Post written by Dennis Yang, MD, from the Division of Gastroenterology and Hepatology, University of Florida, Gainesville, Florida, USA.

The aim of this multicenter prospective pilot study was to evaluate colorectal endoscopic mucosal resection (EMR) training among advanced endoscopy fellows using a novel assessment tool. Despite the broad application of colorectal EMR, markers of training competency are lacking. With an increasing focus on outcomes-based education, there is a need to develop and use instruments designed to evaluate procedure-specific core skills.

This pilot study used a novel colorectal EMR assessment tool to evaluate the performance of 6 advanced endoscopy trainees at 6 centers. Learning curve analysis revealed that less than half of the trainees achieved competence for key cognitive and technical aspects of colorectal EMR; yet, all of them reported feeling comfortable performing colorectal EMR independently at the end of training. The minimum threshold to achieve overall competence was estimated at 25 cases.

The preliminary data from this pilot study suggests that a relatively low proportion of trainees achieved competence on key cognitive and technical aspects of colorectal EMR during their 12-month advanced endoscopy fellowship. Our initial findings serve as an initial framework for competence thresholds and indicates the need of future large well-designed studies using validated standardized assessment tools to evaluate the performance of colorectal EMR among trainees.

Figure 1. Representation of how a cumulative sum (CUSUM) analysis is used to evaluate learning curves in endoscopic training. This statistical method permits continuous assessment of performance against a predetermined standard to detect training trends. During training, if the CUSUM curve (red arrow line) crosses the upper decision limit (unacceptable threshold) from below, the failure rates have reached preset unacceptable rates, indicating the need for further training. Competency is defined when the CUSUM curve (blue arrow line) crosses the lower decision limit (competence threshold) from above. If the CUSUM curve remains between the 2 decision limits (yellow arrow line), then ongoing observation is indicated.

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