ORAL ABSTRACTS 44 A Prospective Multicenter Study Evaluating Learning Curves and Competence in EUS and ERCP Among Advanced Endoscopy Trainees (AETs): The Rapid Assessment of Trainee Endoscopy Skills (RATES) Study Sachin Wani* 1 , Rajesh N. Keswani 4 , Matt Hall 1 , Dan Mullady 2 , Andrew Y. Wang 9 , Christopher J. DiMaio 3 , V. Raman Muthusamy 5 , Amit Rastogi 6 , Lindsay Hosford 1 , Robert H. Wilson 1 , Linda Carlin 8 , Swan Ellert 8 , Rabindra R. Watson 5 , Srinadh Komanduri 4 , Gregory A. Cote 7 , Raj Shah 1 , Steven Edmundowicz 2 , Dayna S. Early 2 1 Gastroenterology and Hepatology, University of Colorado, Aurora, CO; 2 Washington University School of Medicine, St. Louis, MO; 3 Icahn School of Medicine at Mount Sinai, New York, NY; 4 Northwestern University, Chicago, IL; 5 University of California, Los Angeles, Los Angeles, CA; 6 University of Kansas, Kansas City, MO; 7 Medical University of South Carolina, Charleston, SC; 8 Colorado Clinical and Translational Sciences Institute, Aurora, CO; 9 University of Virginia Health System, Charlottesville, CO Background: Based on the recently implemented Next Accreditation System, trainee assessment should occur on a continuous basis with individualized feedback. We have shown that AETs achieve EUS and ERCP competence at varying rates, validating the shift from defining competence via an absolute number of procedures to well- defined metrics. Aims: (i) To refine EUS and ERCP learning curves using a large national sample of AET Programs (AETPs). (ii) To develop a centralized database that allows assessment of performance in relation to peers. Methods: ASGE recognized AETPs were invited to participate. AETs were graded on every ERCP and every 3 rd EUS exam by attendings after completion of 25 hands-on EUS and ERCP exams. We have previously developed and validated The EUS and ERCP Skills Assessment Tool (TEESAT) which assesses technical and cognitive competence in a continuous fashion. Grading for each skill was done using a 4-point scoring system: 1-no assis- tance, 2-minimal verbal cues, 3-multiple verbal cues or hands on assistance and 4- unable to complete. A comprehensive data collection and reporting system was built using REDCap, a web-based data collection software, and SAS to create learning curves using cumulative sum (CUSUM) analysis. Individual results and comparison to peers were sent to AETs and trainers quarterly. Comprehensive learning curves were created for overall and individual technical and cognitive components of EUS and ERCP performance using CUSUM analysis. Acceptable and unacceptable failure rates were set a priori; success was defined as skill score of 1 or 2. AETs with <20 evaluations were excluded. Results: Of the 62 programs invited, 20 AETPs and 22 AETs participated in this study and 20 AETs were included in the final analysis. At the end of training, median number of EUS and ERCP performed/AET was 300 (range 155-650) and 350 (125-500), respectively. Overall, 3786 exams were graded (EUS: 1137; ERCP – biliary 2280, pancreatic 369). Majority of graded EUS exams were performed for pancreatobiliary indications (57%) and ERCP exams for ASGE biliary grade of difficulty 1 (67%). Learning curves for individual endpoints, and overall technical/cognitive aspects in EUS and ERCP were successfully shared with all AETPs at pre-defined intervals and demonstrated substantial variability (Tables 1, 2). Ma- jority of trainees achieved overall technical (EUS: 82%; ERCP: 60%) and cognitive (EUS: 76%; ERCP: 100%) competency at conclusion of training. Conclusions: Results of this study demonstrate substantial variability in achieving competency for per- forming EUS and ERCP. The feasibility of establishing a centralized national database to report individualized EUS and ERCP learning curves via a novel web-based comprehensive data collection and reporting system is reported. Further ongoing work will evaluate impact of individualized feedback on competency. Table 1. Learning curves and competence in EUS Study Endpoint No. of AETS meeting inclusion criteria* No. of evaluations No. of AETs achieving competence (%) No. of AETs achieving competence (%) Primary analysis* Sensitivity analysis** Technical aspects EUS Stations Intubation 17 1063 17 (100) 16 (94.1) AP window 6 281 6 (100) 4 (66.6) Body of pancreas 15 908 12 (80) 10 (66.6) Tail of pancreas 15 887 12 (80) 6 (40) Head/neck of pancreas 16 911 14 (87.5) 8 (50) Uncinate process 15 753 11 (73.3) 3 (20) Ampulla 13 702 9 (69.2) 4 (30.7) Gallbladder 10 407 9 (90) 6 (60) Study Endpoint No. of AETS meeting inclusion criteria* No. of evaluations No. of AETs achieving competence (%) No. of AETs achieving competence (%) Primary analysis* Sensitivity analysis** Common bile duct 15 822 14 (93.3) 5 (33.3) Portosplenic confluence 13 700 12 (92.3) 7 (53.8) Celiac axis 14 832 14 (100) 7 (50) Achieves FNA 10 344 5 (50) 1 (10) Cognitive aspects Identify lesion of interest/ appropriately ruled out 16 970 13 (81.2) 7 (43.7) Appropriate differential diagnosis 16 868 14 (87.5) 8 (50) Appropriate management plan (FNA, refer to surgery, surveillance) 16 960 15 (93.7) 9 (56.2) Overall Technical Success 17 1070 14 (82.3) 11 (64.7) Overall Cognitive Success 17 1061 13 (76.4) 8 (47) * Primary analysis: success defined as score of 1 or 2 (no assistance/minimal verbal cues), Acceptable failure rate -p0Z0.1 and unacceptable failure rate - p1Z0.3; ** Sensitivity analysis: success defined as score of 1 (stringent definition of success). Table 2. Learning curves and competence in ERCP Study Endpoint No. of AETS meeting inclusion criteria* No. of evaluations No. of AETs achieving competence (%) No. of AETs achieving competence (%) Primary analysis* Sensitivity analysis** Basic technique Intubation 20 2239 20 (100) 19 (95) Achieving short position 20 2226 19 (95) 15 (75) Identifying the papilla 20 2223 19 (95) 18 (90) Technical aspects Overall cannulation 19 2075 13 (68.4) 6 (31.5) Cannulation – native papilla 17 1041 3 (17.6) 0 (0) Stent removal 14 737 13 (92.8) 9 (64.2) Wire placement in biliary duct 18 1815 16 (88.8) 8 (44.4) Sphincterotomy 15 731 10 (66.6) 0 (0) Balloon sweep 19 1602 18 (94.7) 10 (52.6) Stone clearance 14 697 12 (85.7) 6 (42.8) Stricture dilation 10 432 9 (90) 3 (30) Stent insertion 17 1029 14 (82.3) 3 (17.6) Cognitive aspects Demonstrated clear understanding of indication 20 2264 20 (100) 14 (70) Appropriate use of fluoroscopy 20 2169 18 (90) 7 (35) Proficient use of real time cholangiogram 20 2219 19 (95) 9 (45) Logical plan based on cholangiogram 20 2220 19 (95) 10 (50) Demonstrated understanding of use of indomethacin 19 1630 19 (100) 16 (84.2) Overall Technical Success 20 2259 12 (60) 5 (25) Overall Cognitive Success 20 2268 20 (100) 17 (85) * Primary analysis: success defined as score of 1 or 2 (no assistance/minimal verbal cues), Acceptable failure rate -p0Z0.1 and unacceptable failure rate - p1Z0.3; ** Sensitivity analysis: success defined as score of 1 (stringent definition of success). www.giejournal.org Volume 83, No. 5S : 2016 GASTROINTESTINAL ENDOSCOPY AB113