From the Guidelines
Endoscopic ultrasound (EUS) learning should begin with a dedicated training programme that improves knowledge and skills in EUS, as evidenced by the Asian EUS group workshops 1.
Key Components of EUS Learning
- Observation of the procedure should be in high-volume centres experienced in interventional EUS
- Hands-on training should begin in the porcine model
- Trainees should familiarise themselves with the steps of the procedure and instruments that they are using
- When proficiency is obtained in models, trainees should then perform the procedure under the supervision of an experienced endoscopist
Importance of Structured Training
A comprehensive learning pathway is essential for achieving clinical competence and ensuring patient safety, as it combines two complex skills—endoscopy and ultrasonography—requiring significant hand-eye coordination and spatial orientation abilities 1.
Learning Curve and Mastery
The learning curve varies by procedure type, with diagnostic EUS generally easier to master than interventional techniques, and mastery typically requires dedicated training and continued practice to maintain proficiency. Regular self-assessment using quality metrics helps track progress, and developing competence in various EUS applications requires different levels of experience, making a systematic training approach essential. Given the availability of more recent and higher quality evidence from the Asian EUS group 1, the recommendations from the emergency ultrasound guidelines 1 are not prioritized in this context.
From the Research
Endoscopic Ultrasound Learning Overview
- Endoscopic ultrasound (EUS) is a crucial modality for diagnosing and managing pancreatobiliary and gastrointestinal disorders, requiring both cognitive and technical abilities 2.
- The learning process for EUS involves acquiring theoretical knowledge and technical skills, which can be achieved through various training programs, including formal EUS training, preceptorships, and short-term intensive training programs 2, 3.
Steps to Learn Endoscopic Ultrasound
- Acquiring theoretical knowledge through lectures, textbooks, and other educational materials 2, 3.
- Training on simulators to develop technical skills 3.
- Supervised performance on patients to apply theoretical knowledge and technical skills in a real-world setting 3.
- Completing validated exams to assess competency and ensure basic knowledge and skills are acquired before proceeding to the next step 3.
Achieving Competency in Endoscopic Ultrasound
- The American Society for Gastrointestinal Endoscopy (ASGE) recommends completing 150 EUS procedures to assess competency, but new evidence suggests this threshold may be underestimated 4.
- Studies have shown that achieving competency in EUS can require anywhere from 30 to 295 procedures, depending on the specific indication and level of competency being assessed 4.
- Advanced endoscopy training programs and specialty societies may need to re-assess the structure of EUS training to ensure trainees are adequately prepared to perform EUS procedures independently 4.
Diagnostic and Therapeutic Indications for Endoscopic Ultrasound
- EUS has a wide range of diagnostic indications, including staging of gastroesophageal and rectal cancers, and diagnosing diseases of the pancreaticobiliary area 5, 6.
- Therapeutic indications for EUS include aid in endoscopic drainage of pancreatic pseudocysts and celiac axis neurolysis for the treatment of pain from pancreatic cancer 6.
- EUS provides high accuracy for the diagnosis and staging of various benign and malignant conditions, making it a valuable tool in clinical practice 5.