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Objective evaluation of endoscopy skills during training

O W Cass¹, M L Freeman, C J Peine

¹Hennepin County Medical Center, Minneapolis, Minnesota.

Annals of Internal Medicine

|January 1, 1993

Summary

Achieving initial competency in gastrointestinal endoscopy requires over 100 supervised procedures. This includes both upper gastrointestinal endoscopy and colonoscopy, with specific benchmarks for esophageal and cecal intubation.

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Area of Science:

Gastroenterology
Medical Education
Surgical Training

Background:

Gastrointestinal endoscopy is a crucial diagnostic and therapeutic tool.
Defining objective competency benchmarks for trainees is essential for patient safety and effective training.

Purpose of the Study:

To determine the number of supervised gastrointestinal endoscopic procedures needed for initial competency.
To evaluate the efficacy of a simple objective grading system in assessing competency.

Main Methods:

Prospective, cross-sectional study involving gastroenterology fellows and surgery residents.
Trainees were assessed using a microcomputer program with specific grading criteria for esophagogastroduodenoscopy and colonoscopy.
Key performance indicators included esophageal intubation, pyloric traversal, duodenal recognition, splenic flexure traversal, cecal intubation, and recognition of abnormalities.

Main Results:

Initial competency in esophageal intubation (90% success) was achieved after more than 100 procedures.
Cecal intubation success rate reached only 84% after 100 supervised colonoscopies.
Objective grading revealed a significant number of procedures were required to meet competency standards.

Conclusions:

Over 100 supervised upper gastrointestinal endoscopies are necessary to achieve initial technical competence.
More than 100 supervised colonoscopies are required to reach initial technical competence in gastrointestinal endoscopy.
The findings highlight the substantial procedural volume needed for proficiency in gastrointestinal endoscopy.