Assessing Competency and Training of Upper Endoscopy in a General Surgery Residency Program.

BACKGROUND: Guidelines for optimal endoscopic training for surgical residents have not been formally integrated into modern teaching programs. Our purpose was to apply two endoscopic evaluation tools (EE-1 and EE-2) designed to measure surgical resident competency in the performance of esophagogastroduodenoscopy (EGD). METHODS: Prospectively collected data were reviewed from consecutive EGDs in a single institution by a single attending surgeon over 3 years (July 2008 to July 2011). Demographic, procedural, and outcome data were collected. Residents were graded at the completion of each procedure by the attending surgeon using EE-1 and EE-2. Descriptive statistics were calculated, and comparisons based on PGY levels were made using Fisher's exact and Kruskal-Wallis tests. P < 0.05 was considered significant. RESULTS: All procedures (N = 50) were performed by residents under the direct attending surgeon supervision. Average patient age was 51 years (range, 31-79 years), 66% were women, and 66% were Caucasian. PGY-3 residents performed 62% of the procedures. Average resident participation was 84% of each procedure. Biopsies were performed in 80% of patients and dilatations in 16%. All EGDs were successfully completed (average time, 13.1 min). EE-1 results demonstrated significantly different grades (P < 0.05) among PGY levels in seven of eight variables. EE-2 grades were significantly different (P < 0.05) among PGY levels in all 10 variables with a general trend of improvement as PGY level increased. There were no mortalities or morbidities. CONCLUSIONS: Residents can perform EGDs safely and expeditiously with appropriate supervision. Methods to assess competency continue to evolve and should remain an area of active research.

Assessing resident performance and training of colonoscopy in a general surgery training program.

BACKGROUND: Recently, the adequacy of endoscopy training in general surgery residency programs has been questioned. Efforts to improve resident endoscopic training and to judge competency are ongoing but not well studied. We assessed resident performance using two assessment tools in colonoscopy in a general surgery residency program. METHODS: Prospectively collected data were reviewed from consecutive colonoscopies by a single surgeon: September 2008 to June 2011. Colonoscopies performed without residents were excluded. Data included patient demographics, procedural data, and outcomes. Following the colonoscopy, residents were graded by the attending surgeon using up two different assessment tools. Descriptive statistics were calculated and outcomes were compared. RESULTS: Colonoscopies were performed by residents in 100 patients. Average age was 52 (range, 22-79) years. Females made up 66 % of patients, and 63 % were Caucasian. Postgraduate level (PG-Y) 3 level residents performed 72 % of colonoscopies. The average resident participation was 73 % of the procedure. Biopsies were performed in 35 %; adenomatous polyps were found in 17 % and invasive cancer in 1 %. Bowel preparation was deemed good in 76 % of patients. Colonoscopy was completed in 90 % of patients. Reasons for incomplete exam were technical (7 patients), inability to pass a stricture (2 patients), and poor prep (1 patient). For completed full colonoscopies, the average time to reach the cecum was 22 min, and withdrawal time was 13 min. Resident assessments were made in 89 of the colonoscopies using 2 separate assessment tools. There were no mortalities; the morbidity rate was 3 %. Morbidities included a perforation related to a biopsy requiring surgery and partial colectomy, a postpolypectomy bleed requiring repeat colonoscopy with clipping of the bleeding vessel, and a patient with transient bradycardia requiring atropine during the procedure. CONCLUSIONS: Using objective assessment tools, overall resident skill and knowledge in performing colonoscopy appears to improve based on increasing PG-Y level, although this was not evident with all categories measured. Methods to assess competency continue to evolve and should be the focus of future research.