University of Miami Miller School of Medicine Helps Shape National Standards for Endoscopic Ultrasound Training
The Miller School’s Advanced Endoscopy Fellowship is participating in an ASGE pilot designed to develop objective milestones and a standardized national curriculum for endoscopic ultrasound training.
Key Takeaways
- The Miller School’s Advanced Endoscopy Fellowship is participating in an ASGE pilot to develop a standardized national curriculum for endoscopic ultrasound training.
- Faculty members and fellows will complete standardized evaluations every two weeks to track technical proficiency and clinical judgment.
- Results from participating institutions will help experts identify training milestones and skills associated with EUS competency.
As endoscopic ultrasound becomes an increasingly important tool for diagnosing and treating complex gastrointestinal diseases, including pancreatic cancer, the University of Miami Miller School of Medicine is helping shape how future physicians across the country learn the procedure.
The Miller School’s Advanced Endoscopy Fellowship has been included in a pilot program led by the American Society for Gastrointestinal Endoscopy (ASGE) to develop a standardized national curriculum for endoscopic ultrasound, commonly known as EUS.
National Standards for Endoscopic Ultrasound Training
The initiative addresses a longstanding challenge in advanced endoscopy education. Although EUS has been taught in fellowship programs for decades, there has never been a universally accepted framework for determining when a trainee has achieved competency.
“For years, there’s been advanced endoscopy fellowships around the country that teach EUS, but there’s not really a standardized curriculum,” said Sunil Amin, M.D., an associate professor of digestive health and liver diseases and program director of the Miller School’s Advanced Endoscopy Fellowship.
The ASGE’s Advanced Endoscopy Committee created the pilot program to establish objective milestones and assessment methods that could eventually become a national benchmark for training programs. Approximately 16 fellowship programs are participating in the pilot, according to Dr. Amin, out of more than 100 EUS training programs nationwide.
National Recognition for a Young Fellowship
While the University of Miami’s fellowship is only entering its fifth year, its inclusion reflects the program’s growing reputation among leaders in the field.
“The fact that we were selected to participate speaks to the fact that we are a high-volume center that is well respected across the country,” Dr. Amin said.
The fellowship provides advanced training in procedures that are critical for diagnosing and managing diseases of the pancreas, bile ducts and gastrointestinal tract. EUS combines endoscopy and ultrasound technology, allowing physicians to visualize organs and tissues from inside the digestive tract.
“The year is about optimizing exposure to the breadth of advanced endoscopy techniques, and it was clear that UM offered the opportunity for broad and consistent exposure under the tutelage of expert faculty,” said Emil Thyssen, M.D., the program’s current fellow. “The program also emphasizes high-level clinical decision making via triage of patient consultation, which allows for a streamlined balance between procedural and cognitive skill acquisition.”
Frequently Asked Questions
What is endoscopic ultrasound?
Endoscopic ultrasound, or EUS, combines endoscopy and ultrasound technology, allowing physicians to visualize organs and tissues from inside the digestive tract.
Why is a standardized EUS curriculum needed?
EUS has been taught in fellowship programs for decades, but there has not been a universally accepted framework for determining when a trainee has achieved competency.
How will the pilot evaluate trainees?
Faculty members and fellows will complete standardized evaluations every two weeks to track technical proficiency and clinical judgment in specific EUS procedures.
Training in a Challenging Clinical Environments
A key strength of the program is the breadth of clinical experience available to fellows. Trainees work with six faculty members and rotate across both the University of Miami Hospital and Jackson Memorial Hospital, exposing them to markedly different patient populations and case types.
“The patient population is so incredibly diverse,” Dr. Amin said. “The fellows are really exposed to everything you could possibly be exposed to in advanced endoscopy.”
“A mentor of mine once told me, ‘When you serve multiple populations, one disease can manifest as multiple different illnesses,’” Dr. Thyssen said. “That’s certainly true at UM/Jackson, and the fellowship provides an opportunity to then extrapolate your training to future populations in practice.”
The program’s procedural volume is another distinguishing feature. Across the health system, physicians perform more than 1,000 EUS procedures annually, while individual fellows participate in more than 400 procedures during their training year.
The Miller School’s expertise in pancreatic disease further expands educational opportunities. Fellows gain experience evaluating patients undergoing pancreatic cancer screening because of inherited genetic risk, as well as patients with established cancers, recurrent disease and more subtle abnormalities that can be difficult to detect.
“Advanced endoscopy training is a steep learning curve and requires acquisition of a lot of technical skill in a short, one-year program,” Dr. Thyssen said. “Being in a high-volume environment is the most efficient way of acquiring those skills and was a major factor that went into my decision to want to be at UM for training.”
“You get to see the normal pancreas as well as the cancers and the pathology and the recurrent cancers, which are very subtle and hard to see,” Dr. Amin said. “I think it just offers a huge breadth of cases.”
Measuring Mastery
During the yearlong pilot, faculty members and fellows will complete standardized evaluations every two weeks. The assessments focus on specific EUS procedures and are designed to track growth in technical proficiency and clinical judgment over time.
The data collected from participating institutions will help experts identify meaningful milestones in training and determine the skills physicians need to be considered competent in EUS. The pilot’s evaluation phase is expected to continue throughout the fellowship year, followed by analysis and recommendations over the subsequent year.
“Being part of a pilot program for training is exciting,” Dr. Thyssen said. “It allows me to have a structured framework to see growth over time which is measurable. Objectivity allows me to find specific benchmarks to try and achieve in a timely manner. The opportunity also shows the commitment of our faculty to emphasize program development and be recognized and trusted by national organizations such as the ASGE in leading these efforts.”
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Tags: American Society of Gastrointestinal Endoscopy, Division of Digestive Health and Liver Diseases, Dr. Sunil Amin, endoscopy, gastroenterology, Gastroenterology & Hepatology, Gastrointestinal Endoscopy, liver disease, pancreatic cancer, pancreatitis