Is Current Surgery Resident and GI Fellow Training Adequate to Pass FES?

Aimee K Gardner, PhD1, Daniel J Scott, MD1, Ross E Willis, PhD2, Kent Van Sickle, MD2, Michael S Truitt, MD3, John Uecker, MD4, Jeffrey M Marks, MD5, Brian J Dunkin, MD6. 1University of Texas Southwestern Medical Center at Dallas, 2University of Texas Health Sciences Center San Antonio, 3Dallas Methodist Hospital, 4University of Texas Southwestern Medical Center at Austin, 5Case Western Reserve University, 6Houston Methodist Hospital

Background: Beginning in 2018, all graduates in General Surgery residency programs will be required to pass the Fundamentals of Endoscopic Surgery (FES) examination as part of the ABS Fundamentals of Endoscopy Curriculum (FEC). The purpose of this study was to assess the adequacy of current surgical residency and Gastroenterology (GI) fellowship flexible endoscopy training as measured by performance on the FES examination.

Methods: Fifth-year general surgery residents and GI fellows across five institutions were invited to complete the FES examination. All general surgery residents had met ACMGE/ABS case volume requirements as well as additional institution-specific requirements for endoscopy, including some or all of the following: didactic modules, simulator training, and dedicated rotations. All participants completed FES testing at the end of their respective academic year. Procedure volumes were obtained from ACGME case logs. Curricular components for each specialty and institution were recorded.

Results: Twenty-three PGY5 residents and 16 GI Fellows completed the examination. Average case numbers for PGY5s were 79.0±26.9 colonoscopies and 46.3±12.6 EGDs. First-year GI Fellows (N=7) reported 118.1±68.4 colonoscopies and 156.4±92.0 EGDs. Second-year fellows (N=3) reported 462.0±307.0 colonoscopies and 411.0±260.1 EGDs. Third-year fellows (N=6) reported 480.17±67.1 colonoscopies and 365.5±44.7 EGDs. The overall pass rate for all participants was 79.5%, with 69.6% of residents and 93.8% of fellows passing both the cognitive and skills components. For surgery residents, pass rates were 78.3% for manual skills and 82.6% for cognitive. On the skills examination, Task 2 (loop reduction) was associated with the lowest performance. Data indicated no significant correlation between cognitive and skills scores. Experience with colonoscopy cases significantly correlated with skills scores (r =.44, p<.05), whereas EGD cases revealed no significant correlations. Receiver operating characteristics (ROC) curves were examined among the resident cohort.  The minimum number of cases associated with passing FES the skills component was 101. Significant variability existed in curricular components across institutions.

Conclusions: These data suggest that current flexible endoscopy training may not be sufficient for all trainees to pass the examination. Implementing additional components of the FEC may prove beneficial in achieving more uniform pass rates on the FES examination.

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