BACKGROUND The study investigates the connection between academic productivity and industry earnings in foot and ankle orthopedic surgery fellowships.Utilizing metrics like the H-index and Open Payments Database(OPD)d...BACKGROUND The study investigates the connection between academic productivity and industry earnings in foot and ankle orthopedic surgery fellowships.Utilizing metrics like the H-index and Open Payments Database(OPD)data,it addresses a gap in understanding the relationship between scholarly achievements and financial outcomes,providing a basis for further exploration in this specialized medical field.AIM To elucidate the trends between academic productivity and industry earnings across foot and ankle orthopedic surgery fellowship programs in the United States.METHODS This study is a retrospective analysis of the relationship between academic productivity and industry earnings of foot and ankle orthopedic surgery fellowships at an individual faculty and fellowship level.Academic productivity was defined via H-index and recorded from the Scopus website.Industry earnings were recorded from the OPD.RESULTS Forty-eight foot and ankle orthopedic surgery fellowships(100%of fellowships)in the United States with a combined total of 165 physicians(95.9%of physicians)were included.Mean individual physician(n=165)total life-time earnings reported on the OPD website was United States Dollar(USD)451430.30±1851084.89(range:USD 25.16-21269249.85;median:USD 27839.80).Mean physician(n=165)H-index as reported on Scopus is 14.24±12.39(range:0-63;median:11).There was a significant but weak correlation between individual physician H-index and individual physician total life-time earnings(P<0.001;Spearman’s rho=0.334)and a significant and moderate positive correlation between combined fellowship H-index and total life-time earnings per fellowship(P=0.004,Spearman’s rho=0.409).CONCLUSION There is a significant and positive correlation between academic productivity and industry earnings at foot and ankle orthopedic surgery fellowships in the United States.This observation is true on an individual physician level as well as on a fellowship level.展开更多
BACKGROUND Fellowship directors(FDs)in sports medicine influence the future of trainees in the field of orthopaedics.Understanding the characteristics these leaders share must be brought into focus.For all current spo...BACKGROUND Fellowship directors(FDs)in sports medicine influence the future of trainees in the field of orthopaedics.Understanding the characteristics these leaders share must be brought into focus.For all current sports medicine FDs,our group analyzed their demographic background,institutional training,and academic experience.AIM To serve as a framework for those aspiring to achieve this position in orthopaedics and also identify opportunities to improve the position.METHODS Fellowship programs were identified using both the American Orthopaedic Society for Sports Medicine and the Arthroscopy Association of North America Sports Medicine Fellowship Directories.The demographic and educational background data for each FD was gathered via author review of current curriculum vitae(CVs).Any information that was unavailable on CV review was gathered from institutional biographies,Scopus Web of Science,and emailed questionnaires.To ensure the collection of as many data points as possible,fellowship program coordinators,orthopaedic department offices and FDs were directly contacted via phone if there was no response via email.Demographic information of interest included:Age,gender,ethnicity,residency/fellowship training,residency/fellowship graduation year,year hired by current institution,time since training completion until FD appointment,length in FD role,status as a team physician and H-index.RESULTS Information was gathered for 82 FDs.Of these,97.5%(n=80)of the leadership were male;84.15%(n=69)were Caucasian,7.32%(n=6)were Asian-American,2.44%(n=2)were Hispanic and 2.44%(n=2)were African American,and 3.66%(n=3)were of another race or ethnicity.The mean age of current FDs was 56 years old(±9.00 years),and the mean Scopus H-index was 23.49(±16.57).The mean calendar years for completion of residency and fellowship training were 1996(±15 years)and 1997(±9.51 years),respectively.The time since fellowship training completion until FD appointment was 9.77 years.17.07%(n=14)of FDs currently work at the same institution where they completed residency training;21.95%(n=18)of FDs work at the same institution where they completed fellowship training;and 6.10%(n=5)work at the same institution where they completed both residency and fellowship training.Additionally,69.5%(n=57)are also team physicians at the professional and/or collegiate level.Of those that were found to currently serve as team physicians,56.14%(n=32)of them worked with professional sports teams,29.82%(n=17)with collegiate sports teams,and 14.04%(n=8)with both professional and collegiate sports teams.Seven residency programs produced the greatest number of future FDs,included programs produced at least three future FDs.Seven fellowship programs produced the greatest number of future FDs,included programs produced at least four future FDs.Eight FDs(9.75%)completed two fellowships and three FDs(3.66%)finished three fellowships.Three FDs(3.66%)did not graduate from any fellowship training program.The Scopus H-indices for FDs are displayed as ranges that include 1 to 15(31.71%,n=26),15 to 30(34.15%,n=28),30 to 45(20.73%,n=17),45 to 60(6.10%,n=5)and 60 to 80(3.66%,n=3).Specifically,the most impactful FD in research currently has a Scopus H-index value of 79.By comparison,the tenth most impactful FD in research had a Scopus H-index value of 43(accessed December 1,2019).CONCLUSION This study provides an overview of current sports medicine FDs within the United States and functions as a guide to direct initiatives to achieve diversity equality.展开更多
With the growth in multimodality imaging technology,there is heightened interest in advanced imaging training within the cardiology fellow community.The ideal training models for multimodality imaging remain to be det...With the growth in multimodality imaging technology,there is heightened interest in advanced imaging training within the cardiology fellow community.The ideal training models for multimodality imaging remain to be determined and there are uncertainties about the manpower needs for cardiologists with advanced multimodality imaging expertise.This commentary discusses several areas pertaining to training of cardiology fellows in multimodality imaging.展开更多
Data are scarce regarding surgical and non-surgical education in accredited Female Pelvic Medicine and Reconstructive Surgery (FPMRS) fellowships in theUnited States. We compared surgical and non-surgical and educatio...Data are scarce regarding surgical and non-surgical education in accredited Female Pelvic Medicine and Reconstructive Surgery (FPMRS) fellowships in theUnited States. We compared surgical and non-surgical and education among training programs and expected surgical comfort level with pelvic reconstructive procedures from the perspective of the fellow and program director. An online survey was distributed to program directors and fellows from the 39 accredited FPMRS fellowships at the time (2010). Domains evaluated in the survey were academic education requirements;surgical approaches to prolapse and to incontinence;other surgical procedures;and research and publication expectations. In total, forty fellows from 21 programs and directors from 27 programs. The most common surgical procedures performed for apical, anterior, and posterior prolapse were uterosacral ligament suspension, native tissue anterior colporrhaphy, and posterior colporrhaphy, respectively. Differences in perceived surgical comfort level were seen for coccygeus suspension, graftreinforced posterior colporrhaphy, rectus fascial sling, urethral bulking agent, cystoscopic ureteral stent placement and bowel repair. A greater proportion of program directors reported that fellows would be comfortable performing these procedures upon graduation than the proportion reported by the fellows themselves. Differences exist in FPMRS training nationwide, however, responding fellows appeared to be trained in multiple approaches to prolapse repair. Differences were seen in surgical comfort level as perceived by fellows and program directors.展开更多
Background: The 2010 US Renal Data System annual report revealed that peritoneal dialysis is used by only 7% of end-stage renal disease patients on chronic dialysis vs. hemodialysis which is used by 93% of such patien...Background: The 2010 US Renal Data System annual report revealed that peritoneal dialysis is used by only 7% of end-stage renal disease patients on chronic dialysis vs. hemodialysis which is used by 93% of such patients, despite documented benefits of peritoneal dialysis over hemodialysis in these cases. Purpose: We examined whether education of nephrology fellows contributed to underutilization of peritoneal dialysis in the US. Methods: Self-report questionnaires were administered electronically to nephrology fellowship training program directors, October 2010-March 2011 (55% response). Results: Median number of training faculty and patients/fellow were significantly lower for peritoneal-dialysis vs. hemodialysis training. Hours of didactic teaching for fellows over their 2-year training period were significantly lower for peritoneal dialysis vs. hemodialysis. Peritoneal dialysis training was 20% of total training vs. 80% for hemodialysis. Most program directors (87%) believed lack of trained faculty in peritoneal dialysis and insufficient peritoneal dialysis patient population contributed to inadequate fellows’ peritoneal dialysis training. Conclusions: Findings suggest that current nephrology fellowship training in peritoneal dialysis is inadequate and contributes to its underutilization.展开更多
BACKGROUND The Limb Lengthening and Reconstruction Society(LLRS)is a premier orthopedic specialty organization that promotes limb reconstruction for all ages.LLRS membership characteristics,however,are poorly reported...BACKGROUND The Limb Lengthening and Reconstruction Society(LLRS)is a premier orthopedic specialty organization that promotes limb reconstruction for all ages.LLRS membership characteristics,however,are poorly reported.This study delineates orthopedic surgeon LLRS members’demographic traits,academic achievement,leadership attainment,and geographical distribution across the United States.AIM To inform aspiring orthopedic professionals,as well as to promote growth and diversity in both the LLRS organization and overarching field.METHODS This cross-sectional study examined United States LLRS members’academic,leadership,demographic,and geographical attributes.After reviewing the 2023 LLRS member directory,Google search results were matched to the listings and appended to the compiled data.Sex and ethnicity were evaluated visually utilizing retrieved images.The Hirsch index(H-index)of academic activity,residency and fellowship training,other graduate degrees,leadership positions,practice type(academic or non-academic),and spoken languages were categorized.LLRS members per state and capita determined geographic distribution.The Mann Whitney U test was applied to compare H-index between males and females,as well as to assess member differences pertaining to affiliation with academic vs non-academic practice facilities.RESULTS The study included 101 orthopedic surgeons,78(77.23%)Caucasian and 23(22.77%)non-Caucasian,79(78.22%)male and 22(21.78%)female.Surgeons with DO degrees comprised only 3.96%(4)of the cohort,while the vast majority held MDs[96.04%(97)].Mean H-index was 10.55,with male surgeons having a significantly higher score(P=0.002).Most orthopedic surgeons(88.12%,)practiced in academic centers.Of those professionals who occupied leadership positions,14%were women,while 86%were men.Additionally,19(37.25%)United States regions and the District of Columbia lacked an LLRS-member orthopedic surgeon.Total per capita rate across the United States was 0.30 LLRS orthopedic surgeons per 1 million people.CONCLUSION Over 21%of LLRS members are women,surpassing prior benchmarks noted in orthopedic faculty reporting.LLRS members’high research productivity scores imply field dedication that can refine expertise in the limb lengthening and reconstruction space.Gender disparities in leadership remain,however,necessitating greater equity efforts.A low rate of LLRS representation per capita must be addressed geographically as well,to affect improvements in regional care access.This study can serve to support aspiring orthopedic professionals,inform diversity,leadership,and field advancement strategies,and maintain the continued goal of enhanced patient care worldwide.展开更多
Aim:Aneed for Neurologists exists in the USA.The majority of Neurology residency graduates go on to additional subspecialty training. Methods: Data from the Accreditation Council for Graduate Medical Education from 20...Aim:Aneed for Neurologists exists in the USA.The majority of Neurology residency graduates go on to additional subspecialty training. Methods: Data from the Accreditation Council for Graduate Medical Education from 2001-2014 and the United Council for Neurologic Subspecialties from was analyzed for trends in the number of Neurology subspecialty training programs and their composition. Results: There has been an overall trend of growth in the number of accredited Neurology subspecialty training programs and fellows. These trends vary between specific subspecialties. Conclusion: The authors provide an overview of the contemporary state of Neurology subspecialty training in the USA. A clearer understanding of subspecialty training allows for anticipation of workforce surpluses and deficits.展开更多
Endoscopic-retrograde-cholangiopancreatography(ERCP) is now a vital modality with primarily therapeutic and occasionally solely diagnostic utility for numerous biliary/pancreatic disorders. It has a significantly stee...Endoscopic-retrograde-cholangiopancreatography(ERCP) is now a vital modality with primarily therapeutic and occasionally solely diagnostic utility for numerous biliary/pancreatic disorders. It has a significantly steeper learning curve than that for other standard gastrointestinal(GI) endoscopies, such as esophagogastroduodenoscopy or colonoscopy, due to greater technical difficulty and higher risk of complications. Yet, GI fellows have limited exposure to ERCP during standard-three-year-GI-fellowships because ERCP is much less frequently performed than esophagogastroduodenoscopy/colonoscopy. This led to adding an optional year of training in therapeutic endoscopy. Yet many graduates from standard three-year-fellowships without advanced training intensely pursue independent/unsupervised ERCP privileges despite inadequate numbers of performed ERCPs and unacceptably low rates of successful selective cannulation of desired(biliary or pancreatic) duct. Hospital credentialing committees have traditionally performed ERCP credentialing, but this practice has led to widespread flouting of recommended guidelines(e.g., planned privileging of applicant with 20% successful cannulation rate, or after performing only 7 ERCPs);and intense politicking of committee members by applicants, their practice groups, and potential competitors. Consequently, some gastroenterologists upon completing standard fellowships train and learn ERCP 'on the job' during independent/unsupervised practice, which can result in bad outcomes: high rates of failed bile duct cannulation. This severe clinical problem is indicated by publication of ≥ 12 ERCP competency studies/guidelines during last 5 years. However, lack of mandatory, quantitative, ERCP credentialing criteria has permitted neglect of recommended guidelines. This work comprehensively reviews literature on ERCP credentialing;reviews rationales for proposed guidelines;reports problems with current system;and proposes novel criteria for competency. This work advocates for mandatory, national, written,minimum, quantitative, standards, including cognitive skills(possibly assessed by a nationwide examination), and technical skills, assessed by number performed(≥ 200-250 ERCPs), types of ERCPs, success rate(approximately ≥ 90%cannulation of desired duct), and letters of recommendation by program director/ERCP mentor. Mandatory criteria should ideally not be monitored by a hospital committee subjected to intense politicking by applicants, their employers, and sometimes even competitors, but an independent national entity,like the National Board of Medical Examiners/American Board of Internal Medicine.展开更多
文摘BACKGROUND The study investigates the connection between academic productivity and industry earnings in foot and ankle orthopedic surgery fellowships.Utilizing metrics like the H-index and Open Payments Database(OPD)data,it addresses a gap in understanding the relationship between scholarly achievements and financial outcomes,providing a basis for further exploration in this specialized medical field.AIM To elucidate the trends between academic productivity and industry earnings across foot and ankle orthopedic surgery fellowship programs in the United States.METHODS This study is a retrospective analysis of the relationship between academic productivity and industry earnings of foot and ankle orthopedic surgery fellowships at an individual faculty and fellowship level.Academic productivity was defined via H-index and recorded from the Scopus website.Industry earnings were recorded from the OPD.RESULTS Forty-eight foot and ankle orthopedic surgery fellowships(100%of fellowships)in the United States with a combined total of 165 physicians(95.9%of physicians)were included.Mean individual physician(n=165)total life-time earnings reported on the OPD website was United States Dollar(USD)451430.30±1851084.89(range:USD 25.16-21269249.85;median:USD 27839.80).Mean physician(n=165)H-index as reported on Scopus is 14.24±12.39(range:0-63;median:11).There was a significant but weak correlation between individual physician H-index and individual physician total life-time earnings(P<0.001;Spearman’s rho=0.334)and a significant and moderate positive correlation between combined fellowship H-index and total life-time earnings per fellowship(P=0.004,Spearman’s rho=0.409).CONCLUSION There is a significant and positive correlation between academic productivity and industry earnings at foot and ankle orthopedic surgery fellowships in the United States.This observation is true on an individual physician level as well as on a fellowship level.
文摘BACKGROUND Fellowship directors(FDs)in sports medicine influence the future of trainees in the field of orthopaedics.Understanding the characteristics these leaders share must be brought into focus.For all current sports medicine FDs,our group analyzed their demographic background,institutional training,and academic experience.AIM To serve as a framework for those aspiring to achieve this position in orthopaedics and also identify opportunities to improve the position.METHODS Fellowship programs were identified using both the American Orthopaedic Society for Sports Medicine and the Arthroscopy Association of North America Sports Medicine Fellowship Directories.The demographic and educational background data for each FD was gathered via author review of current curriculum vitae(CVs).Any information that was unavailable on CV review was gathered from institutional biographies,Scopus Web of Science,and emailed questionnaires.To ensure the collection of as many data points as possible,fellowship program coordinators,orthopaedic department offices and FDs were directly contacted via phone if there was no response via email.Demographic information of interest included:Age,gender,ethnicity,residency/fellowship training,residency/fellowship graduation year,year hired by current institution,time since training completion until FD appointment,length in FD role,status as a team physician and H-index.RESULTS Information was gathered for 82 FDs.Of these,97.5%(n=80)of the leadership were male;84.15%(n=69)were Caucasian,7.32%(n=6)were Asian-American,2.44%(n=2)were Hispanic and 2.44%(n=2)were African American,and 3.66%(n=3)were of another race or ethnicity.The mean age of current FDs was 56 years old(±9.00 years),and the mean Scopus H-index was 23.49(±16.57).The mean calendar years for completion of residency and fellowship training were 1996(±15 years)and 1997(±9.51 years),respectively.The time since fellowship training completion until FD appointment was 9.77 years.17.07%(n=14)of FDs currently work at the same institution where they completed residency training;21.95%(n=18)of FDs work at the same institution where they completed fellowship training;and 6.10%(n=5)work at the same institution where they completed both residency and fellowship training.Additionally,69.5%(n=57)are also team physicians at the professional and/or collegiate level.Of those that were found to currently serve as team physicians,56.14%(n=32)of them worked with professional sports teams,29.82%(n=17)with collegiate sports teams,and 14.04%(n=8)with both professional and collegiate sports teams.Seven residency programs produced the greatest number of future FDs,included programs produced at least three future FDs.Seven fellowship programs produced the greatest number of future FDs,included programs produced at least four future FDs.Eight FDs(9.75%)completed two fellowships and three FDs(3.66%)finished three fellowships.Three FDs(3.66%)did not graduate from any fellowship training program.The Scopus H-indices for FDs are displayed as ranges that include 1 to 15(31.71%,n=26),15 to 30(34.15%,n=28),30 to 45(20.73%,n=17),45 to 60(6.10%,n=5)and 60 to 80(3.66%,n=3).Specifically,the most impactful FD in research currently has a Scopus H-index value of 79.By comparison,the tenth most impactful FD in research had a Scopus H-index value of 43(accessed December 1,2019).CONCLUSION This study provides an overview of current sports medicine FDs within the United States and functions as a guide to direct initiatives to achieve diversity equality.
文摘With the growth in multimodality imaging technology,there is heightened interest in advanced imaging training within the cardiology fellow community.The ideal training models for multimodality imaging remain to be determined and there are uncertainties about the manpower needs for cardiologists with advanced multimodality imaging expertise.This commentary discusses several areas pertaining to training of cardiology fellows in multimodality imaging.
文摘Data are scarce regarding surgical and non-surgical education in accredited Female Pelvic Medicine and Reconstructive Surgery (FPMRS) fellowships in theUnited States. We compared surgical and non-surgical and education among training programs and expected surgical comfort level with pelvic reconstructive procedures from the perspective of the fellow and program director. An online survey was distributed to program directors and fellows from the 39 accredited FPMRS fellowships at the time (2010). Domains evaluated in the survey were academic education requirements;surgical approaches to prolapse and to incontinence;other surgical procedures;and research and publication expectations. In total, forty fellows from 21 programs and directors from 27 programs. The most common surgical procedures performed for apical, anterior, and posterior prolapse were uterosacral ligament suspension, native tissue anterior colporrhaphy, and posterior colporrhaphy, respectively. Differences in perceived surgical comfort level were seen for coccygeus suspension, graftreinforced posterior colporrhaphy, rectus fascial sling, urethral bulking agent, cystoscopic ureteral stent placement and bowel repair. A greater proportion of program directors reported that fellows would be comfortable performing these procedures upon graduation than the proportion reported by the fellows themselves. Differences exist in FPMRS training nationwide, however, responding fellows appeared to be trained in multiple approaches to prolapse repair. Differences were seen in surgical comfort level as perceived by fellows and program directors.
文摘Background: The 2010 US Renal Data System annual report revealed that peritoneal dialysis is used by only 7% of end-stage renal disease patients on chronic dialysis vs. hemodialysis which is used by 93% of such patients, despite documented benefits of peritoneal dialysis over hemodialysis in these cases. Purpose: We examined whether education of nephrology fellows contributed to underutilization of peritoneal dialysis in the US. Methods: Self-report questionnaires were administered electronically to nephrology fellowship training program directors, October 2010-March 2011 (55% response). Results: Median number of training faculty and patients/fellow were significantly lower for peritoneal-dialysis vs. hemodialysis training. Hours of didactic teaching for fellows over their 2-year training period were significantly lower for peritoneal dialysis vs. hemodialysis. Peritoneal dialysis training was 20% of total training vs. 80% for hemodialysis. Most program directors (87%) believed lack of trained faculty in peritoneal dialysis and insufficient peritoneal dialysis patient population contributed to inadequate fellows’ peritoneal dialysis training. Conclusions: Findings suggest that current nephrology fellowship training in peritoneal dialysis is inadequate and contributes to its underutilization.
文摘BACKGROUND The Limb Lengthening and Reconstruction Society(LLRS)is a premier orthopedic specialty organization that promotes limb reconstruction for all ages.LLRS membership characteristics,however,are poorly reported.This study delineates orthopedic surgeon LLRS members’demographic traits,academic achievement,leadership attainment,and geographical distribution across the United States.AIM To inform aspiring orthopedic professionals,as well as to promote growth and diversity in both the LLRS organization and overarching field.METHODS This cross-sectional study examined United States LLRS members’academic,leadership,demographic,and geographical attributes.After reviewing the 2023 LLRS member directory,Google search results were matched to the listings and appended to the compiled data.Sex and ethnicity were evaluated visually utilizing retrieved images.The Hirsch index(H-index)of academic activity,residency and fellowship training,other graduate degrees,leadership positions,practice type(academic or non-academic),and spoken languages were categorized.LLRS members per state and capita determined geographic distribution.The Mann Whitney U test was applied to compare H-index between males and females,as well as to assess member differences pertaining to affiliation with academic vs non-academic practice facilities.RESULTS The study included 101 orthopedic surgeons,78(77.23%)Caucasian and 23(22.77%)non-Caucasian,79(78.22%)male and 22(21.78%)female.Surgeons with DO degrees comprised only 3.96%(4)of the cohort,while the vast majority held MDs[96.04%(97)].Mean H-index was 10.55,with male surgeons having a significantly higher score(P=0.002).Most orthopedic surgeons(88.12%,)practiced in academic centers.Of those professionals who occupied leadership positions,14%were women,while 86%were men.Additionally,19(37.25%)United States regions and the District of Columbia lacked an LLRS-member orthopedic surgeon.Total per capita rate across the United States was 0.30 LLRS orthopedic surgeons per 1 million people.CONCLUSION Over 21%of LLRS members are women,surpassing prior benchmarks noted in orthopedic faculty reporting.LLRS members’high research productivity scores imply field dedication that can refine expertise in the limb lengthening and reconstruction space.Gender disparities in leadership remain,however,necessitating greater equity efforts.A low rate of LLRS representation per capita must be addressed geographically as well,to affect improvements in regional care access.This study can serve to support aspiring orthopedic professionals,inform diversity,leadership,and field advancement strategies,and maintain the continued goal of enhanced patient care worldwide.
文摘Aim:Aneed for Neurologists exists in the USA.The majority of Neurology residency graduates go on to additional subspecialty training. Methods: Data from the Accreditation Council for Graduate Medical Education from 2001-2014 and the United Council for Neurologic Subspecialties from was analyzed for trends in the number of Neurology subspecialty training programs and their composition. Results: There has been an overall trend of growth in the number of accredited Neurology subspecialty training programs and fellows. These trends vary between specific subspecialties. Conclusion: The authors provide an overview of the contemporary state of Neurology subspecialty training in the USA. A clearer understanding of subspecialty training allows for anticipation of workforce surpluses and deficits.
基金a phase achievement of the volume on history of science and technology under the Project for Compilation of the New General History of China,a Major Academic and Cultural Project of the National 14th Five-Year Plan。
文摘Endoscopic-retrograde-cholangiopancreatography(ERCP) is now a vital modality with primarily therapeutic and occasionally solely diagnostic utility for numerous biliary/pancreatic disorders. It has a significantly steeper learning curve than that for other standard gastrointestinal(GI) endoscopies, such as esophagogastroduodenoscopy or colonoscopy, due to greater technical difficulty and higher risk of complications. Yet, GI fellows have limited exposure to ERCP during standard-three-year-GI-fellowships because ERCP is much less frequently performed than esophagogastroduodenoscopy/colonoscopy. This led to adding an optional year of training in therapeutic endoscopy. Yet many graduates from standard three-year-fellowships without advanced training intensely pursue independent/unsupervised ERCP privileges despite inadequate numbers of performed ERCPs and unacceptably low rates of successful selective cannulation of desired(biliary or pancreatic) duct. Hospital credentialing committees have traditionally performed ERCP credentialing, but this practice has led to widespread flouting of recommended guidelines(e.g., planned privileging of applicant with 20% successful cannulation rate, or after performing only 7 ERCPs);and intense politicking of committee members by applicants, their practice groups, and potential competitors. Consequently, some gastroenterologists upon completing standard fellowships train and learn ERCP 'on the job' during independent/unsupervised practice, which can result in bad outcomes: high rates of failed bile duct cannulation. This severe clinical problem is indicated by publication of ≥ 12 ERCP competency studies/guidelines during last 5 years. However, lack of mandatory, quantitative, ERCP credentialing criteria has permitted neglect of recommended guidelines. This work comprehensively reviews literature on ERCP credentialing;reviews rationales for proposed guidelines;reports problems with current system;and proposes novel criteria for competency. This work advocates for mandatory, national, written,minimum, quantitative, standards, including cognitive skills(possibly assessed by a nationwide examination), and technical skills, assessed by number performed(≥ 200-250 ERCPs), types of ERCPs, success rate(approximately ≥ 90%cannulation of desired duct), and letters of recommendation by program director/ERCP mentor. Mandatory criteria should ideally not be monitored by a hospital committee subjected to intense politicking by applicants, their employers, and sometimes even competitors, but an independent national entity,like the National Board of Medical Examiners/American Board of Internal Medicine.
