Megan Delisle, MD, Courtney Chernos, MD, Jason Park, MD, MEd, FRCSC, Krista Hardy, MD, MSc, FRCSC, Ashley Vergis. University of Manitoba
Introduction: Our objective was to assess flexible endoscopy training in Royal College of Physicians and Surgeons of Canada (RCPSC) General Surgery residency programs. Implementation of competency-based medical education for RCPSC General Surgery residencies is to occur in 2019. Relevant milestones and entrustable professional activities for endoscopy should be defined by pre-existing evidence-based endoscopy curriculum guidelines.
Methods: A 35-question survey was developed using endoscopy curriculum guidelines from the Society of American Gastrointestinal and Endoscopic Surgeons and the American Board of Surgery. All 17 RCPSC General Surgery program directors were contacted to complete the questionnaire via the web-based SurveyMonkey.ca ® platform.
Results: All 17 program directors completed the survey.
Programs have an average of 2.8 months (range 0-4, SD 1.1) of dedicated endoscopy training. One program reported no endoscopy rotation. Half of the programs have cognitive (n=7, 46.7%) and technical (n=8, 53.3%) skills training before endoscopy rotations. Pre-rotation endoscopy simulation is available in 10 programs (83.3%). During endoscopy rotations, seven programs (46.6%) have a didactic curriculum and 11 programs (73.3%) have exposure to gastrointestinal bleeding clinically. Upon completion of endoscopy rotations, four programs (26.7%) have formal skills assessments and two have formal knowledge examinations (13.3%). All programs require endoscopy procedures be logged throughout residency, but only three include quality indicators (21.4%). One program requires residents to obtain Fundamentals of Endoscopic Surgery certification.
Figure 1: Mean Number of Endoscopy Procedures
|Gastroscopies (range, SD)||Colonoscopies (range, SD)|
|Endoscopy Rotations||82 (10-150, 33.6)||156 (40-350, 76.3)|
|Entire Residency||150 (20-400, 98.6)||241 (50-500, 127.2)|
The number of months of dedicated endoscopy training is significantly correlated with the total number of endoscopic procedures performed over entire residencies (p=0.03). Snare polypectomy, hemorrhoid banding and percutaneous endoscopic gastrostomy tube placement are the only endoscopic procedures residents are reported to perform independently. Eleven program directors (73.3%) believe residents are prepared for independent endoscopy, while four disagree (26.7%). Program directors’ perceptions of residents’ preparedness are significantly correlated with the number of endoscopic procedures performed by residents (p<0.01).
Conclusion: Deficits exist in endoscopy training in RCPSC General Surgery residencies. Resident competency appears to be significantly correlated with procedure numbers and few programs have adopted formal curriculums and assessments. As we move towards competency-based education, entrustable professional activities and milestones should be supported by evidence-based, formal skills and knowledge assessments.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 85332
Program Number: S085
Presentation Session: MIS Education Session
Presentation Type: Podium