MULTICENTER STUDY EVALUATING LEARNING CURVES AND COMPETENCE IN COLORECTAL ENDOSCOPIC MUCOSAL RESECTION (C-EMR) AMONG ADVANCED ENDOSCOPY TRAINEES USING AN EMR STANDARDIZED ASSESSMENT TOOL (EMR-STAT): INTERIM ANALYSIS

Background: There is a lack of data on training benchmarks to define competence in colorectal EMR (C-EMR) among advanced endoscopy trainees (AETs). Previous pilot data from our group demonstrated a relatively low proportion of AETs achieve competence on key cognitive and technical aspects of C-EMR. We aimed to perform an interim analysis on C-EMR training among AETs and assess their performance using the EMR-STAT during the first trimester of their advanced endoscopy fellowship (AEF).
Methods: Prospective multicenter study evaluating AETs C-EMR training using the EMR-STAT. The tool was previously validated in the pilot study for standardized evaluation of key cognitive and technical C-EMR skills (Figure 1). A 4-point scoring system was used to grade these endpoints. Global rating was provided using a 10-point scoring system. For interim analysis, competence was defined as a score of 3 or 4 for each endpoint and ≥7 for overall assessment. Cumulative sum analysis was used to establish competence for cognitive and technical components of C-EMR and overall performance. Prior to the study, participating AETs completed questionnaire about their GI fellowship training in endoscopic resection.
Results: Twenty-five AETs from 18 institutions are enrolled in this ongoing study. On survey questionnaire, the AETs reported having performed a mean of 41.4 C-EMRs (interquartile range [IQR]: 10-50) before the onset of their AEF and most received cognitive training in C-EMR during their general GI fellowship (n=20; 80%). In the first trimester of their AEF, out of the 25 AETs, 15 have performed a mean of 9.1 C-EMRs (range 1-30). Mean lesion size was 26.7±11.6 and mean EMR time of 26.1±18.1 minutes. En-bloc resection rate for polyp sizes 11-20 mm was 41.3% (19/46). Competence in cognitive skills, such as assessment of polyp morphology and pit/vascular pattern, was achieved by AETs in 90.4% and 83.1%, respectively. AETs were graded as competent in submucosal lift injection and snare resection in 69.9% and 63.2%, respectively. Overall competence based on the global score was attained in 53.7% of the cases. On cumulative sum analysis, only 2 AETs crossed the competence threshold for cognitive skills and 1 AET for technical skills. The minimum threshold to achieve competence was 18 C-EMRs (Figure 2).
Conclusions: Standardized evaluation of competence in C-EMR training is critical for quality assurance in patient care. There was high variability in the number of C-EMRs performed by AETs and low overall en-bloc resection rates for polyps 11-20 mm in size. In aggregate, AETs were graded as competent in only half of the C-EMR cases and only 2 AETs have crossed the minimum threshold of competence. Ongoing data acquisition from this study will provide insight into the current state of C-EMR training during AEF and establish competence thresholds for quality metrics.