SNFGE SNFGE
 
Thématique :
- Endoscopie/Imagerie
Originalité :
Très original
Solidité :
Très solide
Doit faire évoluer notre pratique :
Pas encore
 
 
Nom du veilleur :
Professeur Emmanuel CORON
Coup de coeur :
 
 
Gut
  2017/06  
 
  2017 Jun;66(6):1022-1033  
  doi: 10.1136/gutjnl-2015-310443.  
 
  The learning curve to achieve satisfactory completion rates in upper GI endoscopy: an analysis of a national training database  
 
  Ward ST, Hancox A, Mohammed MA, Ismail T, Griffiths EA, Valori R, Dunckley P  
  https://www.ncbi.nlm.nih.gov/pubmed/26976733  
 
 

Abstract

OBJECTIVE:

The aim of this study was to determine the number of OGDs (oesophago-gastro-duodenoscopies) trainees need to perform to acquire competency in terms of successful unassisted completion to the second part of the duodenum 95% of the time.

DESIGN:

OGD data were retrieved from the trainee e-portfolio developed by the Joint Advisory Group on GI Endoscopy (JAG) in the UK. All trainees were included unless they were known to have a baseline experience of >20 procedures or had submitted data for <20 procedures. The primary outcome measure was OGD completion, defined as passage of the endoscope to the second part of the duodenum without physical assistance. The number of OGDs required to achieve a 95% completion rate was calculated by the moving average method and learning curve cumulative summation (LC-Cusum) analysis. To determine which factors were independently associated with OGD completion, a mixed effects logistic regression model was constructed with OGD completion as the outcome variable.

RESULTS:

Data were analysed for 1255 trainees over 288 centres, representing 243 555 OGDs. By moving average method, trainees attained a 95% completion rate at 187 procedures. By LC-Cusum analysis, after 200 procedures, >90% trainees had attained a 95% completion rate. Total number of OGDs performed, trainee age and experience in lower GI endoscopy were factors independently associated with OGD completion.

CONCLUSIONS:

There are limited published data on the OGD learning curve. This is the largest study to date analysing the learning curve for competency acquisition. The JAG competency requirement for 200 procedures appears appropriate.

 
Question posée
 
Quelle est la courbe d’apprentissage de l’endoscopie oesogastroduodénale ?
 
Question posée
 
A partir de la modélisation des données obtenues via le portofolio électronique de 1255 internes anglais travaillant dans 288 centres, cette étude montre qu’un seuil de 187 procédures est nécessaire pour atteindre le 2ème duodénum dans plus de 95% des cas.
 
Commentaires

Aucune donnée de ce type en France, où il serait intéressant de mener ce type d’analyse et surtout d'évaluer l’effet potentiel des simulateurs pour raccourcir la courbe d’apprentissage. 

 
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