Download PDF
CC BY-NC-ND 4.0 · Endosc Int Open 2023; 11(02): E193-E201
DOI: 10.1055/a-1981-3047
Review

Global trends in training and credentialing guidelines for gastrointestinal endoscopy: a systematic review

Nasruddin Sabrie
1   Department of Medicine, University of Toronto, Toronto, Canada
,
Rishad Khan
1   Department of Medicine, University of Toronto, Toronto, Canada
2   Division of Gastroenterology, St. Michael’s Hospital, Toronto, Canada
,
Samir Seleq
2   Division of Gastroenterology, St. Michael’s Hospital, Toronto, Canada
,
Hoomam Homsi
2   Division of Gastroenterology, St. Michael’s Hospital, Toronto, Canada
,
Nikko Gimpaya
2   Division of Gastroenterology, St. Michael’s Hospital, Toronto, Canada
,
Rishi Bansal
2   Division of Gastroenterology, St. Michael’s Hospital, Toronto, Canada
,
Michael A. Scaffidi
2   Division of Gastroenterology, St. Michael’s Hospital, Toronto, Canada
,
David Lightfoot
2   Division of Gastroenterology, St. Michael’s Hospital, Toronto, Canada
,
Samir C. Grover
1   Department of Medicine, University of Toronto, Toronto, Canada
2   Division of Gastroenterology, St. Michael’s Hospital, Toronto, Canada
3   The Centre for Therapeutic Endoscopy and Endoscopic Oncology, St. Michael's Hospital, Toronto, Canada
4   Li Ka Shing Knowledge Institute, Toronto, Canada
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Background and study aims Credentialing, the process through which an institution assesses and validates an endoscopist’s qualifications to independently perform a procedure, can vary by region and country. Little is known about these inter-societal and geographic differences. We aimed to systematically characterize credentialing recommendations and requirements worldwide.

Methods We conducted a systematic review of credentialing practices among gastrointestinal and endoscopy societies worldwide. An electronic search as well as hand-search of World Endoscopy Organization members’ websites was performed for credentialing documents. Abstracts were screened in duplicate and independently. Data were collected on procedures included in each document (e. g. colonoscopy, ERCP) and types of credentialing statements (procedural volume, key performance indicators (KPIs), and competency assessments). The primary objective was to qualitatively describe and compare the available credentialing recommendations and requirements from the included studies. Descriptive statistics were used to summarize data when appropriate.

Results We screened 653 records and included 20 credentialing documents from 12 societies. Guidelines most commonly included credentialing statements for colonoscopy, esophagogastroduodenoscopy (EGD), and ERCP. For colonoscopy, minimum procedural volumes ranged from 150 to 275 and adenoma detection rate (ADR) from 20 % to 30%. For EGD, minimum procedural volumes ranged from 130 to 1000, and duodenal intubation rate of 95 % to 100%. For ERCP, minimum procedural volumes ranged from 100 to 300 with selective duct cannulation success rate of 80 % to 90 %. Guidelines also reported on flexible sigmoidoscopy, capsule endoscopy, and endoscopic ultrasound.

Conclusions While some metrics such as ADR were relatively consistent among societies, there was substantial variation among societies with respect to procedural volume and KPI statements.

Supplementary material



Publication History

Received: 22 July 2022

Accepted after revision: 16 November 2022

Accepted Manuscript online:
17 November 2022

Article published online:
23 February 2023

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Adler DG, Bakis G, Coyle WJ. et al. Principles of training in GI endoscopy. Gastrointest Endosc 2012; 75: 231-235
    Google Scholar
  • 2 Faigel DO, Baron TH, Adler DG. et al. ASGE guideline: guidelines for credentialing and granting privileges for capsule endoscopy. Gastrointest Endosc 2005; 61: 503-505
    CrossrefPubMedGoogle Scholar
  • 3 Faulx AL, Lightdale JR, Acosta RD. et al. Guidelines for privileging, credentialing, and proctoring to perform GI endoscopy. Gastrointest Endosc 2017; 85: 273-281
    Google Scholar
  • 4 Powell DE, Carraccio C. Toward competency-based medical education. N Engl J Med 2018; 378: 3-5
    CrossrefPubMedGoogle Scholar
  • 5 Faigel DO, Baron T, Lewis B. et al. Ensuring competence in endoscopy. ASGE policy and procedures manual for gastrointestinal endoscopy: guidelines for training and practice 2005.
    PubMedGoogle Scholar
  • 6 Ekkelenkamp VE, Koch AD, de Man RA. et al. Training and competence assessment in GI endoscopy: a systematic review. Gut 2016; 65: 607-615
    Google Scholar
  • 7 Khan R, Zheng E, Wani S. et al. Colonoscopy competence assessment tools: A systematic review of validity evidence. Endosc 2021; 53: 1235-1245
    Article in Thieme ConnectPubMedGoogle Scholar
  • 8 Sedlack RE, Coyle WJ. ACE Research Group. Assessment of competency in endoscopy: establishing and validating generalizable competency benchmarks for colonoscopy. Gastrointest Endosc 2016; 83: 516-523
    Google Scholar
  • 9 Sedlack RE, Coyle WJ, Obstein KL. et al. ASGE’s assessment of competency in endoscopy evaluation tools for colonoscopy and EGD. Gastrointest Endosc 2014; 79: 1-7
    Google Scholar
  • 10 Siau K, Crossley J, Dunckley P. et al. Colonoscopy Direct Observation of Procedural Skills assessment tool for evaluating competency development during training. The Am J Gastroenterol 2020; 115: 234-243
    CrossrefPubMedGoogle Scholar
  • 11 Siau K, Hodson J, Valori RM. et al. Performance indicators in colonoscopy after certification for independent practice: outcomes and predictors of competence. Gastrointest Endosc 2019; 89: 482-482
    CrossrefPubMedGoogle Scholar
  • 12 Taber S, Frank JR, Harris KA. et al. Identifying the policy implications of competency-based education. Med Teacher 2010; 32: 687-691
    CrossrefPubMedGoogle Scholar
  • 13 Moher D, Liberati A, Tetzlaff J. et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009; 6: e1000097
    Google Scholar
  • 14 Ang T, Cheng J, Khor J. et al. Guideline on training and credentialing in endoscopic retrograde cholangiopancreatography. Singapore Med J 2011; 52: 654-657
    PubMedGoogle Scholar
  • 15 Mesenas S, Ang TL, Khor C. et al. Guidelines for endoscopic ultrasonography. Ann Acad Med Singapore 2010; 39: 489-492
    CrossrefPubMedGoogle Scholar
  • 16 Endoscopy Guidance Group for New Zealand. Guidelines for Local Credentialing in Adult Endoscopy. Wellington, New Zealand. 2021
    PubMedGoogle Scholar
  • 17 Conjoint Committee For Recognition of Training in Gastrointestinal Endoscopy. Information for Applicants. Melbourne, Australia: Gastroenterological Society of Australia, Royal Australasian College of Surgeons, Royal Australasian College of Physicians; 2015
    Google Scholar
  • 18 Arya N, Sahai AV, Paquin SC. Credentialing for endoscopic ultrasound: A proposal for Canadian guidelines. Endosc Ultrasound 2016; 5: 4
    CrossrefPubMedGoogle Scholar
  • 19 Romagnuolo J, Enns R, Ponich T. et al. Canadian credentialing guidelines for colonoscopy. Can J Gastroenterol Hepatol 2008; 22: 17-22
    PubMedGoogle Scholar
  • 20 Ponich T, Enns R, Romagnuolo J. et al. Canadian credentialing guidelines for esophagogastroduodenoscopy. Can J Gastroenterol 2008; 22: 349-354
    Google Scholar
  • 21 Enns R, Romagnuolo J, Ponich T. et al. Canadian credentialing guidelines for flexible sigmoidoscopy. Can J Gastroenterol 2008; 22: 115-119
    CrossrefPubMedGoogle Scholar
  • 22 Springer J, Enns R, Romagnuolo J. et al. Canadian credentialing guidelines for endoscopic retrograde cholangiopancreatography. Can J Gastroenterol 2008; 22: 547-551
    CrossrefPubMedGoogle Scholar
  • 23 Swiss Society of Gastroenterology. Cholangio-pancréatographie endoscopique rétrograde ERCP (SSG). Bern, Switzerland: Schweizerisches Institut für ärztliche Weiter- und Fortbildung, Institut suisse pour la formation médicale postgraduée et continue; 2015
    Google Scholar
  • 24 Polskie Towarzystwo Gastroenterologii. Przyznawanie dyplomu potwierdzającego umiejętności wykonywania badań endoskopowych. Warsaw, Poland. 2021
    PubMedGoogle Scholar
  • 25 Lim Y-J, Moon J-S, Chang D-K. et al. Korean Society of Gastrointestinal Endoscopy (KSGE) guidelines for credentialing and granting previleges for capsule endoscopy. Korean J Gastrointest Endosc; 2008. 37. 393-402
    Google Scholar
  • 26 Moon HS, Choi EK, Seo JH. et al. Education and training guidelines for the board of the Korean Society of Gastrointestinal Endoscopy. Clin Endosc 2017; 50: 345
    Google Scholar
  • 27 Eisen GM, Dominitz JA, Faigel DO. et al. Guidelines for credentialing and granting privileges for endoscopic ultrasound. Gastrointest Endosc 2001; 54: 811-814
    CrossrefPubMedGoogle Scholar
  • 28 Siau K, Beales IL, Haycock A. et al. JAG consensus statements for training and certification in oesophagogastroduodenoscopy. Frontline Gastroenterol 2022; 13: 193-205
    Google Scholar
  • 29 Siau K, Keane MG, Steed H. et al. UK Joint Advisory Group consensus statements for training and certification in endoscopic retrograde cholangiopancreatography. Endosc Int Open 2022; 10: E37-E49
    Google Scholar
  • 30 Joint Advisory Group on Gastrointestinal Endoscopy. JETS Certification Pathways: Trainee Certification Process. London, UK: Royal College of Physicians;
    Google Scholar
  • 31 Johnson G, Webster G, Boškoski I. et al. Curriculum for ERCP and endoscopic ultrasound training in Europe: European Society of Gastrointestinal Endoscopy (ESGE) position statement. Endoscopy 2021; 53: 1071-1087
    Article in Thieme ConnectPubMedGoogle Scholar
  • 32 Dafnis G, Granath F, Påhlman L. et al. The impact of endoscopists’ experience and learning curves and interendoscopist variation on colonoscopy completion rates. Endoscopy 2001; 33: 511-517
    Article in Thieme ConnectPubMedGoogle Scholar
  • 33 Lee T, Blanks R, Rees C. et al. Longer mean colonoscopy withdrawal time is associated with increased adenoma detection: evidence from the Bowel Cancer Screening Programme in England. Endoscopy 2013; 45: 20-26
    PubMedGoogle Scholar
  • 34 Kaminski MF, Regula J, Kraszewska E. et al. Quality indicators for colonoscopy and the risk of interval cancer. N Engl J Med 2010; 362: 1795-1803
    CrossrefPubMedGoogle Scholar
  • 35 Wani S, Hall M, Wang AY. et al. Variation in learning curves and competence for ERCP among advanced endoscopy trainees by using cumulative sum analysis. Gastrointest Endosc 2016; 83: 711-719
    CrossrefPubMedGoogle Scholar
  • 36 Ekkelenkamp VE, Koch AD, Rauws EA. et al. Competence development in ERCP: the learning curve of novice trainees. Endoscopy 2014; 46: 949-955
    Article in Thieme ConnectPubMedGoogle Scholar
  • 37 Huang RJ, Thosani NC, Barakat MT. et al. Evolution in the utilization of biliary interventions in the United States: results of a nationwide longitudinal study from 1998 to 2013. Gastrointest Endosc 2017; 86: 319-326
    CrossrefPubMedGoogle Scholar
  • 38 Park JM, Huo SM, Lee HH. et al. Longer observation time increases proportion of neoplasms detected by esophagogastroduodenoscopy. Gastroenterology 2017; 153: 460-469
    CrossrefPubMedGoogle Scholar
  • 39 Khan R, Gimpaya N, Vargas JI. et al. The Toronto Upper Gastrointestinal Cleaning Score (TUGCS): a prospective validation study. Endoscopy 2022; DOI: 10.1055/a-1865-4180.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 40 Matharoo M, Haycock A, Sevdalis N. et al. A prospective study of patient safety incidents in gastrointestinal endoscopy. Endoscopy international open 2017; 5: E83
    Article in Thieme ConnectPubMedGoogle Scholar
  • 41 Cotton PB, Feussner D, Dufault D. et al. A survey of credentialing for ERCP in the United States. Gastrointest Endosc 2017; 86: 866-869
    Google Scholar
  • 42 Siau K, Green JT, Hawkes ND. et al. Impact of the Joint Advisory Group on Gastrointestinal Endoscopy (JAG) on endoscopy services in the UK and beyond. Frontline gastroenterology 2019; 10: 93-106
    CrossrefPubMedGoogle Scholar
  • 43 Thomson A. ERCP credentialing approaches in Australia and throughout the world. Gastrointestinal Endoscopy 2018; 87: 1365
    CrossrefPubMedGoogle Scholar