Post written by David L. Diehl, MD, FASGE, AGAF, from the Department of Medicine and Pathology, Geisinger Commonwealth School of Medicine, Department of Gastroenterology, Geisinger Medical Center, Danville, Pennsylvania, USA.

It’s time to rethink endoscopic training in gastroenterology.

The practice of gastroenterology is changing because of increased subspecialization as well as current mechanisms of reimbursement. In the early days of endoscopy, there was a limited range of therapeutic interventions, and all endoscopists were trained to perform these safely and effectively.

In the last several years, despite an acceleration of innovation, adoption of novel technologies in clinical practice has lagged. We feel that some of the reasons for this can be traced back to our fellowship training programs. A narrowed endoscopic focus of the general gastroenterology faculty in fellowship training programs along with productivity-based compensation has had an unintended detrimental effect on the skillset of our graduating trainees.

The widespread shift of academic training programs to productivity-based compensation has resulted in pressure for efficiency. This often translates to less “scope time” for trainees. There also has been a migration of endoscopic procedures from the general endoscopist to other specialties or therapeutic endoscopists. For example, at some institutions, interventional radiology or general surgery routinely perform PEG tube placement. Larger colon polyps may be referred to surgery despite viable options for endoscopic resection in many cases. Luminal strictures often get punted to the interventional endoscopist.

These trends have resulted in a generation of endoscopists with inadequate training in a range of basic endoscopic procedures that they may encounter in practice. This in turn leads to undertraining of fellows who then become junior faculty. In this essay, we take a closer look at the areas of skill deficit among trainees, find areas of opportunity for expansion, and propose ways to address this looming issue.

More than ever, endoscopic training must keep pace with these developments. Despite advanced endoscopy training programs, there is still a shortfall of therapeutic endoscopists, particularly outside metropolitan areas. A shortfall of general gastroenterologists also is predicted in the next 10 years, and it is imperative that fellows are adequately trained to tackle core endoscopic procedures with confidence, manage adverse events without anxiety, and ultimately embrace and adopt transformative innovation to improve outcomes for our patients.

Read the full article online.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.