Authors: Raf Bisschops, Evelien Dekker, James E. East, Gavin Johnson, Pedro Pimentel-Nunes, David S. Sanders, Mario Dinis-Ribeiro, Thierry Ponchon
ESGE has initiated the development of curricula for postgraduate training in advanced endoscopic procedures. This introductory paper explains the rationale and the methodology of the process.
The challenge of postgraduate training in endoscopy
Because of the accelerated development of new diagnostic and therapeutic techniques, qualified and certified endoscopists are confronted with new challenges in terms of achieving competence and providing up-to-date safe patient care in gastrointestinal endoscopy. Indeed, most standard curricula for endoscopy training during a gastroenterology or surgical fellowship do not cover new diagnostic or therapeutic techniques.
In addition, some older techniques like endoscopic retrograde cholangiopancreatography (ERCP) have become more difficult to learn owing to a shift from being formerly a diagnostic intervention to now being a solely therapeutic intervention, with increasing levels of technical difficulty when combined with interventional endoscopic ultrasound (EUS). Indeed, a generation of endoscopists who had the opportunity to obtain lots of experience in improving their cannulation rates, one of the key performance measures for ERCP , is now slowly retiring and the next generation is confronted with more complex cases earlier in their career. Because of the shift to therapeutic ERCP and the inherent potential complications, this is not included as standard in the core curriculum of gastrointestinal fellows in many countries.
Furthermore, there seems to be continuously increasing demand for interventional therapeutic endoscopy, which has in itself become more complex with the introduction of new and more invasive procedures (peroral endoscopic myotomy, endoscopic submucosal dissection [ESD], and combined EUS and ERCP for hepatobiliary interventions, among others). This in turn will increase the demand for more human resources in interventional endoscopy, all of whom need to be properly trained.
ESGE has in the past embraced quality in endoscopy as one of the main themes to put on the agenda in order to provide the highest quality of endoscopic care to our patients . Evidently, the quality of the delivered patient care will be directly related to the technical and cognitive skills of the endoscopist. As a consequence, the quality of endoscopy is correlated with the quality of training.