Endoscopic training in gastroenterology fellowship: adherence to core curriculum guidelines

Abstract

Background

The Gastroenterology Core Curriculum and American Society of Gastrointestinal Endoscopy provide guidelines for endoscopic training. Program adherence to these recommendations is unclear. This study aims to assess endoscopic training experience during fellowship.

Methods

Design: Questionnaire study. Setting: The questionnaire was circulated to US fellowship programs, with the assistance of the American Gastroenterological Association. Participants: Graduating third-year fellows.

Results

Seventy-three fellows returned the questionnaire. Nearly all fellows met the required numbers for esophagoduodenoscopy (98 %) and colonoscopy (100 %), with fewer meeting requirements for PEG (73 %) and non-variceal hemorrhage (75 %). The majority of fellows did not meet minimum numbers for variceal banding (40 %), esophageal dilation (43 %), capsule endoscopy (42 %). Fellows rated training in cognitive aspects of endoscopy as 3.86 [1 (inadequate), 5 (excellent)] and reported greatest emphasis on interpreting endoscopic findings and least on virtual colonography. Quality indicators of endoscopy received little emphasis (rating of 3.04; p = 0.00001), with adenoma detection rate being least emphasized. Fifty-six percent of fellows reported having routine endoscopy conferences. Half of the programs have endoscopic simulators, with 15 % of fellows being required to use simulation. Following direct hands-on experience, fellows rated external endoscopy courses (64 %) as the next most useful experience.

Conclusions

Many fellows do not meet required numbers for several endoscopic procedures, and quality indicators receive little emphasis during training. Most programs do not provide simulation training or hold regular endoscopy conferences. Fellowship programs should perform internal audits and make feasible adjustments. Furthermore, it may be time for professional societies to revisit training guidelines.