Considerable Heterogeneity in Endoscopy Training Across European Gastroenterology Curricula

Aims Endoscopic diagnostic and therapeutic possibilities are continuously expanding. Adequate training and confirmation of competence before independent practice are more essential than ever to ensure high-quality patient care. Historically, endoscopy training has been a part of gastroenterology board certification, with training requirements specified in the national gastroenterology curricula. In this study, we present a comparative analysis of endoscopy training as defined in the national curricula across Europe.

Methods We identified and collected curricula for gastroenterology board certification from 40 out of 49 UEG member states for a structured evaluation of endoscopy training conditions. Two independent investigators extracted data, following automated translation into English using commercially available software (DeepL). Descriptive statistics were applied, and continuous variables were reported as the mean with the interquartile range.

Results Endoscopic training was included in all curricula examined, with competency in esophagogastroduodenoscopy (EGD) and colonoscopy being mandatory in all 40 curricula. Most curricula defined specific target numbers for performed EGDs and colonoscopies, but 12/40 (30%) did not specify case numbers. The number of required cases varied significantly for EGD (median 300, IQR 200-300) and colonoscopy (median 200, IQR 100-300). Curricula showed even greater variability in training for more advanced endoscopic techniques, such as endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS). Notably, 35% of curricula (14/40) did not include training in these techniques. The required case numbers for ERCP were reported in 50% of curricula that included ERCP training (12/24) and showed considerable heterogeneity (median 30, IQR 15-100), with the highest required number being 150. Case numbers for EUS were mentioned in a third of curricula (8/24), again with wide variation (median 40, IQR 14-75).

Conclusions Across all curricula studied, there is consensus that training in colonoscopy and esophagogastroduodenoscopy is fundamental to gastroenterology training. Competency in these procedures is most commonly defined by case numbers, but there is considerable heterogeneity in the required number of procedures performed. No consensus exists regarding training in ERCP and EUS across European curricula. Alarmingly, the required case numbers for ERCP varied widely and were often far below the recommended procedure volume of 300 suggested by the ESGE, with similar results observed for EUS. A common discussion among all stakeholders on the best way to incorporate training in endoscopic techniques and measures of competency in the respective curricula should be encouraged to improve endoscopic training conditions throughout Europe.