Resident Training in Flexible Gastrointestinal Endoscopy: A Review of Current Issues and Options

Abstract

The Residency Review Committee for Surgery (RRC-S) re-cently mandated a 293% increase in required flexible gastroin-testinalendoscopyexperienceforgeneralsurgeryresidents.De-spite this heightened accreditation emphasis, resident exposureto flexible endoscopy remains erratic even in volume-adequatesettings. A successful endoscopy training program requiresplanning, educator and resident buy-in, and proper trainingtools. So, how does the program director in surgery change thecurriculum to prepare trainees for successful completion of theprogram?Stepstowardamoreuniformandappropriatetrainingexpe-rienceshouldincludeaddressingcurrentAccreditationCouncilforGraduateMedicalEducation(ACGME)policies,efficientlyusing available resources, including simulators, and institutinga validated, standardized endoscopy curriculum incorporatingrecommendations from surgery and gastrointestinal societies.Trainees also may benefit from structured experiences with ru-ral surgeons or other high-volume endoscopy providers. Incor-poration of multidisciplinary initiatives focused on expandingandstandardizingendoscopytrainingalsomaybehelpful.Suchinitiativesincludedevelopmentofstandardizednationalcurric-ula and proficiency-oriented skills assessment. Another bur-geoning initiative is natural orifice translumenal endoscopicsurgery (NOTES), which lends itself to novel technology de-sign, expansion and application of fundamental endoscopicskills,multidisciplinarytrainingandresearchmodels,plusout-comes assessment.Along with reviewing the aforementioned issues, this ar-ticle articulates the perspective that flexible endoscopy is anintegral part of general surgery and that alimentary tractsurgery will involve increasing utilization of endoscopictechniques in the future. If gastrointestinal surgeons are toprovide integrated and current patient care, it will be neces-sary to incorporate intralumenal and potentially translume-nal endoscopic techniques as they evolve. This article detailsthe available strategies to prepare general surgery residentsfor the scope of contemporary practice.