Fellows Completing a Canadian Two Year Training Program in Gastroenterology Complete Enough Endoscopic Procedures to Satisfy ASGE Guidelines and Are Competent Colonoscopists in Their First Year of Practice

Abstract

Background: One of the greatest tasks facing gastroenterology training programs is teaching fellows to perform endoscopic procedures adequately and safely. Most organizations and hospital privileging committees rely on procedure numbers as a surrogate marker of competence. The American Society for Gastrointestinal Endoscopy (ASGE) recommends GI trainees to perform a minimum of 130 diagnostic gastroscopies and 140 colonoscopies (CS) during their fellowship. The standard length of a GI fellowship in United States is 3 years whereas Canada and several other countries have a mandatory 2 year fellowship. Surgical residents also perform gastroscopies and colonoscopies and often routinely do these procedures once in practice without our further training. Purpose: To assess the number of endoscopic procedures performed by GI trainees, surgical residents and practicing gastroenterologists over 2 years period and to determine how competent our fellows are in the first year of practice. Procedures done by staff give a view for the trainees of the number of procedures to be expected in the future. Methods: We reviewed all endoscopic procedures performed in our institution according to type of practice or training level. We reviewed procedures performed by the following 4 groups; GI fellows with faculty supervision, surgical residents, academic gastroenterologist (80% academic/20% clinical) and full-time clinical gastroenterologists over a 2 year period. Endoscopic procedures done by 3 graduating fellows in their first year of clinical practice were also reviewed and their rates of successful cecal intubation were determined. Results: 19 endoscopists (7 GI fellows, 6 surgical residents, 3 academic staff and 3 clinical staff) performed 16,810 procedures during the study period. The average number of endoscopic procedures performed over 2 years was; GI fellows 632 ± 41 procedures per fellow (214 ± 18.6 CS), surgical residents 158 ± 31 (106 ± 24.7 CS) (only 2 of 7 performed >140 CS), academic staff 807 ± 43.6 (392 ± 5 CS) and clinical staff 3006 ± 641.1 (1642 ± 200.9 CS). Cecal intubation rate for the graduated GI fellows in their first year of clinical practice was 86.5% to 96.6% (mean = 90%). Conclusion: All our GI fellows achieved the required number of endoscopic procedures according to ASGE recommendations, however; only 2 of 7 surgical residents achieved this number over a 2 year period. Upon graduation our fellows were competent colonoscopists, achieving cecal intubation rates similar to those reported for staff endoscopists at the Mayo Clinic and above rates reported elsewhere in the literature.