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Analysis of learning curves in gastroscopy training: the need for composite measures for defining competence
  1. Keith Siau1,2,
  2. Toshio Kuwai3,
  3. Sauid Ishaq1,4
  1. 1Department of Gastroenterology, Dudley Group Hospitals NHS Foundation Trust, Dudley, UK
  2. 2Joint Advisory Group, Royal College of Physicians, London, UK
  3. 3Department of Gastroenterology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Hiroshima, Japan
  4. 4Department of Medicine, Birmingham City University, Birmingham, West Midlands, UK
  1. Correspondence to Profosser Sauid Ishaq, Department of Gastroenterology, Birmingham City University, Dudley Group Hospitals, Dudley, DY1 2HQ, United Kingdom; Sauid.Ishaq{at}dgh.nhs.uk

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We read with interest and commend the study by Ward and colleagues which explores the learning curve in gastroscopy.1 The authors apply a D2 intubation rate of >95% as a proxy marker of trainee competency, and conclude that 187–200 procedures are sufficient to achieve this, in line with Joint Advisory Group (JAG) certification criteria.2 We would like to debate the following points with the authors.

While we agree that D2 intubation and J-maneouvre reflect procedural completion and rely on motor skill, we argue that this stand-alone measure is insufficient to define competence. Competence is defined by the American Society for Gastrointestinal Endoscopy as the 'minimal level of skill, knowledge and/or expertise derived through training and experience that is required to safely and proficiently perform …

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