The Definitions Document: A Reference for Use of SAGES Guidelines

This statement was reviewed and approved by the Board of Governors of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) on Jan 2009.


Authorization by a health care organization allowing a health care practitioner to provide a defined class of patient care services.


A medical or surgical procedure performed by two or more competent health care practitioners within the same or different specialties. These practitioners will have expertise in various portions of the procedure, so that all aspects of the procedure are safely and proficiently performed. Common examples of collaborative practice are 1) A surgeon(s) would provides anatomical access to allow the other(s) to perform a specific task. 2) Two surgeons in the same specialty with complimentary technical skills and knowledge.


Competency of the applicant and/or institution regarding patient selection, peri-procedural care, conduct of the operation, technical skill and equipment necessary to safely complete the procedure using laparoscopic and/or thoracoscopic techniques, and the ability to proceed immediately with the traditional open procedure


A health care practitioner’s capability to utilize their skill and knowledge, derived through training and experience, to safely and proficiently perform a task or procedure. – OR – The ability of a health care practitioner to perform up to defined expectations.


A co-surgeon is one of two or more surgeons of the same or different specialties working together to perform a specific procedure. Each co-surgeon assumes primary responsibility for that portion of the patient care and operative procedure that falls within his/her area of expertise.


This is a limited period of instruction that should offer category I Continuing Medical Education (CME) credits that meet American Medical Association (AMA) standards. The course should be taught by instructors with appropriate clinical experience. The curriculum should include didactic instruction, hands on experience utilizing inanimate and/or animate educational tools, and the opportunity to observe performance of the task by an instructor. Documentation must verify the level of the attendee’s participation, i.e. attendance, mastery of course objectives, etc. A formal course alone is generally not appropriate training to begin performing a procedure independently.


Documented evidence of licensure, education, training, experience, or other qualifications.


  1. Case list that must specify the applicant’s role (primary surgeon/operator, co-surgeon, first assistant, chief resident, junior resident or observer). Complications, outcomes, and conversion to traditional techniques should be included if known. The applicant must specify if these details are not known.
  2. Summary letter from preceptor and/or program director and/or chief of surgery (should state if applicant can independently and competently perform the procedure in question).


Specialized areas within the field of surgery, which require unique knowledge and skills related to equipment, physiology, and operative technique, whether the procedure is performed inside or outside of the traditional operating room.


Optional recommendation; many alternatives may be appropriate


Mandatory or indispensable recommendation


Competency and participation in the necessary pre-treatment preparation process, treatment course, and post-treatment period by both the responsible physician and the facility where the patient will be cared for.


A surgeon with appropriate basic knowledge and experience seeking individual training in skills and/or procedures not learned in prior formal training. The trainee must have appropriate background knowledge, demonstrated basic skills, and clinical experience relevant to the proposed curriculum.


An expert surgeon who undertakes to impart his/her clinical knowledge and skills in a defined setting to a preceptee. The preceptor must be appropriately privileged, board certified, skilled, and experienced in the procedure(s) and or technique(s) in question. In order to serve as a preceptor in a specific procedure or technique, the surgeon (preceptor) must be a recognized authority (e.g. publications, presentations, extensive clinical experience) in the particular field of expertise.


An individual educational program in which a health care practitioner acquires additional skills, judgment, and/or knowledge to improve his/her performance of specific medical or surgical techniques and/or procedures. The preceptorship should define eligibility for participation, have a defined curriculum, and provide documentation of attendance, successful/unsuccessful completion of the program, and whether or not the health care practitioner can independently perform the intended procedure.


A quantifiable examination of a trainee’s level of clinical knowledge, manual skills or technical proficiency prior to commencing a training course.


The process whereby a specific scope and content of patient care services (that is, clinical privileges) are authorized for a health care practitioner by a health care organization based on evaluation of the individual’s credentials and performance.


A quantifiable examination of a trainee’s level of clinical knowledge, manual skills or technical proficiency after completion of a training course.


A proctor differs from a consultant or a preceptor in that he/she functions as an observer and evaluator, does not directly participate in patient care, does not serve simultaneously as a preceptor, and receives no fees from the patient. Proctoring may be an element of the privileging process. The proctor should be responsible to the privileging committee, and not to the patient or to the individual being proctored. The proctor must have qualifications allowing him/her to make a determination of competency based on the observations. These qualifications should be defined by the appropriate staff of the health care facility. In rare cases, a proctor may intervene during a procedure on an emergency basis, and assume responsibility for patient care in order to preserve the welfare of the patient.


Highly desirable recommendation; a limited number of alternatives may be appropriate


The ability to use one’s knowledge effectively and readily for the performance of a task or procedure.


A specialized, dedicated location (separate from the patient care area) in which a health care practitioner or student acquires, refines, and/or improves his/her ability to perform specific medical/surgical tasks or procedures utilizing animate and/or inanimate educational tools.


This document was prepared and revised by the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES)

This statement was reviewed and approved by the Board of Governors of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) on Jan 2009.

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Guidelines for clinical practice are intended to indicate preferable approaches to medical problems as established by experts in the field. These recommendations will be based on existing data or a consensus of expert opinion when little or no data are available. Guidelines are applicable to all physicians who address the clinical problem(s) without regard to specialty training or interests, and are intended to indicate the preferable, but not necessarily the only acceptable approaches due to the complexity of the healthcare environment. Guidelines are intended to be flexible. Given the wide range of specifics in any health care problem, the surgeon must always choose the course best suited to the individual patient and the variables in existence at the moment of decision.

Guidelines are developed under the auspices of the Society of American Gastrointestinal and Endoscopic Surgeons and its various committees, and approved by the Board of Governors. Each clinical practice guideline has been systematically researched, reviewed and revised by the guidelines committee, and reviewed by an appropriate multidisciplinary team. The recommendations are therefore considered valid at the time of its production based on the data available. Each guideline is scheduled for periodic review to allow incorporation of pertinent new developments in medical research knowledge, and practice.