Endoscopy Training

Goals and Objectives

The objective of the Endoscopy Rotation is to provide trainees with critical, supervised instruction in gastrointestinal endoscopy to assure quality care for patients with digestive diseases.

At the end of the first 12 months of core clinical training, the fellow is expected to achieve basic and clinical knowledge, judgmental skills, and the technical competence requisite for performing these procedures. Thus the endoscopic rotation not only includes technical proficiency but also an understanding of their indications, contraindications, and complications of the various endoscopic procedures and the ability to interpret their results.

Method of Teaching

Facilities and Resources

Faculty. At the present time, the endoscopy training supervisor is Dr. G. S. Raju who is an experienced and skilled endoscopist. Dr. G. S. Raju trained in therapeutic endoscopy at Beth Israel and Deaconess Medical Center & Harvard Medical School, Boston. He is ultimately responsible for the didactic instruction and supervision of all elective and emergency procedures as well as maintaining quality assurance. Faculty supervision in the endoscopy unit is provided by rotation in half-day blocks, of a cadre of skilled endoscopists including Drs. Bhutani, Dupont, Luthra, Nath, Pasricha, Sellin, Shabot, Snyder, Soloway and Szauter. Endoscopic supervision in the Unit consists not only of directly observing and guiding the trainee as he or she manipulates the endoscope but also continuing instruction in endoscopic decision-making, technique, and interpretation of findings and the ongoing evaluation of procedures, reports, and photographic records.

Facilities. The present endoscopy unit is a modern inpatient and ambulatory care facility that provides a safe and efficient environment for both emergent and routine endoscopy. The unit is staffed by well trained RNs and technicians all of whom are properly trained as gastrointestinal endoscopy assistants. It is equipped with modern videoscopic equipment in three procedure rooms and in addition has a dedicated X-ray suite with a state-of-the-art fluoroscopy unit for the performance of ERCPs. The unit is provided with an eleven-bed recovery area staffed by 2-3 nurses.

Endoscopic Experience
Figure 1: Number of selected endoscopic procedures performed in the Endoscopy Unit at UTMB for 2003. These volumes of procedures are more than adequate to meet the ASGE guidelines for achieving the threshold for competence in routine procedures (Table 1).

Figure 1.

Table 1.

MINIMUM NUMBER OF PROCEDURES BEFORE COMPETENCY CAN BE ASSESSED

* Included in total number
# Includes at least 40 sphincterotomies and 10 stent placements

+ For competence in imaging both mucosal and submucosal abnormalities, a minimum of 100 supervised cases is recommended.

For comprehensive competence in all aspects of EUS, a minimum of 150 supervised cases, of which 75 should be pancreatobiliary and 50 EUS guided FNA is recommended.

‡ Intramural lesions or lymph nodes. Must be competent to perform mucosal EUS.

‡‡ Must be competent to perform pancreaticobiliary EUS.

** Data is not yet available on the minimum number of enteroscopies performed

Our fellows are exposed to sufficient numbers of new and follow-up inpatients and outpatients of varied age (adult and geriatric) and of both sexes and with a variety of common and uncommon digestive disorders to permit a broad endoscopic experience. Endoscopic experience with gastrointestinal hemorrhage encompasses acute and chronic bleeding of the upper and lower gastrointestinal tract, including acute variceal hemorrhage.

Evaluation Procedure and Assessment of Competence

Judgment as well as interpretive and technical skills are evaluated in every trainee (Table 2). Regular, ongoing feedback is provided both verbally by the supervising faculty and by means of a quarterly written report filled by all attending faculty, similar in format to that for the nonendoscopic components of the training program. The competency of all fellows is documented by the training program director and by the endoscopy director. The program director has the responsibility to confirm or deny the technical competency and endoscopic exposure of trainees. Documentation of procedures performed is recorded through a computer database that identifies and evaluates the procedure(s) performed and any complications.

TABLE 2: Guidelines for Endoscopic Training: Parameters of Competency