When Trainees Reach Competency in Performing EUS: A Systematic Review

Abstract

Introduction: National guidelines currently advocate for the completion of 150 endoscopic ultrasound (EUS) procedures prior to assessing trainee competency. However, these recommendations were founded on expert opinion and limited evidence. In the era of competency-based medical education new evidence has emerged suggesting that this historical procedural threshold is underestimating training requirements. Therefore, we systematically evaluated the learning curve for achieving competency in EUS. Methods: Two authors independently searched MEDLINE from 1946 to March 25, 2016 as well as the grey literature for full-text citations assessing the learning curve for EUS competency. A learning curve was defined as either a tabulated or graphic depiction of competency as a function of rising EUS experience with a minimum of two data points along the learning curve being required. Results: In total 8 studies warranted inclusion, which assessed 28 trainees and 7051 EUS procedures. Upon study stratification: 3 studies assessed mucosal lesion evaluation, 3 studies assessed EUS fine needle aspiration (EUS-FNA) and 2 studies assessed comprehensive competency. Concerning the 3 studies, which assessed mucosal lesion T-staging accuracy, competency was achieved by 65 to 231 EUS procedures. Concerning the 3 studies, which assessed EUS-FNA, competency was achieved by 30 to 40 EUS procedures. Of the 2 studies, which assessed comprehensive competency, only 4 of 17 trainees achieved competency by 225 to 295 EUS procedures. Conclusion: As competency assessment in EUS has matured to now use comprehensive competency, which more closely reflects clinical practice, the number of EUS procedures required to obtain competency has surpassed current recommendations. Therefore, specialty societies and advanced endoscopy training programs need to revisit the current structure of EUS training.