Training in Gastrointestinal Endoscopy in Canada: A Survey of Program Directors in Gastroenterology

Abstract

Background: Core GI training in Canada is 2 years in length. Little is known about the quality of endoscopy training in Canada. Furthermore, there exist no data as to how endoscopic skill acquisition is measured. Aim: To identify how endoscopy is taught to Canadian GI trainees, and to quantify the program directors' assessments of endoscopic competency. Methods: A 15-question survey was posted on the Canadian Association of Gastroenterology (CAG) website in 2003 for 3 months. All program directors of accredited GI training programs in Canada were asked to complete an on-line survey that included questions about the endoscopy curriculum, supervision, methods of evaluation, and the director's perception of residents' endoscopic competence. Responses were recorded in 5-point Likert scales. Results: 18 of 19 program directors responded (95%), including all 6 pediatric and 12/13 adult programs. Fifteen programs (78%) indicated that they had a formal endoscopy training curriculum. Yet many programs did not offer formal teaching on: informed consent (28%), safety and sedation (39%), indications and complications (44%), alternatives to endoscopy (11%), antibiotic prophylaxis (22%), recognition and management of complications (39%), endoscopy unit management (11%), endoscope and accessory design and their operations (22%). All programs used evaluation by the supervising attending. A supervising faculty member was present during 91-100% of procedures performed by trainees in 61% of programs. Documentation of procedural numbers was required in 61%, yet, 55% did not use threshold numbers to evaluate competency. Directors were more confident in competence for diagnostic than therapeutic procedures. Case conference, video clips, still pictures, research projects, and journal clubs were preferred teaching aids. The most important procedures to learn were felt to be diagnostic and therapeutic upper GI endoscopy and colonoscopy, flexible sigmoidoscopy, variceal band ligation, hemostatic injection therapy, and hot snare polypectomy. No differences were noted between pediatric and adult program responses. Conclusion: This survey provides a snapshot of program directors' perception of endoscopic training in Canada. There exist discrepancies with published recommendations from national endoscopic societies. Further studies are needed to determine whether the trainees' perceived level of competence by program directors correlates with objective assessments of endoscopic ability.