Endoscopy training under the SIMPL lens: insights on resident competency and autonomy

Area of Science:

• Medical Education
• Surgical Training
• Gastrointestinal Endoscopy

Background:

• Concerns persist regarding general surgery residents' endoscopic competency despite simulation training and certification.
• No prior studies have directly assessed resident endoscopic performance in clinical settings.
• This study evaluates competency and autonomy using the SIMPL database.

Purpose of the Study:

• To assess general surgery resident competency and autonomy in colonoscopy, upper endoscopy, and sigmoidoscopy/proctoscopy.
• To identify performance gaps in endoscopic procedures among graduating residents.

Main Methods:

• Retrospective analysis of 3,325 endoscopic procedures from the SIMPL database (January 2015 - August 2025).
• Faculty-rated performance dichotomized as competent vs. not competent; autonomy as meaningful vs. not meaningful.
• Logistic regression analyzed performance and autonomy by training year and case complexity.

Main Results:

• Competent performance observed in 35.3% of colonoscopies, 50.0% of upper endoscopies, and 42.3% of sigmoidoscopies/proctoscopies.
• Meaningful autonomy observed in 60.7% of colonoscopies, 68.9% of upper endoscopies, and 59.2% of sigmoidoscopies/proctoscopies.
• Only 23.6% of complex colonoscopies met competency standards; chief residents showed higher competency (70.6% colonoscopy).

Conclusions:

• Nearly one-third of chief resident colonoscopies did not meet practice-ready competency.
• Performance in complex cases was notably lower, with less than half demonstrating meaningful autonomy.
• Findings indicate significant gaps in current endoscopy training, necessitating enhanced educational strategies.