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114 ASSESSMENT OF ENDOSCOPIC TRAINING OF GENERAL SURGERY RESIDENTS S Asfaha, S Alqahtani, RJ Hilsden, AR MacLean, PL Beck In this study, we reviewed the number of endoscopies performed by gastroenterology (GI) fellows and surgical residents graduating over a three year period. Given the variable practices of general surgeons, we examined the number of endoscopies performed by staff GI specialists and general surgeons in large (>100,000 persons) and small (<100,000 persons) communities.
In lieu of the increasing demands for endoscopy, one of the greatest challenges to residency programs has been ensuring competency of new trainees. Assessing endoscopic competency can be a difficult process. The American Society of Gastrointestinal Endoscopy (ASGE) recommends that a minimum of 130 esophagogastroduodenoscopies (EGDs) and 140 colonoscopies be performed to assess competency.
Alberta physician billing data from January 1, 1994 to December 31, 2001 were used to determine endoscopic procedure number and patterns of use. We also reviewed the number of endoscopies performed by all GI fellows and surgery residents completing their training programs in 2004-2006.
The number of colonoscopies, but not EGDs, performed by gastroenterologists in large cities increased (~2 fold) over an eight year period. The number of endoscopies performed by surgeons in similar areas and time periods did not change significantly. In contrast, in smaller communities, the number of EGDs and colonoscopies performed by surgeons increased ~2 fold (from ~4,065 to 7,288 EGDs) and ~4 fold (from ~1,909 to ~7,629 colonoscopies) respectively. There was minimal variation in the number of colonoscopies (~3,000) performed by gastroenterologists in smaller communities over this same time interval. However, there was considerable difference in the number of procedures completed by GI fellows vs surgery residents (average number of EGDs: surgery residents 29 ± 5.6 vs gastroenterology fellows 363.9 ± 12.7; average number of colonoscopies: surgery residents 91 ± 14.2 vs gastroenterology fellows 247.8 ± 21.6).
Given that increasing endoscopies in the community are performed by general surgeons, residency training programs need to ensure competency of their trainees. GI fellows, but not surgery residents, achieved the required number of endoscopic procedures recommended by the ASGE. These data suggest that we must re-examine our training programs and/or our methods for evaluating endoscopic competence.