Skip to main content
SpringerLink
Log in

The SAGES flexible endoscopy course for fellows: a worthwhile investment in furthering surgical endoscopy

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

The SAGES flexible endoscopy course for minimally invasive surgery (MIS) fellows improves confidence and skills in performing gastrointestinal (GI) endoscopy. This study evaluated the long-term retention of these confidence levels and investigated how fellows changed practices within their fellowships due to the course.

Methods

Participating MIS fellows completed surveys 6 months after the course. Respondents rated their confidence to independently perform 16 endoscopic procedures (1 = not at all; 5 = very), barriers to use of endoscopy, and current uses of endoscopy. Respondents also noted participation in additional skills courses and status of fundamentals of endoscopic surgery (FES) certification. Comparisons of responses from the immediate post-course survey to the 6-month follow-up survey were examined. McNemar and paired t tests were used for analyses.

Results

23 of 57 (40%) course participants returned to the 6-month survey. No major barriers to endoscopy use were identified. Fellows reported less competition with GI providers as a barrier to practice compared to their original post-course expectations (50% vs. 86%, p < 0.01). In addition, confidence was maintained in performing the majority of the 16 endoscopic procedures, although fellows reported significant decreases in confidence in independently performing snare polypectomy (− 26%; p < 0.05), control of variceal bleeding (− 39%; p < 0.05), colonic stenting (− 48%; p < 0.01), BARRX (− 40%; p < 0.05), and TIF (− 31%; p < 0.05). Fewer fellows used the GI suite to manage surgical problems than was anticipated post course (26% vs. 74%, p < 0.01). Fellows who passed FES noted no significant loss of independence, changes in use, or barriers to use. 18% made additional partnerships with industry after the course. 41% stated flexible endoscopy has influenced their post-fellowship job choice.

Conclusions

The SAGES flexible endoscopy course for MIS fellows results in long-term practice changes with participating fellows maintaining confidence to perform the majority of taught endoscopic procedures 6 months later. Additionally, fellows experienced no major barriers to implementing endoscopy into practice.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Halverson AL, Hughes TG, Borgstrom DC, Sachdeva AK, DaRosa DA, Hoyt DB (2013) What surgical skills rural surgeons need to master. J Am Coll Surg 217:919–923

    Article  PubMed  Google Scholar 

  2. Valentine RJ, Jones A, Biester TW, Cogbill TH, Borman KR, Rhodes RS (2011) General surgery workloads and practice patterns in the Unites States, 2007 to 2009. Ann Surg 254:520–526

    Article  PubMed  Google Scholar 

  3. Hazey JW, Marks JM, Mellinger JD, Trus TL, Chand B, Delaney CP, Dunkin BJ, Fanelli RD, Fired GM, Martinez JM, Pearl JP, Poulose BK, Sillin LF, Vassiliou MC, Melvin WS (2014) Why fundamentals of endoscopic surgery (FES)? Surg Endosc 28:701–703

    Article  PubMed  Google Scholar 

  4. The American Board of Surgery (2017) Flexible endoscopy curriculum for general surgery residents. https://www.absurgery.org/xfer/abs-fec.pdf. Accessed 9 May 2018

  5. The American Board of Surgery. The American board of surgery training requirements. http://www.absurgery.org/default.jsp?certgsqe_training. Accessed 9 May 2018

  6. Gardner AK, Marks JM, Pauli EM, Majumder A, Dunkin BJ (2017) Changing attitudes and improving skills: demonstrating the value of the SAGES flexible endoscopy course for fellows. Surg Endosc 31:147–152

    Article  PubMed  Google Scholar 

  7. Scott TM, Hameed SM, Evans DC, Simons RK, Sidhu RS (2008) Objective assessment of surgical decision making in trauma after a laboratory-based course: durability of cognitive skills. Am J Surg 195:599–603

    Article  PubMed  Google Scholar 

  8. Maagaard M, Sorensen JL, Oestergaard J, Dalsgaard T, Grantcharov TP, Ottesen BS, Larsen CR (2011) Retention of laparoscopic procedural skills acquire on a virtual-reality surgical trainer. Surg Endosc 25:722–727

    Article  PubMed  Google Scholar 

  9. Okusanya OT, Kornfield ZN, Reinke CE, Morris JB, Sarani B, Williams NN, Kelz RR (2012) The effect and durability of a pregraduation boot camp on the confidence of senior medical student entering surgical residencies. J Surg Educ 69:536–543

    Article  Google Scholar 

  10. Mueller CL, Kaneva P, Fried GM, Feldman LS, Vassiliou MC (2014) Colonoscopy performance correlates with scores on the FES™ manual skills test. Surg Endosc 28:3081–3085

    Article  CAS  PubMed  Google Scholar 

  11. Cunningham CT, Quan H, Hemmelgam B, Noseworthy T, Beck CA, Dixon E, Samuel S, Ghali WA, Sykes LL, Jette N (2015) Exploring physician specialist response rates to web-based surveys. BMC Med Res Methodol 15:32

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

The authors wish to thank the participants in the 2016 SAGES Endoscopy Course for Fellows for their participation in the course evaluations and follow-up surveys.

Author information

Authors and Affiliations

  1. Department of Surgery, Uniformed Services University of the Health Sciences/Walter Reed National Military Medical Center, 8901 Wisconsin Ave., Bethesda, MD, 20889, USA

    Walter Kucera, Matthew Nealeigh & E. Matthew Ritter

  2. Department of Surgery, Houston Methodist Hospital, Houston, TX, USA

    Brian Dunkin

  3. Department of Surgery, Baylor College of Medicine, Houston, TX, USA

    Aimee Gardner

Authors
  1. Walter Kucera
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Matthew Nealeigh
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Brian Dunkin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. E. Matthew Ritter
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Aimee Gardner
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Walter Kucera.

Ethics declarations

Disclosures

Dr. Dunkin serves as a consultant for and has received honoraria from Olympus, Boston Scientific, Medtronic, and Ethicon. He has served as a consultant for Pacira. He is the Executive Vice President of SurgWise Consulting. None of these relationships had any impact on the conduct or design of the above work. Dr. Gardner is the President and CEO of SurgWise consulting. This relationship had no impact on the conduct or design of the above work. Dr. Kucera, Dr. Nealeigh, and Dr. Ritter have no conflicts of interest or financial ties to disclose.

Additional information

Disclaimer

The opinions or assertions contained herein are the private ones of the authors and are not to be construed as official or reflecting the views of the Department of Defense, the Uniformed Services University of the Health Sciences, or any other agency of the U.S. Government.

Appendix 1: questionnaire elements

Appendix 1: questionnaire elements

  • Rate the extent to which these potential barriers affect practice (1 = not at all, 2 = minimally, 3 = somewhat, 4 = moderately, 5 = very)

    • Competition with GI colleagues

    • Hospital Credentialing

    • Lack of opportunities to gain adequate skills

    • Not confident in skills

    • Not important to practice

    • Inadequate resources

  • How are you currently using endoscopy in your practice/fellowship

    • In the OR

      • Adjunct to surgical procedure

      • Manage problems related to surgery

      • Per-oral endoscopic myotomy (POEM)

      • Other therapeutic procedures

    • In the GI Lab

      • Manage problems related to surgery

      • Diagnostic upper endoscopy

      • Diagnostic and therapeutic upper endoscopy

      • Diagnostic colonoscopy

      • Diagnostic and therapeutic colonoscopy

  • Rate your current level of confidence performing each of the following procedures (1 = not at all, 2 = minimally, 3 = somewhat, 4 = moderately, 5 = very)

    • Diagnostic upper endoscopy

    • Diagnostic colonoscopy

    • Colonoscopy with snare polypectomy

    • Percutaneous endoscopic gastrostomy (peg)

    • Balloon dilation of stricture

    • Upper endoscopy with management of non-variceal bleeding

    • Upper endoscopy with management of variceal bleeding

    • Esophageal stenting

    • Colonic stenting

    • Band endoscopic mucosal resection (EMR)

    • Balloon radiofrequency ablation of esophageal mucosa (Barrx™; Medtronic, Fridley, MN)

    • Lower esophageal sphincter radiofrequency therapy (Stretta®; Mediri Therapeutics, Greenwich, CT)

    • Use of Apollo OverStitch™ Device (Apollo Endosurgery, Austin, TX)

    • Use of Esophyx™ Device for TIF (Endogastric Solutions, Redmond, WA)

    • Foreign Body Removal

    • Per-oral endoscopic myotomy (POEM)

  • Have you modified your fellowship experience as a result of this course

    • Did not do anything different as a result of the course

    • Actively sought additional flexible endoscopy cases outside of my service

    • Arranged to do a flexible endoscopy rotation at my institution

    • Arranged to do a flexible endoscopy rotation at another institution

    • Actively sought additional flexible endoscopy cases on my service

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kucera, W., Nealeigh, M., Dunkin, B. et al. The SAGES flexible endoscopy course for fellows: a worthwhile investment in furthering surgical endoscopy. Surg Endosc 33, 1189–1195 (2019). https://doi.org/10.1007/s00464-018-6395-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-018-6395-6

Keywords

Search

Navigation