U.S. Gastroenterology Fellowship Programs Are Not Practicing Competency Based Medical Education in Endoscopy Training: National Survey of GI Program Directors and GI Trainees

Abstract

Introduction: ACGME emphasizes importance of medical trainees meeting performance benchmarks and demonstrating readiness for unsupervised practice. The aims were to describe current methods of endoscopy training and assessment of competence and compare GI trainee (GIT) and GI program director (GPD) perceptions of current endoscopy curriculum quality and what is valued in competence assessment.Table 1Methods: ACGME accredited GPDs and GITs completed an online survey of domains relevant to endoscopy training and competency assessment. Content validity was verified by expert panel of 13 academic GIs. IRB approved. Results: Sixty-four percent (94/148) of GPDs and 47% of GITs (546/1167) responded. Only 77% of GPDs reported having a formal endoscopy curriculum and only 39% of GITs are aware of a formal curriculum. According to GPDs, the vast majority of programs assess competence by procedure volume (85%) and attending evaluations (96%). Minority use independent procedure completion rates (38%), adverse event rates (32%), skills assessment tools (30%) or validated quality metrics (28%). Ten percent of GITs are unaware how endoscopy competence is assessed. Only 64% of GPDs reported requiring fellows to meet specific benchmarks by year of training and only 65% of GPDs and GITs reported that current competency assessment by year of training is good or very good. GPDs rated their programs as having better quality of endoscopy training compared to GITs (tab1A) and GPDs rate quality of feedback better than GITs. Both GITs and GPDs value the importance of quality metrics in assessment of competence, GITs more so than GPDs (tab1B). Conclusion: Although both GITs and GPDs rate quality of current endoscopy training highly (GPD>GIT) and both value quality metrics (GIT>GPD), minority of programs assess competence by year of training or metrics that demonstrate readiness for independent practice. There is a need for improved endoscopy curricula to include competency-based measures which are better suited to demonstrate readiness for unsupervised practice.