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

Despite required simulation training and Fundamentals of Endoscopic Surgery certification, concerns remain about endoscopic competency among graduating general surgery residents. No prior study has directly evaluated resident endoscopic performance in clinical practice. Using the Society for Improving Medical Professional Learning (SIMPL) database, this study assesses general surgery resident competency and autonomy in colonoscopy, upper endoscopy, and sigmoidoscopy/proctoscopy.

A retrospective analysis of the SIMPL database was conducted for general surgery residents completing endoscopic procedures between January 2015 and August 2025. Faculty-rated performance was dichotomized as competent (practice-ready/exceptional) versus not competent (unprepared/inexperienced/intermediate performance) and resident autonomy was dichotomized as meaningful (passive help/supervision only) versus not meaningful (show and tell/active help). Descriptive statistics on performance and autonomy were evaluated, including agreement between resident and faculty evaluations. Logistic regression was used to assess resident performance and autonomy according to training year, with case complexity as a covariate.

A total of 3,325 cases were evaluated, consisting of 2,696 colonoscopies, 364 upper endoscopies, and 265 sigmoidoscopies/proctoscopies. Faculty observed competent performance in 35.3% of colonoscopies, 50.0% of upper endoscopies, and 42.3% of sigmoidoscopies/proctoscopies. Faculty observed meaningful autonomy in 60.7% of colonoscopies, 68.9% of upper endoscopies, and 59.2% of sigmoidoscopies/proctoscopies. The likelihoods of achieving competency and meaningful autonomy in the most complex colonoscopies were 23.6% and 40.8%, respectively. At the chief resident level, faculty observed competency in 70.6% of colonoscopies, 89.5% of upper endoscopies, and 87.3% of sigmoidoscopies/proctoscopies.

Nearly one-third of colonoscopies performed by chief residents did not meet practice-ready competency standards, representing the most concerning finding of this study. Performance was even lower for complex cases, with fewer than one-quarter achieving competency and less than half demonstrating meaningful autonomy. Together, these findings highlight gaps in current training pathways and underscore the need to strengthen endoscopy education.