Endoscopy in Canada: Proceedings of the National Roundtable.

Noah Switzer,Elijah Dixon,Anthony Gomes,Chris De Gara,James Ellsmere,Melina Vassiliou,Nori Bradley,Steve Schwaitzberg,Jill Tinmouth

doi:10.1155/2015/643463

Abstract

This 2014 roundtable discussion, hosted by the Canadian Association of General Surgeons, brought together general surgeons and gastroenterologists with expertise in endoscopy from across Canada to discuss the state of endoscopy in Canada. The focus of the roundtable was the evaluation of the competence of general surgeons at endoscopy, reviewing quality assurance parameters for high-quality endoscopy, measuring and assessing surgical resident preparedness for endoscopy practice, evaluating credentialing programs for the endosuite and predicting the future of endoscopic services in Canada. The roundtable noted several important observations. There exist inadequacies in both resident training and the assessment of competency in endoscopy. From these observations, several collaborative recommendations were then stated. These included the need for a formal and standardized system of both accreditation and training endoscopists.

Highlights

Noah Switzer MD1, Elijah Dixon MD BSc MScEpi FRCSC FACS2, Jill Tinmouth MD PhD3, Nori Bradley MD4, Melina Vassiliou MD MEd FRCSC5, Steve Schwaitzberg MD FACS6, Anthony Gomes MD LMCC FRCSC7, James Ellsmere MD MSc FRCSC8, Chris de Gara MB MS FRCS FACS FFSTEd1
Can J Gastroenterol Hepatol 2015;29(5):259-265. This 2014 roundtable discussion, hosted by the Canadian Association of General Surgeons, brought together general surgeons and gastroenterologists with expertise in endoscopy from across Canada to discuss the state of endoscopy in Canada
The focus of the roundtable was the evaluation of the competence of general surgeons at endoscopy, reviewing quality assurance parameters for high-quality endoscopy, measuring and assessing surgical resident preparedness for endoscopy practice, evaluating credentialing programs for the endosuite and predicting the future of endoscopic services in Canada

Summary

ENDOSCOPY IN CANADA AND CURRENT ISSUES FOR THE GENERAL SURGEON

The suggested definition of competency in colonoscopy is defined as a cecal intubation rate (CIR) >90%; there are many other measures of competence including adenoma detection rate (ADR), sedation usage, withdrawal time, interval colorectal cancer detection rates and surveillance recommendations It has been widely debated whether absolute procedural numbers alone equate to adequate training in endoscopy, measuring the competency of trainees from both general surgery and gastroenterology residency training programs becomes more of a numbers game. A formal subspecialty training program (≥2 years) must be completed for credentialing, while for other physicians, notably surgical residents, at least six months of technical training and knowledge acquisition in colonoscopy is recommended These training periods were selected as the minimum believed to be required to successfully achieve three vital parameters: ≥85% CIR; ≥300 colonoscopies; and cognitive proficiency in aspects of the procedure (knowledge of the indications, contraindications and surveillance recommendations). Performance indicators and auditable outcomes A distinction is drawn in the report between quality indicators, where sufficient evidence exists to recommend targets, and auditable

Endoscopy in Canada

MEASURING COMPETENCE IN FLEXIBLE ENDOSCOPY

WORKING GROUP OBSERVATIONS AND DISCUSSION

Findings

CONCLUSION