title: How should we establish the clinical case numbers required to achieve proficiency in flexible endoscopy?
abstract: BACKGROUND
  Recommended procedure numbers for upper endoscopy (UE) and colonoscopy (C) are 35 and 50 for surgical residents, and 130 and 140 for gastroenterology fellows, respectively. The purpose of this study was to challenge the methods used to determine proficiency in flexible endoscopy.
  
  
  METHODS
  Global assessment of gastrointestinal endoscopic skills (GAGES) was used to evaluate 139 procedures. Scores for UE were compared using self-reported case numbers and grouped according to requirements for each discipline. C scores were compared using the requirements to define novice and experienced endoscopists. Procedure volumes were plotted against GAGES scores.
  
  
  RESULTS
  Three groups were compared for UE based on case volumes: fewer than 35 cases (group 1), 35 to 130 cases (group 2), and more than 130 cases (group 3). There was no difference between group 2 (17.8 +/- 1.8) and group 3 (19.1 +/- 1.1), but both scored higher than group 1 (14.4 +/- 3.7; P < .05). For C, the scores were 11.8 +/- 3.8 (novices) and 18.8 +/- 1.34 (experienced; P < .001) at a 50-case minimum and 12.4 +/- 4.2 and 18.8 +/- 1.3 (P < .001) for a 140-case proficiency cut-off level, respectively. The curve of procedures versus GAGES plateaued at 50 (UE) and 75 (C).
  
  
  CONCLUSIONS
  The surgical and gastroenterology case recommendations may not represent the experience needed to achieve proficiency. GAGES scores could help define proficiency in basic endoscopy.
authors.affiliation: McGill University Health Centre, Montreal General Hospital, 1650 Cedar Ave., L9-518, Montreal, Quebec, Canada H3G 1A4. melina.vassiliou@mcgill.ca
authors.forename: Melina C
authors.initials: MC
authors.lastname: Vassiliou
authors.forename: Pepa A
authors.initials: PA
authors.lastname: Kaneva
authors.forename: Benjamin K
authors.initials: BK
authors.lastname: Poulose
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Dunkin
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Marks
authors.forename: Riadh
authors.initials: R
authors.lastname: Sadik
authors.forename: Gideon
authors.initials: G
authors.lastname: Sroka
authors.forename: Mehran
authors.initials: M
authors.lastname: Anvari
authors.forename: Klaus
authors.initials: K
authors.lastname: Thaler
authors.forename: Gina L
authors.initials: GL
authors.lastname: Adrales
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Hazey
authors.forename: Jenifer R
authors.initials: JR
authors.lastname: Lightdale
authors.forename: Vic
authors.initials: V
authors.lastname: Velanovich
authors.forename: Lee L
authors.initials: LL
authors.lastname: Swanstrom
authors.forename: John D
authors.initials: JD
authors.lastname: Mellinger
authors.forename: Gerald M
authors.initials: GM
authors.lastname: Fried
mesh_terms: D000704:Analysis of Variance; D002983:Clinical Competence; D003113:Colonoscopy / Q000379:methods / Q000706:statistics & numerical data; D003162:Competency-Based Education / Q000379:methods; D004503:Education, Medical, Graduate / Q000379:methods; D020776:Endoscopes, Gastrointestinal; D016099:Endoscopy, Gastrointestinal / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007396:Internship and Residency; D008297:Male; D011336:Probability; D011792:Quebec; D012015:Reference Standards; D013647:Task Performance and Analysis; D016526:Workload / Q000706:statistics & numerical data*