DEVELOPMENT OF AMERICAN SOCIETY FOR GASTROINTESTINAL ENDOSCOPY (ASGE) MINIMUM STANDARDS FOR TRAINING IN INTERVENTIONAL ENDOSCOPY WITHIN DEDICATED INTERVENTIONAL ENDOSCOPY FELLOWSHIP PROGRAMS

INTRODUCTION:
Training in interventional endoscopy is offered by interventional endoscopy fellowship programs (IEFPs) not accredited by the ACGME. The number of these programs has increased exponentially with a concurrent increase in the breadth and complexity of these procedures. ACGME-accredited fellowships are governed by competency-based education, yet what constitutes a “high-quality” non-accredited IEFP has not been defined. Using an evidence-based consensus process, we aimed to establish minimum standards for IEFPs.

METHODS:
The RAND UCLA Appropriateness Method, a modified Delphi process to develop quality indicators (QIs), was utilized. A task force drafted potential QIs (structure, process and outcome) in 6 categories: a) activity preceding training, b) structure of IEFPs, c) training in ERCP, d) EUS, e) endoscopic mucosal resection (EMR) and f) luminal stenting. Three rounds of iterative feedback from 20 experts were conducted. Round 0 involved discussion of project details. In Round 1 experts independently ranked proposed QIs on a 9-point scale ranging from highly inappropriate (1) to highly appropriate (9). Next, proposed QIs were discussed and re-worded in a group meeting followed by Round 2 in which experts independently re-ranked proposed QIs and provided benchmarks (when applicable). The median score for each QI was calculated. Mean absolute deviation from the median was calculated and appropriateness of potential QIs was assessed using: (i) BIOMED Concerted Action on Appropriateness definition, (ii) P-value method and (iii) inter-percentile range adjusted for symmetry definition. A QI was deemed appropriate if median score was ≥7 and met criteria for appropriateness using all 3 defined statistical methods.

RESULTS:
Of 89 proposed QIs, 37 met criteria as appropriate for a QI (activity preceding training, 2; structure of IEFPs, 10; ERCP, 7; EUS, 8; EMR, 7; luminal stenting, 3) (Tables 1 & 2). Minimum thresholds were defined for 19 relevant QIs for number of trainers, procedures during fellowship and procedures prior to assessment of competence. Among the final appropriate QIs 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.

CONCLUSION:
This ASGE-led initiative established minimum standards for training in interventional endoscopy. These may be assessed by all stakeholders and would ensure adequate training in interventional endoscopic procedures (ERCP, EUS, EMR, luminal stenting) during fellowship. This would also facilitate compliance with the ACGME/Next Accreditation System requirements of ensuring that trainees reach specific milestones in their progression to achieving cognitive and technical competency.