Assessment of endoscopic training of general surgery residents in a North American health region

Background: Ensuring competency of trainees is a challenge for residency programs. The American Society for Gastrointestinal Endoscopy (ASGE) recommends that a minimum of 130 EGDs and 140 colonoscopies be performed to assess competency. Objective: We assessed the number of endoscopies performed by surgery and gastroenterology residents during their training. Endoscopy patterns were also assessed for staff gastroenterology specialists and general surgeons in Alberta, Canada. Design: Physician billing data were used to determine endoscopic practice patterns, and the number of endoscopies performed by gastroenterology fellows and surgery residents were obtained. Setting: Major teaching hospital. Main Outcome Measurement: Procedure numbers. Results: In large cities, the number of colonoscopies performed by gastroenterologists increased (∼2-fold) over the study period (there was minimal change in endoscopy numbers by surgeons). In contrast, in smaller communities, EGDs and colonoscopies by surgeons increased about 2-fold (from ∼4065 to 7288) and about 4-fold (from ∼1909 to ∼7629), respectively (with only a minimal increase in colonoscopies (∼3000), by gastroenterologists. During training, gastroenterology fellows performed significantly more procedures (EGDs, 29 ± 5.6 by surgery residents vs 363.9 ± 12.7 by gastroenterology fellows; colonoscopies, 91 ± 14.2 by surgery residents vs 247.8 ± 21.6 by gastroenterology fellows). Limitation: All training data are from a single teaching center. Conclusions: All gastroenterology fellows, but none of the surgery residents, achieved the minimum number of endoscopic procedures recommended by the ASGE to assess competency. These data suggest that we must reexamine our training programs and/or our methods for evaluating endoscopic competence.