Wani S, Cote GA, Keswani RN, Yadlapati RH, Hall M, O'Hara J, Berzin TM, Burbridge RA, Chahal P, Cohen J, Coyle WJ, Early D, Guda NM, Inamdar S, Khanna L, Kulkarni A, Rosenkranz L, Sharma N, Shin EJ, Siddiqui UD, Sinha J, Vanderveldt H, and Draganov PV
Background and Aims: Training in interventional endoscopy is offered by nonaccredited advanced endoscopy fellowship programs (AEFPs). The number of these programs has increased dramatically with a concurrent increase in the breadth and complexity of interventional endoscopy procedures. Accreditation is governed by competency-based education, yet what constitutes a "high-quality" nonaccredited AEFP has not been defined. Using an evidence-based consensus process, we aimed to establish standards for AEFPs., Methods: The RAND UCLA appropriateness method, a well-described modified Delphi process to develop quality indicators, was used. A task force established by the American Society for Gastrointestinal Endoscopy drafted potential quality indicators (structure, process, and outcome) in 6 categories: activity preceding training; structure of AEFPs; training in ERCP, EUS, and EMR; and luminal stent placement. Three rounds of iterative feedback from 20 experts were conducted. Round 0 involved discussion of project details. In round 1, experts independently ranked proposed quality indicators on a 9-point interval scale ranging from highly inappropriate (1) to highly appropriate (9). Next, proposed quality indicators were discussed and reworded in a group meeting followed by round 2, in which experts independently reranked proposed quality indicators and provided benchmarks (when applicable). The median score for each quality indicator was calculated. Mean absolute deviation from the median was calculated, and appropriateness of potential quality indicators was assessed using the BIOMED concerted action on appropriateness definition, P value method, and interpercentile range adjusted for symmetry definition. A quality indicator was deemed appropriate if the median score was ≥7 and met criteria for appropriateness using all 3 defined statistical methods., Results: Of 89 proposed quality indicators, 37 statements met criteria as appropriate for a quality indicator (activity preceding training, 2; structure of AEFPs, 10; training in ERCP, 7; training in EUS, 8; training in EMR, 7; luminal stent placement, 3). Minimum thresholds were defined for 19 relevant quality indicators for number of trainers, procedures during fellowship, and procedures before assessment of competence. Among the final appropriate quality indicators were that all trainees should undergo qualitative and quantitative competence assessments using validated tools at least quarterly with documented feedback throughout the training period and that trainees should track outcomes and relevant quality metrics for specific procedures., Conclusions: This consensus process using validated methodology established standards for an AEFP in an effort to ensure adequate training in the most commonly taught interventional endoscopic procedures (ERCP, EUS, EMR, and luminal stent placement) during fellowship. An important component of an AEFP is the use of competency-based assessments that are compliant with the Accreditation Council for Graduate Medical Education's Next Accreditation System, with the goal of ensuring that trainees achieve specific milestones in their progression to achieving cognitive and technical competency., Competing Interests: Disclosure The following authors disclosed financial relationships: G. A. Cote: Consultant for Interpace Diagnostics and Olympus Corporation; research support from Abbvie Pharmaceuticals. R. N. Keswani: Consultant for Medtronic and Boston Scientific. R. H. Yadlapati: Consultant for Medtronic, Phathom Pharmaceuticals, and StatLinkMD; research support from Ironwood Pharmaceuticals; advisory board with stock options in RJS Mediagnostix. T. M. Berzin: Consultant for Medtronic, Boston Scientific, Wision AI, Magentiq Eye, and RSIP Vision. P. Chahal: Consultant for Boston Scientific and Medtronic. J. Cohen: Consultant for Olympus America and Micro-Tech; stock owner in GI Windows, Virtual Health Partners, and Rom-Tech; owner of MD Medical Navigators. W. J. Coyle: Speaker for Abbvie, Pharm and Regeneron, and Pharm D. Early: Scientific advisory board for Guardant Health. N. M. Guda: Consultant for Boston Scientific and Hemostasis Inc LLC; speaker for Lupin Pharmaceuticals, India. S. Inamdar: Consultant for Pentax Medical. E. J. Shin: Consultant for Boston Scientific. U. D. Siddiqui: Consultant and speaker for Olympus, Boston Scientific, ConMed, Medtronic, and Cook Medical; research support from Olympus and Boston Scientific. All other authors disclosed no financial relationships., (Copyright © 2024 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.)