Bret T. Petersen, MD, MASGE

Associate Editor



Bret T. Petersen, MD, MASGE, is Professor of Medicine in the Division of Gastroenterology and Hepatology at the Mayo Clinic in Rochester, Minnesota. His practice is focused in the Mayo Pancreas Clinic and the Advanced Endoscopy Group. His professional interests include pancreatic and biliary diseases, performance and outcomes of ERCP, and delivery of endoscopic services. At Mayo, Dr. Petersen is a past Director of Endoscopy and has served on multiple clinic and foundation committees. He has directed numerous American Society for Gastrointestinal Endoscopy (ASGE) and Mayo courses, particularly related to the performance of ERCP. He has received the Mayo Award for Excellence, GI Fellows Award for Outstanding Teacher, and Department of Medicine Laureate Award (GI), as well as the Master Endoscopist Award of the ASGE. Dr. Petersen is the incoming Secretary for (ASGE) and a past Chair of the Technology and Quality Assurance in Endoscopy committees.



Boston Scientific 

Advisory Board 

Ethicon/J & J



Ensuring Adequate Procedure Volumes for Advanced Trainees to Reach Competence

Bret T. Petersen, MD, MASGE reviewing Wani S, et al. Gastrointest Endosc 2019 Feb 7.

The volume of endoscopic retrograde cholangiopancreatography (ERCP) or endoscopic ultrasonography (EUS) procedures that should be performed to reach competency is unknown. Using the previously validated EUS and ERCP Skills Assessment Tool (TEESAT) for assessment of competence, the authors from 32 advanced training centers prospectively evaluated 37 advanced trainees (ATs) following every fifth EUS and ERCP examination to define the number of procedures required to reach competence by the “average” AT. A 4-point grading scale for overall, technical, and cognitive components of the procedures was employed. Aggregation of cumulative sum (CUSUM) learning curves for all ATs enabled estimation of learning curves for the average trainee. At entry, most ATs had limited experience (EUS 52%, median 20 cases; ERCP 68%, median 50 cases). Median volumes performed by ATs during advanced training were: EUS - 400 (range 200-750; 69% pancreatobiliary) and ERCP - 361 (250-650, 72% ASGE difficulty 1). The average AT achieved competence in core skills for EUS (fine needle aspiration) by 225 procedures and for ERCP (biliary sphincterotomy) by 250 procedures; however, more complex grade 2 (of 4) ERCPs required about 300 cases to achieve competence.

These data should help potential training programs assess their ability to provide sufficient numbers for trainees to reach competence. Similarly, they should help prospective ATs select which advanced training programs they apply to. While not all trainees reach competence during their advanced year, the authors previously demonstrated in a corollary dataset that essentially all ATs do reach competence during their first year of practice.
Note to readers:
At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

Wani S, Han S, Simon V, et al. Setting minimum standards for training in EUS and ERCP: Results from a prospective multicenter study evaluating learning curves and competence among advanced endoscopy trainees. Gastrointest Endosc 2019 Feb 7. (Epub ahead of print) (