A Systematic Review

ASSESSMENT OF THE LEARNING CURVE IN HEALTH TECHNOLOGIES A Systematic Review

ERCP Educational Guidelines for Fellows

Redefining Emergency Medicine Procedures: Canadian Competence and Frequency Survey

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