Learning Curve Analyses for Achieving Satisfactory Procedural Completion Rates in Paediatric Oesophagogastroduodenoscopy. Issue 3 (March 2020)

• Record Type: Journal Article
• Authors: Barraclough, Harriet; Siau, Keith; Ward, Stephen T.; Dunckley, Paul; Hawkes, Neil; Thomson, Mike; Narula, Priya
• Is Part Of: Journal of pediatric gastroenterology and nutrition. Volume 70:Issue 3(2020)
• Publication Date: 2020-03
• Subjects: competency -- learning curve -- oesophagogastroduodenoscopy -- paediatric endoscopy -- training; Children -- Nutrition -- Periodicals; Pediatric gastroenterology -- Periodicals; Infants -- Nutrition -- Periodicals; Nutrition disorders in children -- Periodicals; Child Nutrition -- Periodicals; Digestive System -- growth & development -- Periodicals; Gastrointestinal Diseases -- Periodicals; Infant Nutrition -- Periodicals; Nutrition Disorders -- Periodicals; Child; 618.923
• DOI: 10.1097/MPG.0000000000002460
• Languages: English
• ISSNs: 0277-2116

Abstract

ABSTRACT: Background: The learning curve in paediatric oesophagogastroduodenoscopy (OGD) is unknown. Using ≥95% D2 (second part of the duodenum) intubation rates as a marker of technical competency, we conducted learning curve analyses to identify when trainees achieve competency in paediatric OGD. Factors associated with competency were also evaluated. Methods: This nationwide study analysed data from paediatric OGD procedures prospectively entered into the UK endoscopy training e-portfolio between 2014 and 2018. Moving average and learning curve cumulative summation analyses were performed to determine procedural numbers required to achieve ≥95% D2 intubation rates. Factors associated with D2 intubation were assessed using a multivariable binary logistic regression approach. Results: A total of 8929 procedures performed by 61 trainees were identified. These 61 trainees had recorded a mean of 124.6 procedures (range 22–571, interquartile range 165). By moving average analysis, 95% D2 intubation was achieved after 79 procedures. By learning curve cumulative summation analysis, 81.6% of trainees were competent after 100 procedures. Multivariable factors associated with unassisted procedural completion included: lifetime procedure count ( P < 0.001), higher trainee seniority ( P < 0.001), patient age ( P = 0.002), outpatient status ( P < 0.001), and attendance at a national Basic Skills OGD course ( P = 0.011). Conclusions: This study demonstrates that, on average, 79 procedures in paediatric OGD are required to attain the competency outcome of ≥95% D2 intubation rates. By 100 procedures, 81.6% of our sample had achieved ≥95% D2 intubation. The minimum procedural count of 100 set by the UK and international training programmes can be used alongside existing objective assessment measures to safeguard competency within a training cohort.