Influence of fellowship training on the performance of ERCP

Participation of fellows of different levels of training may effect the performance of endoscopie procedures, especially ERCP Procedure time and drug requirement for conscious sedation and other factors may be altered during this teaching activity. Objectives: To assess the impact of I, II and III Year fellows on ERCP completion time and quantity of drugs used for conscious sedation. Material and Methods: 500 ERCPs at a VAMC were reviewed All ERCPs were performed by or under the supervision of one Staff gastroenterologist (S) and different fellows in training. The following teams were defined A: S+IIIYr. B: S+IIYr; C: S+IYr; D: S+II+IIIYr; E: S+I+HIYr Results: A IIIYr Fellow was involved in 86%; a IIYr in 51% and a IYr in 18% of cases. 58% of the procedures were therapeutic. With different levels of participation, the fellows' involvement in the therapeutic procedure was similar to the above figures. Duration in min., and drug doses in mg (mean±SEM) used by each team and the statistical differences between groups are shown below Team A Team B Team C Team D Team E Time 52.2±2.21 ag 61.1±3.7 48.3±6.5 de 66.4±2.6 ad 65.5±4.4 eg Demerol 80.9±3.2 b 91.6±7.4 ch 63.1±7.0 bcd 88.9±2.9 df 71.9±4.3 fh Valium 6.6±0.3 ab 8.5±0.8 c 4.7±0.6 bcde 9.7±0.4 adf 7.30±0.7 ef a,b,c,d,e,f,g,h p<0.05 All teams decreased their procedure times as the year progressed, but only Team B reached statistical significance (71.9±4.3 vs. 53.2±5.03 min), (p=0.01). Conclusions: 1) Procedure time was significantly shorter with the most experienced (Team A), and Team C (where attending takes over procedure). 2) Drug dosage was inversely proportional to level of fellowship training. 3) Procedure time decreased as each team gained experience.