The assessment of endosonographers in training

Table 1 Number of trainee-performed endosonography-procedures required for the adequate performance of the different steps of a diagnostic endosonography-examination not including fine needle aspiration

Ref.	Procedural step or scanning position
	Intubation1	Esophageal view		Gastric view		Duodenal view
Meenan et al[8] 2003	NA2	25–CNR3		35–CNR		78–CNR
	Intubation	Mediastinum	Celiac axis	Gastric wall	Pancreas (body)	Pancreas (head)	CBD
Hoffman et al[22] 2005	1–23	1–33	8–36	1–47	1–34	15–74	13–134
	Intubation	AP window	Celiac axis		Pancreas (body)	Pancreas (head)	CBD
Wani et al[1] 2013	245–CNR	315–CNR	235–CNR		226–CNR	166–CNR	CNR–CNR4

Each range indicates the number of procedures required for the fastest learning trainee (low end) and the number of procedures required for the slowest learning trainee (high end). Competency not reached means that at least one trainee had not yet reached adequate competence by the end of training period. In the study by Meenan et al[8] five trainees were assessed; in the study by Hoffman et al[22] twelve trainees were assessed; and in the study by Wani et al[1] five trainees were assessed.

¹Intubation of the esophagus with the echoendoscope;

²Not assessed;

³Competency not reached at the end of the training period;

⁴No trainee reached adequate competence. CBD: Common bile duct; CNR: Competency not reached.

Table 2 Assessment form used by Meenan et al[8] to evaluate and assess endosonographers in training using a radial array echoendoscope

Site	Structures	Points
Esophagus	Liver, inferior vena cava/hepatic veins, crus, abdominal aorta, spine, right pleura, thoracic aorta, left atrium, aortic outflow, left pulmonary vein, azygous vein, thoracic duct, right/left bronchus, carina, aortic arch, carotids, trachea, thyroid	18 points (minimum score for competence: 12 points)
Stomach	Stomach wall layer pattern, celiac axis, left adrenal, portal confluence, splenic vein, splenic artery, follow course of splenic vein	8 points (following course of splenic vein: 2 points; minimum score for competence: 5 points)
Duodenum	Gall bladder, portal vein, pancreatic duct, abdominal aorta, inferior vena cava, uncinate process, superior mesenteric vein, superior mesenteric artery, follow course of common bile duct	11 points (following course of common bile duct: 3 points; minimum score for competence: 7.5 points)
Use of ultrasound controls	Frequency, range, brightness/contrast	3 points

Points were awarded for the ability to produce “best views with certainity” from the three different positions of scanning. The minimum score for competence in each of the positions is provided in the rightmost column. Adapted from Meenan et al[8] and reprinted with permission from Georg Thieme Verlag KG.