Assessing Competency and Training of Upper Endoscopy in a General Surgery Residency Program

Guidelines for optimal endoscopic training for surgical residents have not been formally integrated into modern teaching programs. Our purpose was to apply two endoscopic evaluation tools (EE-1 and EE-2) designed to measure surgical resident competency in the performance of esophagogastroduodenoscopy (EGD). Prospectively collected data were reviewed from consecutive EGDs in a single institution by a single attending surgeon over 3 years (July 2008 to July 2011). Demographic, procedural, and outcome data were collected. Residents were graded at the completion of each procedure by the attending surgeon using EE-1 and EE-2. Descriptive statistics were calculated, and comparisons based on PGY levels were made using Fisher's exact and Kruskal-Wallis tests. P < 0.05 was considered significant. All procedures (N = 50) were performed by residents under the direct attending surgeon supervision. Average patient age was 51 years (range, 31-79 years), 66% were women, and 66% were Caucasian. PGY-3 residents performed 62% of the procedures. Average resident participation was 84% of each procedure. Biopsies were performed in 80% of patients and dilatations in 16%. All EGDs were successfully completed (average time, 13.1 min). EE-1 results demonstrated significantly different grades (P < 0.05) among PGY levels in seven of eight variables. EE-2 grades were significantly different (P < 0.05) among PGY levels in all 10 variables with a general trend of improvement as PGY level increased. There were no mortalities or morbidities. Residents can perform EGDs safely and expeditiously with appropriate supervision. Methods to assess competency continue to evolve and should remain an area of active research.