Category Archives: Endoscopic procedures

Training for endoscopic competence (Part 11)

In view of the complexities of endoscopic practice, the Gastroenterology Specialty Committee of the Royal College of Physicians and Surgeons and the national gastroenterology program directors have unanimously adopted the position that there is no place for ‘part-time’ endoscopists in Canada – a position endorsed by the Canadian Association of Gastroenterology and the American Society of Gastrointestinal Endoscopy.

Training for endoscopic competence (Part 10)

To suggest that endoscopic training can be accomplished in less time with fewer cases, less supervision or less attention to the issues which are not directly procedure-related is to ignore the responsibility we have as clinicians to provide the highest quality patient care expeditiously, safely and in the interest of improving outcomes. The practice of gastroenterology has changed. It is no longer a ‘spectator sport’. In the past, diagnostic upper endoscopy for dyspepsia or chronic pyrosis was frequent.

Training for endoscopic competence (Part 9)

experienced endoscopistsFor example, certified gastroenterologists consistently achieve cecal intubation rates approaching 95% . Trainees in certified programs achieve rates of 84% after 100 procedures . Primary care physicians with limited training report cecal intubation rates of 54% to 83%. For upper endoscopy, experienced endoscopists approach 100% success , while inadequately trained practitioners report duodenal intubation rates at 93%. Given the aforementioned carefully considered requirements for proper training in all aspects of endoscopic practice,

Training for endoscopic competence (Part 8)

Unfortunately, such trainees may proceed to perform interventions for which they were not trained. In my own experience, two of three individuals were performing colonoscopy without proper training and all three were engaged in endoscopy in emergency situations in which their training was quite incomplete. Only one of these actually began independent practice in an underserviced region. Whether these practitioners are working in properly equipped and monitored endoscopy units with appropriately trained endoscopy nurses and support staff and programs of quality control and assurance is unknown.

Training for endoscopic competence (Part 7)

gastroenterologySeveral Canadian gastroenterology training programs have evolved collaborative systems to assist in the training of general surgical residents who will integrate endoscopy into their practice activities. In other instances, appropriate endoscopic training is provided as an integral part of the surgical residency. While the initial period of instruction within the gastroenterology-directed rotations may be shorter, most trainees continue to practice endoscopy with their experienced general surgical supervisors, thereby expanding, in a critical way, the total endoscopic training experience.

Training for endoscopic competence (Part 6)

Each trainee is evaluated in a closely supervised environment and in a manner that allows the trainee to mature, in a graduated fashion, into independent, competent endoscopic practice. Such programs also address the equally important issues of endoscopic unit design and function, infection control, the principles and uses of electrosurgical equipment, radiation safety and the critical role of quality assurance and improvement. While the rates of acquisition of endoscopic skills vary from individual to individual,

Training for endoscopic competence (Part 5)

endoscopic interventionWith the expanding roles of different types of endoscopic intervention comes the imperative to ensure that all endoscopists – future and already certified -receive adequate training to enable optimal patient care in terms of efficacy, safety and cost-effectiveness. Endoscopic interventions that are ill-conceived or executed nonexpedi-tiously without due regard for individual patient safety are not acceptable. Endoscopic practice that results in substandard rates of lesion detection or interpretation and correspondingly misguided therapeutic decisions should not be tolerated.

Training for endoscopic competence (Part 4)

This objective is relatively easy to meet; however, it should be understood that endoscopic adequacy requires a great deal more. If the objective is reaching a specific number of procedures for documentation purposes (and subsequent credentialing), this is a different issue. As noted in the preamble, competency requires considerably more than simply a specified number of procedures. Are there conclusions that one can draw? Where we have little data, we can have little for evidence-based conclusions.

Training for endoscopic competence (Part 3)

Endoscopic examinationsRecognition of disease patterns, their diagnosis and management are the utmost priority with this training. Endoscopic examinations should not be the highest priority. With this understood, why then is there continual debate and discussion regarding training endoscopy in only a few months? It is clear that it cannot be taught to a high level in this short period of time; therefore, a substandard level is deemed acceptable to some. The single exception to this may be with screening FS, where only a small number of procedures are required for this indication.

Training for endoscopic competence (Part 2)

The training of rotating residents in endoscopy is a difficult task. Often, these residents are present for less than a few months, and no attempt at objective assessment of endoscopic skills are undertaken (or, in fact, planned). Many residents early in their career may have never even seen an endoscopy, and may not have had the opportunity to manage any GI disorders. Most institutions, therefore, tend to concentrate on the cognitive aspects of gastroenterology rather than the technical aspects.

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