Training in basic gastrointestinal endoscopic procedures: a European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA) Position Statement

Abstract

Main StatementsThis ESGE Position Statement provides structured and evidence-based guidance on the essential requirements and processes involved in training in basic gastrointestinal (GI) endoscopic procedures. The document outlines definitions; competencies required, and means to their assessment and maintenance; the structure and requirements of training programs; patient safety and medicolegal issues. 1 ESGE and ESGENA define basic endoscopic procedures as those procedures that are commonly indicated, generally accessible, and expected to be mastered (technically and cognitively) by the end of any core training program in gastrointestinal endoscopy. 2 ESGE and ESGENA consider the following as basic endoscopic procedures: diagnostic upper and lower GI endoscopy, as well as a limited range of interventions such as: tissue acquisition via cold biopsy forceps, polypectomy for lesions ≤ 10 mm, hemostasis techniques, enteral feeding tube placement, foreign body retrieval, dilation of simple esophageal strictures, and India ink tattooing of lesion location. 3 ESGE and ESGENA recommend that training in GI endoscopy should be subject to stringent formal requirements that ensure all ESGE key performance indicators (KPIs) are met. 4 Training in basic endoscopic procedures is a complex process and includes the development and acquisition of cognitive, technical/motor, and integrative skills. Therefore, ESGE and ESGENA recommend the use of validated tools to track the development of skills and assess competence. 5 ESGE and ESGENA recommend incorporating a multimodal approach to evaluating competence in basic GI endoscopic procedures, including procedural thresholds and the measurement and documentation of established ESGE KPIs. 7 ESGE and ESGENA recommend the continuous monitoring of ESGE KPIs during GI endoscopy training to ensure the trainee’s maintenance of competence. 9 ESGE and ESGENA recommend that GI endoscopy training units fulfil the ESGE KPIs for endoscopy units and, furthermore, be capable of providing the dedicated personnel, infrastructure, and sufficient case volume required for successful training within a structured training program. 10 ESGE and ESGENA recommend that trainers in basic GI endoscopic procedures should be endoscopists with formal educational training in the teaching of endoscopy, which allows them to successfully and safely teach trainees.

ESGE and Education in Endoscopy

“…The Education Committee was one of the first committees to be established in 1996. The position of Chair has been held by a series of endoscopists that share a passion regarding education, including Andrzej Nowak (Poland, 1996(Poland, -2000, Aksel Kruse (Denmark, 2000(Denmark, -2004, Lars Aabbaken (Norway, 2004(Norway, -2008 During training, endoscopists need to deepen their theoretical knowledge, learn to manipulate new tools and devices, enhance their ability to identify and differentiate normal versus pathological findings, make timely decisions, communicate, collaborate, and develop leadership within a team [1]. Moreover, they must integrate all these aspects beyond the technical procedure into a patient-centered approach.…”

“…Moreover, they must integrate all these aspects beyond the technical procedure into a patient-centered approach. Therefore, high quality training requires an adequate and up to date intellectual background, technical skills, as well as social and cognitive skills [1].…”

“…Hands on training can offer a valuable opportunity to become familiar with different challenges related to an endoscopic procedure, especially in the early stages of learning a new technique, thereby accelerating learning curves and reducing patient risk [1]. The ESGE has been successfully organizing hands-on endoscopy training sessions for years within major European gastroenterology meetings and especially during ESGE Days.…”