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THE ENDOSCOPIC TRAINING OF GENERAL SURGERY RESIDENTS IN CANADA

R Lee, A Rostom, F Xiao Li, J Love, E Shaffer
University of Calgary, Calgary, Alberta

BACKGROUND: The introduction of national guidelines for colorectal cancer screening and increased public awareness has fueled the demand for colonoscopic procedures in both Canada and the US. Gastroenterologists (GIs) cannot meet this challenge alone and general surgeons (GSs) will often fill the void. The Royal College of Physicians and Surgeons of Canada mandates a 'mastery of surgical skills of [endoscopy]' in a general surgical residency. However, no consensus exists describing the format or goals of this training.
METHODS: A survey was sent to the division heads and program directors of both general surgery (GS) and gastroenterology (GI) programs across Canada (n=62).
RESULTS: 43 (69%) responded, including 22 (51%) GIs and 21 (49%) GSs. Overall, 62% felt both GI and GS should be responsible for the endoscopic education of GS residents; 31% chose GI alone and 7% stated GS alone. By specialty, 62% of GIs specified GI alone should be responsible, 38% both and 0% GS alone. Conversely, 86% of GSs chose both, 14% GS alone and 0% GI alone (p<0.001). Similar statistically significant differences were detected from responses relating to who was believed to be currently responsible (p=0.001). Generally, 36% defined 'competency' by the number of procedures performed, whereas 31% used ileal/cecal/duodenal intubation percentages as the main criteria. The majority (59%) of GIs felt that GS residents should be trained to competency; however, 64% felt they only received exposure to endoscopy, but did not achieve competence. In contrast, most GSs (62%) felt GS residents should attain competency (p<0.05; vs GIs), while 76% believed they actually achieved this goal (p<0.001; vs GIs). Whether acquisition of endoscopy skills should be the primary mandate for GS residents on a GI rotation, 63% of GIs said 'no', though 74% of GSs felt the opposite (p<0.03). This was consistent with responses of how much of a GI rotation should be devoted to endoscopy: GIs specified 52%; GSs indicated 61% (NS).
In summary, there are marked differences of opinion between gastroenterologists and general surgeons concerning the endoscopic training of general surgery residents. These disparities involve the ownership of this responsibility, the form by which it occurs and the end-points achieved. Given the respondents' intimate roles in education, a national consensus may be needed to clarify this form of instruction.

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