Kelli DeLay1, John E Pandolfino2, C Prakash Gyawali3, Jeanetta Frye4, Alexander Kaizer1, Paul Menard-Katcher1, Joshua A Sloan5, Andrew J Gawron6, Kathryn Peterson6, Dustin A Carlson2, Abraham Khan7, Rajesh N Keswani2, Rena Yadlapati1,8. 1. Digestive Health Center, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA. 2. Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA. 3. Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri, USA. 4. Division of Gastroenterology, University of Virginia, Charlottesville, Virginia, USA. 5. Division of Gastroenterology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. 6. Division of Gastroenterology, University of Utah, Salt Lake City, Utah, USA. 7. Center for Esophageal Disease, New York University School of Medicine, New York, New York, USA. 8. UCSD Center for Esophageal Diseases, Division of Gastroenterology, University of California San Diego, San Diego, California, USA.
Abstract
INTRODUCTION: Competency-based medical education (CBME) for interpretation of esophageal manometry is lacking; therefore, motility experts and instructional designers developed the esophageal manometry competency (EMC) program: a personalized, adaptive learning program for interpretation of esophageal manometry. The aim of this study was to implement EMC among Gastroenterology (GI) trainees and assess the impact of EMC on competency in manometry interpretation. METHODS: GI fellows across 14 fellowship programs were invited to complete EMC from February 2018 to October 2018. EMC includes an introductory video, baseline assessment of manometry interpretation, individualized learning pathways, and final assessment of manometry interpretation. The primary outcome was competency for interpretation in 7 individual skill sets. RESULTS: Forty-four GI trainees completed EMC. Participants completed 30 cases, each including 7 skill sets. At baseline, 4 (9%) participants achieved competency for all 7 skills compared with 24 (55%) at final assessment (P < 0.001). Competency in individual skills increased from a median of 4 skills at baseline to 7 at final assessment (P < 0.001). The greatest increase in skill competency was for diagnosis (Baseline: 11% vs Final: 68%; P < 0.001). Accuracy improved for distinguishing between 5 diagnostic groups and was highest for the Outflow obstructive motility disorder (Baseline: 49% vs Final: 76%; P < 0.001) and Normal motor function (50% vs 80%; P < 0.001). DISCUSSION: This prospective multicenter implementation study highlights that an adaptive web-based training platform is an effective tool to promote CBME. EMC completion was associated with significant improvement in identifying clinically relevant diagnoses, providing a model for integrating CBME into subspecialized areas of training.
INTRODUCTION: Competency-based medical education (CBME) for interpretation of esophageal manometry is lacking; therefore, motility experts and instructional designers developed the esophageal manometry competency (EMC) program: a personalized, adaptive learning program for interpretation of esophageal manometry. The aim of this study was to implement EMC among Gastroenterology (GI) trainees and assess the impact of EMC on competency in manometry interpretation. METHODS: GI fellows across 14 fellowship programs were invited to complete EMC from February 2018 to October 2018. EMC includes an introductory video, baseline assessment of manometry interpretation, individualized learning pathways, and final assessment of manometry interpretation. The primary outcome was competency for interpretation in 7 individual skill sets. RESULTS: Forty-four GI trainees completed EMC. Participants completed 30 cases, each including 7 skill sets. At baseline, 4 (9%) participants achieved competency for all 7 skills compared with 24 (55%) at final assessment (P < 0.001). Competency in individual skills increased from a median of 4 skills at baseline to 7 at final assessment (P < 0.001). The greatest increase in skill competency was for diagnosis (Baseline: 11% vs Final: 68%; P < 0.001). Accuracy improved for distinguishing between 5 diagnostic groups and was highest for the Outflow obstructive motility disorder (Baseline: 49% vs Final: 76%; P < 0.001) and Normal motor function (50% vs 80%; P < 0.001). DISCUSSION: This prospective multicenter implementation study highlights that an adaptive web-based training platform is an effective tool to promote CBME. EMC completion was associated with significant improvement in identifying clinically relevant diagnoses, providing a model for integrating CBME into subspecialized areas of training.
Authors: Dustin A Carlson; Karthik Ravi; Peter J Kahrilas; C Prakash Gyawali; Arjan J Bredenoord; Donald O Castell; Stuart J Spechler; Magnus Halland; Navya Kanuri; David A Katzka; Cadman L Leggett; Sabine Roman; Jose B Saenz; Gregory S Sayuk; Alan C Wong; Rena Yadlapati; Jody D Ciolino; Mark R Fox; John E Pandolfino Journal: Am J Gastroenterol Date: 2015-06-02 Impact factor: 10.864
Authors: Rena Yadlapati; Rajesh N Keswani; Jody D Ciolino; David P Grande; Zoe I Listernick; Dustin A Carlson; Donald O Castell; Kerry B Dunbar; Andrew J Gawron; C Prakash Gyawali; Philip O Katz; David Katzka; Brian E Lacy; Stuart J Spechler; Roger Tatum; Marcelo F Vela; John E Pandolfino Journal: Clin Gastroenterol Hepatol Date: 2016-07-27 Impact factor: 11.382
Authors: Sachin Wani; Rajesh N Keswani; Samuel Han; Eva M Aagaard; Matthew Hall; Violette Simon; Wasif M Abidi; Subhas Banerjee; Todd H Baron; Michael Bartel; Erik Bowman; Brian C Brauer; Jonathan M Buscaglia; Linda Carlin; Amitabh Chak; Hemant Chatrath; Abhishek Choudhary; Bradley Confer; Gregory A Coté; Koushik K Das; Christopher J DiMaio; Andrew M Dries; Steven A Edmundowicz; Abdul Hamid El Chafic; Ihab El Hajj; Swan Ellert; Jason Ferreira; Anthony Gamboa; Ian S Gan; Lisa M Gangarosa; Bhargava Gannavarapu; Stuart R Gordon; Nalini M Guda; Hazem T Hammad; Cynthia Harris; Sujai Jalaj; Paul S Jowell; Sana Kenshil; Jason Klapman; Michael L Kochman; Srinadh Komanduri; Gabriel Lang; Linda S Lee; David E Loren; Frank J Lukens; Daniel Mullady; V Raman Muthusamy; Andrew S Nett; Mojtaba S Olyaee; Kavous Pakseresht; Pranith Perera; Patrick Pfau; Cyrus Piraka; John M Poneros; Amit Rastogi; Anthony Razzak; Brian Riff; Shreyas Saligram; James M Scheiman; Isaiah Schuster; Raj J Shah; Rishi Sharma; Joshua P Spaete; Ajaypal Singh; Muhammad Sohail; Jayaprakash Sreenarasimhaiah; Tyler Stevens; James H Tabibian; Demetrios Tzimas; Dushant S Uppal; Shiro Urayama; Domenico Vitterbo; Andrew Y Wang; Wahid Wassef; Patrick Yachimski; Sergio Zepeda-Gomez; Tobias Zuchelli; Dayna Early Journal: Gastroenterology Date: 2018-07-26 Impact factor: 22.682
Authors: S G Patel; R Keswani; G Elta; S Saini; P Menard-Katcher; J Del Valle; L Hosford; A Myers; D Ahnen; P Schoenfeld; S Wani Journal: Am J Gastroenterol Date: 2015-03-24 Impact factor: 10.864
Authors: P J Kahrilas; A J Bredenoord; M Fox; C P Gyawali; S Roman; A J P M Smout; J E Pandolfino Journal: Neurogastroenterol Motil Date: 2014-12-03 Impact factor: 3.598
Authors: Rena Yadlapati; Andrew J Gawron; Rajesh N Keswani; Karl Bilimoria; Donald O Castell; Kerry B Dunbar; Chandra P Gyawali; Blair A Jobe; Philip O Katz; David A Katzka; Brian E Lacy; Benson T Massey; Joel E Richter; Felice Schnoll-Sussman; Stuart J Spechler; Roger Tatum; Marcelo F Vela; John E Pandolfino Journal: Clin Gastroenterol Hepatol Date: 2015-10-20 Impact factor: 11.382