Association for Surgical EducationHow should we establish the clinical case numbers required to achieve proficiency in flexible endoscopy?
Section snippets
Development and validation of the instruments
GAGES upper endoscopy (GAGES-UE) and colonoscopy (GAGES-C) were developed by expert endoscopists and educators. The tools are itemized global ratings scored on a 5-point Likert scale with anchors at 1, 3, and 5. The lowest level of performance is represented by the 1, and 5 is considered ideal. The instruments have been described previously in detail.6 GAGES-UE includes the following fields: intubation of the esophagus, scope navigation, ability to keep a clear endoscopic field, instrumentation
Participants
A total of 139 evaluations were performed among the 11 centers. Most participants were right-handed (96%), and 79% were male. Surgeons constituted 62% of the group, and 38% were gastroenterologists.
Upper endoscopy
The mean GAGES-UE scores and results are shown in Table 1. The GAGES score for endoscopists having previously performed fewer than 35 cases was 14.4 ± 3.7. This was significantly less than the group with intermediate experience of 35 to 130 cases (GAGES, 17.8 ± 1.8) or greater (>130 cases) experience
Comments
There are a plethora of recommendations by various groups and societies regarding credentialing and competence in flexible endoscopy. Several different groups have examined the relationship between the number of procedures and clinical skill. Data supporting the ASGE recommendations are based on a multicenter trial published as an abstract in 1995 by Cass.7 Successful intubation of the esophagus and pylorus were used as outcomes for upper endoscopy. Colonoscopy was evaluated by splenic flexure
Conclusions
Current case recommendations by the ASGE and the RRC may not represent what is actually needed to become proficient in basic flexible endoscopy. GAGES scores may help to define proficiency and to guide training programs, especially because numbers required may vary from one learner to another. GAGES may be a valuable tool to measure outcomes of training strategies and to provide learners with focused, specific feedback.
Acknowledgments
The authors would like to acknowledge all of the participants and individuals from each institution who collected these data. In addition, the authors would like to thank Lisa Jukelevics, Carla Bryant, Sarah Colon, and the members of the Fundamentals of Endoscopic Surgery task force.
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Defining the learning curves of colorectal surgical trainees in colonoscopy using the Assessment of Competency in Endoscopy tool
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2019, Gastrointestinal EndoscopyCitation Excerpt :This assessment showed good test-retest reliability (intraclass correlation coefficient = 0.85), and scores correlated with endoscopy experience and performance of colonoscopy in the clinical setting as measured by unblinded assessors who used the Global Assessment of Gastrointestinal Endoscopic Skill for Colonoscopy (GAGES-C).55,71,99,100 In addition to passing the FES, surgical residents are required to undergo clinical assessment of performance of upper and lower endoscopy by using the GAGES-C tools.99,100 The ABS FEC provides an example of incorporation of simulation into a milestone-based training curriculum for both formative feedback and summative assessment.
Endoscopic Simulators
2019, Clinical Gastrointestinal EndoscopyEndoscopic training: A nationwide survey of French fellows in gastroenterology
2018, Clinics and Research in Hepatology and GastroenterologyCitation Excerpt :Besides most of those preparation courses have been set up recently and mainly involved first and second year fellows. Although the optimal threshold numbers are still being debated, and do not guarantee skill acquisition, there was a correlation between the number of procedures performed and the perceived competence in endoscopy [3,15–17]. During the 4 years of training in gastroenterology, fellows reported having an insufficient median number of weeks dedicated solely to their practical training in endoscopy, and only 35% of fellows in their last year of training had reached the threshold for colonoscopy.
SAGES rebuttal
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