A novel and effective EUS training program that enables visualization of the learning curve: Educational Program of Kindai system (EPOK)

Post written by Mamoru Takenaka, MD, PhD, and Shunsuke Omoto, MD, PhD, both from the Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-sayama, Japan.


This video shows a novel and effective EUS training program that enables the visualization of the learning curve of a trainee in every training session through the evaluation of whether a typical EUS image could be identified and how it was identified. This program was designed to screen for biliopancreatic organs and does not include measures for mediastinal screening.

This program, Educational Program of Kindai (EPOK), is a unique systematic screening protocol with a scoring system. EPOK uses 20 typical EUS images that represent anatomical landmarks: 11 from the stomach, 7 from the duodenum bulb, and 2 from the duodenum second portion.


Score sheets were used to calculate the total score for each examination a trainee performed. By regularly plotting a graph of the individual’s total scores, the learning curve of the trainee can be visualized, and the motivation to aim for a perfect score can be generated.

The left section of the score sheet shows the protocol number and the observation site (eg, No. 1–11 are for stomach observation), and the right section shows the trainee’s score for each part. If the trainee could detect the image without instruction, the score was 2, but if the trainee could detect the image after receiving instruction, the score was 1.

If the trainee could not detect the image even with instruction, the score was 0. If the trainee detected all 20 images without instruction, 40 points were awarded. In EPOK, proficiency in EUS screening was defined as achieving a perfect score (40 points) in 3 separate examinations.

The trainer provides feedback after each test, recording it in the notes section of the score sheet. The feedback indicates to the trainee “what to watch out for” and “what to fix” in the next examination. The trainee is required to review the reasons for low scores (0/1) and prepare for the next examination.

Endoscopic education is a very important topic and a common concern in all countries. This article was submitted because we thought this system for visualizing endoscopic procedures would be useful for endoscopists in all countries. In education regarding endoscopy, it is important to evaluate the learning curve not only for the trainee but also for the trainer.

This system, although useful, would not be possible without the trainer’s enthusiasm for education. Ultimately, the “love” for the trainee plays the most important role in education.

Takenaka_Omoto_figureEducational Program of Kindai system of EUS. During each EUS examination, the trainer (B) issued only verbal instructions to the trainee (A) and scored the trainee according to the score sheet.

Read the full article online.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.

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