Training and competence assessment in GI endoscopy: a systematic review

Area of Science:

• Gastrointestinal Endoscopy
• Medical Education
• Surgical Skills Training

Background:

• Traditional GI endoscopy training relied on fixed threshold numbers, which inadequately reflect individual competence.
• A shift towards individualized assessment and progress tracking is evident, with new tools emerging for training curricula.
• Global training guidelines lack consensus, highlighting the need for standardized approaches to GI endoscopy education.

Purpose of the Study:

• To systematically review current training and assessment methods in GI endoscopy.
• To evaluate the role of simulator-based training and continuous competence assessment in patient-based endoscopy.
• To propose an evidence-based, structured training curriculum for GI endoscopy.

Main Methods:

• A comprehensive literature search was conducted across medical and educational databases.
• Studies were systematically reviewed following a predefined protocol with independent assessment and consensus.
• Inclusion criteria focused on simulators, assessment methods, learning curves, and training programs in GI endoscopy.

Main Results:

• Ninety-four studies met inclusion criteria, with 27 on simulator validation, four showing good validity.
• Simulator training and learning curves showed improved performance in 23 studies, including 17 randomized controlled trials.
• Learning curves in patient-based endoscopy proved valuable for performance measurement, though competence thresholds varied widely.

Conclusions:

• Validated virtual reality (VR) simulators enhance early practical skill acquisition in GI endoscopy.
• Learning curves are superior to threshold numbers for continuous performance assessment and competence evaluation.
• A comprehensive curriculum incorporating simulation and patient-based training with competence assessment is needed for all GI endoscopy procedures.