Why fundamentals of endoscopic surgery (FES)?

Abstract

As flexible endoscopy has moved into the mainstream, gastroenterologists have embraced many of the skills and techniques particular to this modality of diagnosis and intervention. Their adoption of flexible endoscopic technology and training, and the lack of enthusiasm for endoscopic therapy potentials by surgeons, has left many surgical residents and practicing surgeons deficient in endoscopic skills. As a result, education of surgical residents in flexible endoscopy has lagged and training of surgical residents in flexible endoscopy is increasingly coming under scrutiny and has become an area of debate. The medical literature and practice guidelines are replete with articles from surgeons and gastroenterologists debating the appropriate education and training in flexible endoscopy. Both surgical and gastroenterology professional societies have published guidelines for training in flexible endoscopy. These guidelines are often at odds with each other, citing opposing literature supporting their position on appropriate criteria for training in basic upper and lower endoscopy [1][2][3][4]. Flexible endoscopy is a critical element of any general surgeon's and colorectal surgeon's practice. In 2007, 74 % of rural surgeons performed more than 50 flexible endoscopic procedures each year, with 42 % of rural surgeons performing more than 200 flexible endoscopic procedures annually [5]. In a 2010 report on rural, under-served areas that lack gastroenterology services, 39.8 % of an American general surgeons' practice comprises flexible endoscopic procedures [6]. In Canada, surgeons were found to be the primary providers of flexible endoscopic services in smaller urban and rural areas [7].The American Board of Surgery (ABS) has begun to address the training inequity that exists between general surgery residents and gastroenterology fellows [8]. In an effort to ensure surgical residents are fully trained and competent in flexible endoscopy, the ABS has not only increased the minimum requirements for training general surgery residents in flexible endoscopy but has also undertaken the task of formalizing a flexible endoscopy curriculum for its residents. Currently, the ABS and Residency Review Committee (RRC) recommend 35 upper endoscopic procedures and 50 colonoscopies as the minimum number of procedures to be performed by surgical residents. The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) and the ABS have long espoused that numbers do not ensure competency in surgical or endoscopic procedures. This position is fully supported by data. In 2004, the SAGES esophagogastroduodenoscopy (EGD) Outcomes Study Group prospectively reviewed 3,525 EGDs performed by surgeons, showing a high degree of success with low morbidity. There was no correlation between experience (i.e. number of cases performed) and completion rates or major complications [9]. A similar trial by the SAGES Colonoscopy Study Outcomes Group prospectively reviewed 13,580 colonoscopies performed by surgeons and found no correlation between ex...

Is current surgery resident and GI fellow training adequate to pass FES?

“…Although studies examining clinical performance in endoscopy have revealed no differences among general surgeons, colorectal surgeons, and gastroenterologists (GI) [5], the education of surgical residents in flexible endoscopy has come under increased scrutiny [6]. In addition, general surgery residents are expressing concerns about their ability to perform endoscopy upon graduation [7,8] and many residency program directors are experiencing difficulties in providing trainees with an adequate flexible endoscopy curriculum [9].…”

“…FES is a test of knowledge and skill in flexible gastrointestinal endoscopy and consists of a comprehensive, web-based didactic component, a multiple-choice knowledge test, and a fivemodule virtual reality skills examination. These components are designed to teach and validate basic endoscopic knowledge and skills [6,12,13].…”

Current status of endoscopic simulation in gastroenterology fellowship training programs

“…In order to address the limitations associated with traditional endoscopic training and assessment, many forms of simulators have been developed over the past decade [35,36]. As more surgical training programs are implementing simulation as part of the endoscopy curriculum and simulation testing has been mandated as part of the certification process [23][24][25], it is important to understand the role that simulation currently plays in gastroenterology fellowship training. In this study, we demonstrate the prevalence of endoscopic simulators among gastroenterology fellowship programs in the United States.…”

“…In addition, all graduating surgical residents are required to pass the Fundamentals of Endoscopic Surgery (FES), which is the final milestone in the FEC, prior to applying for ABS certification. The FES program includes a web-based didactic lecture, a written multiple choice test on cognitive aspects of endoscopy, and also a virtual reality skills exam to assess hands-on technical skills [23][24][25].…”

Changing attitudes and improving skills: demonstrating the value of the SAGES flexible endoscopy course for fellows

“…Instead, much of the instruction and training for these skills occurred piecemeal throughout training and were led by a combination of faculty from GI, endoscopy, or colorectal services. Fortunately, efforts are currently underway to enhance the design and effectiveness of endoscopic curricula in residency programs [8][9][10][11].…”