BACKGROUND AND AIMS Minimum EUS and ERCP volumes that should be offered per trainee in "high quality" advanced endoscopy training programs (AETPs) are not established. We aimed to define the number of procedures required by an "average" advanced endoscopy trainee (AET) to achieve competence in technical and cognitive EUS and ERCP tasks to help structure AETPs. METHODS American Society for Gastrointestinal Endoscopy (ASGE)-recognized AETPs were invited to participate; AETs were graded on every fifth EUS and ERCP examination using a validated tool. Grading for each skill was done using a 4-point scoring system, and learning curves using cumulative sum analysis for overall, technical, and cognitive components of EUS and ERCP were shared with AETs and trainers quarterly. Generalized linear mixed-effects models with a random intercept for each AET were used to generate aggregate learning curves, allowing us to use data from all AETs to estimate the average learning experience for trainees. RESULTS Among 62 invited AETPs, 37 AETs from 32 AETPs participated. Most AETs reported hands-on EUS (52%, median 20 cases) and ERCP (68%, median 50 cases) experience before starting an AETP. The median number of EUS and ERCPs performed per AET was 400 (range, 200-750) and 361 (range, 250-650), respectively. Overall, 2616 examinations were graded (EUS, 1277; ERCP-biliary, 1143; pancreatic, 196). Most graded EUS examinations were performed for pancreatobiliary indications (69.9%) and ERCP examinations for ASGE biliary grade of difficulty 1 (72.1%). The average AET achieved competence in core EUS and ERCP skills at approximately 225 and 250 cases, respectively. However, overall technical competence was achieved for grade 2 ERCP at about 300 cases. CONCLUSION The thresholds provided for an average AET to achieve competence in EUS and ERCP may be used by the ASGE and AETPs in establishing the minimal standards for case volume exposure for AETs during their training. (Clinical trial registration number: NCT02509416.).

中文翻译：

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设置EUS和ERCP培训的最低标准：一项前瞻性多中心研究的结果，该研究评估了高级内窥镜培训学员的学习曲线和能力。

背景和目的未确定应在“高质量”高级内窥镜训练计划（AETP）中为每个受训者提供的最小EUS和ERCP量。我们旨在定义“平均水平”的高级内窥镜实习生（AET）所需的程序数量，以实现技术和认知EUS和ERCP任务的能力，以帮助构建AETP。方法美国胃肠内窥镜学会（ASGE）认可的AETP被邀请参加。使用经过验证的工具，每进行五次EUS和ERCP检查，就对AET进行评分。每项技能的评分均使用4分评分系统进行，并且每季度与AET和培训师共享EUS和ERCP的总体，技术和认知成分的累积曲线分析所使用的学习曲线。每个AET具有随机截距的广义线性混合效应模型用于生成汇总学习曲线，使我们能够使用来自所有AET的数据来估计受训人员的平均学习经验。结果在62个受邀的AETP中，来自32个AETP的37个AET参加了会议。多数AETs报告在开始AETP之前有动手EUS（52％，中位数20例）和ERCP（68％，中位数50例）的经验。每个AET执行的EUS和ERCP的中位数分别为400（范围200-750）和361（范围250-650）。总体上，对2616项检查进行了评分（EUS，1277； ERCP-胆管，1143；胰腺，196）。大部分分级的EUS检查是针对胰腺胆管疾病的（69.9％），而ERCP检查是针对ASGE胆管疾病的难度为1级的（72.1％）。平均AET在EUS和ERCP核心技能方面的能力分别约为225和250例。但是，大约有300例2级ERCP达到了总体技术能力。结论ASGE和AETP可以使用平均AET达到在EUS和ERCP中的能力所需要的阈值来建立AET培训期间病例数量暴露的最低标准。（临床试验注册号：NCT02509416。）。