Is current surgery resident and GI fellow training adequate to pass FES?

Abstract

The purpose of this study was to assess the adequacy of current surgical residency and gastroenterology (GI) fellowship flexible endoscopy training as measured by performance on the FES examination. Fifth-year general surgery residents and GI fellows across six institutions were invited to participate. All general surgery residents had met ACGME/ABS case volume requirements as well as additional institution-specific requirements for endoscopy. All participants completed FES testing at the end of their respective academic year. Procedure volumes were obtained from ACGME case logs. Curricular components for each specialty and institution were recorded. Forty-eight (28 surgery and 20 GI) trainees completed the examination. Average case numbers for residents were 76±26 colonoscopies and 45±12 EGDs. Among GI fellows, PGY4s (N=10) reported 99±64 colonoscopies and 147±79 EGDs. PGY5s (N=3) reported 462±307 colonoscopies and 411±260 EGDs. PGY6 GI fellows (N=7) reported 515±111 colonoscopies and 418±146 EGDs. The overall pass rate for all participants was 75%, with 68% of residents and 85% of fellows passing both the cognitive and skills components. For surgery residents, pass rates were 75% for manual skills and 85.7% for cognitive. On the skills examination, Task 2 (loop reduction) was associated with the lowest performance. Skills scores correlated with both colonoscopy (r=0.46, p<0.001) and EGD experience (r=0.46, p<0.001). Receiver operating characteristics curves were examined among the resident cohort. The minimum number of total cases associated with passing the FES skills component was 103. Significant variability existed in curricular components across institutions. These data suggest that current flexible endoscopy training may not be sufficient for all trainees to pass the examination. Implementing additional components of the FEC may prove beneficial in achieving more uniform pass rates on the FES examination.