Outcome of training in diagnostic and therapeutic ERCP: A prospective multicenter study

GI fellows acquire a varying amount of ERCP experience during their training. AIM: To describe the outcome of training in diagnostic and therapeutic ERCP in GI fellowship training programs. METHODS; From 1994-1996,16 attendings skilled in ERCP prospectively evaluated GI trainees from 7 university medical centers. Each regular trainee (REG) was allowed at least 20 minutes before the advanced fellow (ADV) or proctor took over. Using pretested objective standardized scales, skills for each component of diagnostic ERCP and each therapeutic manuever were graded immediately after each ERCP. Cognitive and technical ERCP skills were also globally evaluated at conclusion of the training period. RESULTS: 43% of trainees were interested in private practice careers. 94% of trainees were interested in learning ERCP. Trainees participated in a mean of 84% (57-100%) of 2562 ERCPs. 6 ADV and 32 REG trainees completed a mean of 250 (range 103-526) and 57 (range 19-212) ERCPs, respectively, (p=.0003) during their training. REG trainees were much less likely than ADV fellows to attain the ASGE minimum threshold (MIN) of 75 diagnostic ERCPs (25% vs. 100%, p=.001), regardless of center (p=.06). ADV trainee CBD and PD cannulation rates were significantly higher than for REG trainees who reached MIN;ie. 58% vs 82%(p=.001) and 74% vs 87%(p=.01), respectively. Mean CBD (p=.42) and PD (p=.24) cannulation times for ADV and REG trainees were not significantly different. All ADV trainees achieved cognitive and technical competency in diagnostic and therapeutic ERCP. In contrast, only 62% and 59% of REG trainees acquired cognitive competency in diagnostic and therapeutic ERCP, respectively. Only 62%, 3%, and 6% of REG trainees who acquired experience in therapeutic ERCP at centers without ADV programs achieved competency in biliary, pancreatic and precut/needle knife sphincterotomy. Only 38% of REG trainees were competent in biliary plastic stem placement;none were competent in biliary metal and pancreatic stent placement. CONCLUSIONS: Diagnostic and therapeutic ERCP experience varies markedly across university-based GI training programs. Although interest in learning ERCP is high, a minority of REG fellows trained in ERCP eventually attain technical competence at the end of fellowship. Minimum thresholds for evaluating competence in diagnostic and therapeutic ERCP should be reevaluated.