Effect of individualized feedback on learning curves in EGD and colonoscopy: a cluster randomized controlled trial

Gastroenterology fellowships need to ensure that trainees achieve competence in upper endoscopy (EGD) and colonoscopy. Because the impact of structured feedback remains unknown in endoscopy training, this study compared the effect of structured feedback with standard feedback on trainee learning cur...

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Published in:	Gastrointestinal endoscopy Vol. 91; no. 4; pp. 882 - 893.e4
Main Authors:	Han, Samuel, Obuch, Joshua C., Keswani, Rajesh N., Hall, Matt, Patel, Swati G., Menard-Katcher, Paul, Simon, Violette, Ezekwe, Eze, Aagaard, Eva, Ahmad, Asyia, Alghamdi, Saad, Austin, Kerri, Brimhall, Bryan, Broy, Charles, Carlin, Linda, Cooley, Matthew, Di Palma, Jack A., Duloy, Anna M., Early, Dayna S., Ellert, Swan, Gaumnitz, Eric A., Goyal, Jatinder, Kathpalia, Priya, Day, Lukejohn, El-Nachef, Najwa, Kerman, David, Lee, Robert H., Lunsford, Tisha, Mittal, Mohit, Morigeau, Kirsten, Pietrak, Stanley, Piper, Michael, Shah, Anand S., Shapiro, Alan B., Shergill, Amandeep, Sonnier, William, Sorrell, Cari, Vignesh, Shivakumar, Wani, Sachin
Format:	Journal Article
Language:	English
Published:	United States Elsevier Inc 01-04-2020
Subjects:	Clinical Competence Colonoscopy Feedback Gastroenterology - education Humans Learning Curve CUSUM NAS ACE ACGME
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Summary:	Gastroenterology fellowships need to ensure that trainees achieve competence in upper endoscopy (EGD) and colonoscopy. Because the impact of structured feedback remains unknown in endoscopy training, this study compared the effect of structured feedback with standard feedback on trainee learning curves for EGD and colonoscopy. In this multicenter, cluster, randomized controlled trial, trainees received either individualized quarterly learning curves or feedback standard to their fellowship. Assessment was performed in all trainees using the Assessment of Competency in Endoscopy tool on 5 consecutive procedures after every 25 EGDs and colonoscopies. Individual learning curves were created using cumulative sum (CUSUM) analysis. The primary outcome was the mean CUSUM score in overall technical and overall cognitive skills. In all, 13 programs including 132 trainees participated. The intervention arm (6 programs, 51 trainees) contributed 558 EGD and 600 colonoscopy assessments. The control arm (7 programs, 81 trainees) provided 305 EGD and 468 colonoscopy assessments. For EGD, the intervention arm (–.7 [standard deviation {SD}, 1.3]) had a superior mean CUSUM score in overall cognitive skills compared with the control arm (1.6 [SD, .8], P = .03) but not in overall technical skills (intervention, –.26 [SD, 1.4]; control, 1.76 [SD, .7]; P = .06). For colonoscopy, no differences were found between the 2 arms in overall cognitive skills (intervention, –.7 [SD, 1.3]; control, .7 [SD, 1.3]; P = .95) or overall technical skills (intervention, .1 [SD, 1.5]; control, –.1 [SD, 1.5]; P = .77). Quarterly feedback in the form of individualized learning curves did not affect learning curves for EGD and colonoscopy in a clinically meaningful manner. (Clinical trial registration number: NCT02891304.) [Display omitted]
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-News-2 ObjectType-Feature-3 content type line 23
ISSN:	0016-5107 1097-6779
DOI:	10.1016/j.gie.2019.10.032