Sa1463 Measuring EUS Skill Development Among GI Fellows With a Novel Assessment Tool

Measuring EUS Skill Development Among GI Fellows With a Novel Assessment Tool Kalpesh K. Patel, Brijen Shah, Sunil Amin, Jenny Woo, Jonathan M. Buscaglia, Christopher J. DiMaio, Sammy Ho, Reza Y. Akhtar, Divyesh V. Sejpal, Sharmila Anandasabapathy, Satish Nagula, Michelle K. Kim Gastroenterology, Mount Sinai School of Medicine, New York, NY; Gastroenterology, Stony Brook University Medical Center, Stony Brook, NY; Gastroenterology, Memorial SloanKettering Cancer Center, New York, NY; Gastroenterology, Montefiore Medical Center, Bronx, NY Background: Endoscopic Ultrasound (EUS) is an advanced endoscopic procedure, requiring skills which can be challenging to learn. Previous studies have defined numbers of procedures needed to become competent, but have not evaluated the process by which GI fellows acquire specific skills to perform a high-quality exam and systematically identify anatomical landmarks. Aim: To assess acquisition of EUS skills and measure competency with a novel assessment tool. Methods: This was a multi-centered, prospective study with participation from EUS attendings and fellows in four academic hospitals from July to November 2010. The majority of EUS attendings had performed between 500-1000 procedures. We assessed EUS skills with a questionnaire which was completed by both the attending and fellow following each procedure. This questionnaire assessed the fellows’ competence in two domains: previously established EUS quality indicators and anatomical landmarks. Skills were ranked on a 5 point scale (1 observation, minimal competence, 5 independent exam, maximal competence). Competence was defined by a score of 4 or greater for each skill. Results: 7 EUS attendings and 6 GI fellows participated in this study. 107 matched assessments were available for review. The most frequent indications for EUS were pancreatic pathology (53.4%) and subepithelial lesions (15.9%). Mean skill scores for EUS quality indicators for subepithelial, esophageal, and pancreatic lesions were 3.23, 2.73, 2.73 (p 0.05). With respect to anatomy, fellows demonstrated similar skills in identifying mediastinal and pancreatic landmarks (2.366 vs 2.544, p 0.05). Fellows achieved lower skill scores in the transduodenal pancreatic exam (uncinate/head 2.42) as compared to the transgastric pancreatic exam (body/tail 3.10) (p 0.01). Finally, overall competency (demonstration of quality indicators and anatomical landmarks) was similar for use of both radial and linear echoendoscopes (2.48 vs. 2.75, p 0.05). Conclusions: Continuous assessment of skills acquisition during EUS training is feasible and offers useful information for individualized learning plans. Regardless of site of lesion, no significant differences were found in skill acquisition of quality indicators or accurate demonstration of anatomical landmarks. Fellows achieved higher skill scores on pancreatic transgastric landmarks as compared to transduodenal landmarks, confirming that the transduodenal exam and especially the head of the pancreas and uncinate process are the most difficult regions to learn to examine. We hope that with future data collection, we will gain more insight into the achievement of competence in EUS.