Advanced Endoscopy Fellowship Training: Where Do We Stand?

Abstract

Purpose: The national gastrointestinal (GI) societies recognize that GI trainees should have a thorough knowledge of the endoscopic techniques used in the diagnosis and treatment of biliary tract and pancreatic diseases, including ERCP and EUS; however no standards for training have been established by the ACGME. In the absence of standardized guidelines, significant variability has developed among fellowship programs in regards to training in ERCP/EUS. Methods: We conducted a survey amongst GI fellows and program directors across the country to assess how many advanced procedures trainees were exposed to in their fellowship, how comfortable they were performing these procedures, how many felt a fourth year of fellowship was needed, and how many planned to perform advanced procedures such as ERCP and EUS once they graduated. Results: Of those who responded, 30% were program directors (PD), 64% were fellows, and 6% were fourth year advanced fellows (AF). 72% of respondents were from university programs and 86% of them had ERCP and EUS training available. Subgroup analysis showed that 47% of respondents were 2nd and 3rd year fellows, i.e., senior fellows (SF); and of these 71% were uncomfortable performing ERCP (67% performed <50 ERCPs), and 89% were uncomfortable performing EUS (84% performed <50 EUS). 79% of graduating fellows were planning to perform ERCP in their practice. It was noted that 59% of PD vs. 36% of fellows (17% 1st year fellows, 28% 2nd year fellows, 58% 3rd year fellows) and 100% of the AF felt that a fourth year of training is required for adequate training in ERCP and EUS. Conclusion: Our study shows that despite inadequate exposure to ERCP/EUS in standard 3-year fellowship programs, a majority of graduating fellows plan on performing ERCP in their practice. There also appears to be a great divide among PDs and fellows on whether a fourth year of fellowship is required for adequate training in ERCP and EUS. However, our data did show that as fellows progress in their training, there is a trend towards an increased belief that further training in ERCP/EUS is required. Given that a majority of fellows plan on performing these procedures without adequate training during their fellowship, standardized guidelines for training in ERCP and EUS should be developed by the ACGME in concordance with national gastrointestinal societies.