Resident training and endoscopic hospital privileging

Laparoscopic techniques were originally confined to female sterilization. As both instrumentation and methodology improved, gynecological endoscopy was applied to more complex processes, including salpingostomy or salpingectomy for ectopic pregnancy, and ovarian cystectomy or oophorectomy for benign conditions. Now, the laparoscopic treatment of adhesions, endometriosis and hysterectomy is almost commonplace. More sophisticated endoscopic procedures include the management of pelvic floor disease, incontinence and malignancies. However, at least two problems have become readily apparent: (i) there is often limited basic laparoscopic and hysteroscopic teaching during residency and fellowship training; and (ii) there is no standard by which to privilege or train physicians who may not have had any significant endoscopic training during residency. In this article we describe current learning theories and identify goals and specific objectives for residents in implementing a successful training program. We also discuss the mechanisms by which to privilege attending staff for gynecological procedures and the important clinical outcomes that can be improved. Finally, we raise concerns about creating algorithms by which to renew clinical privileges in endoscopic procedures.