Perceptions of Surgical Residents Regarding Endoscopic Training and Competency

Abstract

Purpose: Endoscopic training is mandatory during surgical residency training, and guidelines have been published suggesting a minimum number of procedures and successful completion rates needed to achieve competency. The aim of this study was to assess the perceptions of current surgical residents regarding their training and competency performing endoscopic procedures following completion of a two month endoscopy rotation under the supervision of experienced attending gastroenterologists. Methods: All residents completing the rotation from July 2004 to July 2006 were surveyed. Total endoscopic (upper endoscopy (EGD) and colonoscopy) exposure and number of independently completed procedures were recorded. Perceptions regarding comfort level and adequacy of training both in diagnostic and therapeutic endoscopic interventions were assessed. Data were compared using Welch's t-test assuming unequal variances and chi-squared analysis. P-values <0.05 were considered significant. Results: Sixteen residents completed the endoscopy rotation during the study period. The mean number of endoscopic procedures performed per the endoscopic training rotation was 135.75 + 73.8. (mean 86 colonoscopies and 54 EGDs). Successful completion rates for colonoscopy (43%) were significantly lower than upper endoscopy (83%), (p ≦ 0.001). Residents felt more comfortable with their ability to complete upper endoscopy (p = 0.001) and with the adequacy of their training with EGDs (p = 0.020) as compared to colonoscopy. The mean numbers of colonoscopic polypectomies and endoscopic bleeding therapy performed by residents were 12.0 + 10.4 and 0.3 + 0.2, respectively. Residents rated their comfort level with performing colonic polypectomy much higher than performing upper endoscopic bleeding therapy (p ≦ 0.001). Despite performing fewer procedures than the published minimum recommendations, 45% and 60% of residents reported that they planned to perform colonoscopy and upper endoscopy, respectively, after graduation from residency. Conclusion: Surgical residents in our training program felt more comfortable with their skills and training in EGD than colonoscopy; however, none achieved the published minimum volume or successful completion rates for either procedure. As most cited their intention to perform endoscopic therapy after residency, a two month training experience for surgical residents in endoscopic therapy may not be sufficient to safely and reliably perform these procedures.