title: Status of Competency-Based Medical Education in Endoscopy Training: A Nationwide Survey of US ACGME-Accredited Gastroenterology Training Programs.
abstract: OBJECTIVE
  The Accreditation Council for Graduate Medical Education (ACGME) emphasizes the importance of medical trainees meeting specific performance benchmarks and demonstrating readiness for unsupervised practice. The aim of this study was to examine the readiness of Gastroenterology (GI) fellowship programs for competency-based evaluation in endoscopic procedural training.
  
  
  METHODS
  ACGME-accredited GI program directors (PDs) and GI trainees nationwide completed an online survey of domains relevant to endoscopy training and competency assessment. Participants were queried about current methods and perceived quality of endoscopy training and assessment of competence. Participants were also queried about factors deemed important in endoscopy competence assessment. Five-point Likert items were analyzed as continuous variables by an independent t-test and χ(2)-test was used for comparison of proportions.
  
  
  RESULTS
  Survey response rate was 64% (94/148) for PDs and 47% (546/1,167) for trainees. Twenty-three percent of surveyed PDs reported that they do not have a formal endoscopy curriculum. PDs placed less importance (1—very important to 5—very unimportant) on endoscopy volume (1.57 vs. 1.18, P<0.001), adenoma detection rate (2.00 vs. 1.53, P<0.001), and withdrawal times (1.96 vs. 1.68, P=0.009) in determining endoscopy competence compared with trainees. A majority of PDs report that competence is assessed by procedure volume (85%) and teaching attending evaluations (96%). Only a minority of programs use skills assessment tools (30%) or specific quality metrics (28%). Specific competencies are mostly assessed by individual teaching attending feedback as opposed to official documentation or feedback from a PD. PDs rate the overall quality of their endoscopy training and assessment of competence as better than overall ratings by trainees.
  
  
  CONCLUSIONS
  Although the majority of PDs and trainees nationwide believe that measuring specific metrics is important in determining endoscopy competence, most programs still rely on procedure volume and subjective attending evaluations to determine overall competence. As medical training transitions from an apprenticeship model to competency-based education, there is a need for improved endoscopy curricula which are better suited to demonstrate readiness for unsupervised practice.
authors: Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
authors: S G
authors: SG
authors: Patel
authors: Division of Gastroenterology, Department of Internal Medicine, Northwestern University, Chicago, Illinois, USA.
authors: R
authors: R
authors: Keswani
authors: Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
authors: G
authors: G
authors: Elta
authors: Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
authors: S
authors: S
authors: Saini
authors: Division of Gastroenterology, Department of Internal Medicine, University of Colorado, Aurora, Colorado, USA.
authors: P
authors: P
authors: Menard-Katcher
authors: Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
authors: J
authors: J
authors: Del Valle
authors: Division of Gastroenterology, Department of Internal Medicine, University of Colorado, Aurora, Colorado, USA.
authors: L
authors: L
authors: Hosford
authors: Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
authors: A
authors: A
authors: Myers
authors: Division of Gastroenterology, Department of Internal Medicine, University of Colorado, Aurora, Colorado, USA.
authors: D
authors: D
authors: Ahnen
authors: Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
authors: P
authors: P
authors: Schoenfeld
authors: Division of Gastroenterology, Department of Internal Medicine, University of Colorado, Aurora, Colorado, USA.
authors: S
authors: S
authors: Wani
mesh_terms: D000068:Accreditation; D000328:Adult; D019985:Benchmarking; D002983:Clinical Competence; D003162:Competency-Based Education / Q000379:methods / Q000592:standards / Q000639:trends; D003479:Curriculum; D003625:Data Collection; D004503:Education, Medical, Graduate / Q000379:methods / Q000592:standards / Q000639:trends; D016145:Endoscopy, Digestive System / Q000193:education*; D005257:Fellowships and Scholarships; D005260:Female; D005762:Gastroenterology / Q000193:education*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015397:Program Evaluation; D014481:United States