Endoscopy education in general surgery residencies: meeting the new RRC requirements

The Residency Review Committee (RRC) for General Surgery recently increased the number of endoscopy cases required from 29 to 85. We sought to evaluate how programs were meeting these guidelines and what adaptations were occurring.

Surveys were sent by regular mail and e-mail to program directors at accredited general surgery residencies.

Eighty-one of 250 surveys were returned (24%); 52% were university based; 100% of respondents were compliant with the old requirement, while 90% were compliant with the new RRC levels; 52% utilized a dedicated rotation and commonly in the private practices settings (75%). Virtually every program reported use of endoscopy suites (98%) or operating rooms (85%); fewer (64%) reported endoscopies in ICUs; 29% of programs had at least half of endoscopies taught by non-surgeons. The mean number of endoscopies performed was 160 (range 55-450), which exceeded the mean number of endoscopies (90) program directors believed were needed to gain privileges. The most commonly identified barriers to increasing endoscopy experience were work hour restrictions (38%) and referral patterns (42%).

Most programs responding to our survey are already compliant with the new RRC requirement. Much of this teaching occurs by non-surgeons and commonly away from the dominant teaching hospital. Future changes in endoscopy requirements should consider the impact of increasing nonsurgical teaching time. It seems likely that non-responding programs have even lower numbers than those responding and may have an even higher barrier to successfully increasing endoscopy education by surgeons.