The Canadian Association of General Surgeons hosted the first multi-disciplinary roundtable discussion on endoscopy in Canada February 7th in Toronto, ON. This long-awaited first step in understanding and addressing complex issues and mounting tension was a collegial and welcome conversation among General Surgeons and their Gastroenterologist counterparts. Among the 30 meeting participants were representatives from the Canadian Association of Gastroenterology, Cancer Care Ontario, the Canadian Society of Colon and Rectal Surgeons and the Royal College.
Compelling information was presented at the discussion, including a definition of competence by Dr. Melina Vassiliou, who has been working on the same issue in the US with the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). Dr. Vassiliou stated that by definition, competence can be considered as “having the minimal level of skill, knowledge and expertise, derived through training and experience, that is required to perform a task or procedure safely and proficiently”[i]. This definition helps to clarify who should perform endoscopy, however can be complicated by the fact that those skills and aptitude required have an element of subjectivity, and therefore the standard of competence varied from one individual to another, and was also in constant evolution, just as science and technology was in constant evolution.
Dr. Jill Tinmouth of Cancer Care Ontario presented a step-by-step process of how the guideline for quality colonoscopy in Ontario was developed, which states a minimum of 200 endoscopic procedures be performed annually to be considered a ‘competent’ endoscopist. This figure contrasts with the Global Assessment of Gastrointestinal Endoscopic Skills’ (GAGES) data that demonstrates competence being achieved between 75 and 100 procedures for individuals who are training in endoscopy, which is when scores begin to plateau on a scale when measuring basic skills.
Dr. Steve Schwaitzberg, Past-President of SAGES who worked on pioneering a common set of standards for endoscopic training requirements between GI and Surgical specialties in the US, said that they provided a commitment that a surgeon going into practice offered the same quality in endoscopic procedures as a gastroenterologist going into practice. Along with that commitment came an understanding that all training in the endoscopic suite served the same need, regardless of the specialty of the trainee. Dr. Schwaitzberg underscored the importance of clearly defining competence to appropriately begin to tackle this issue by stating: “Competence is taught and mastery is sought”.
The CAGS Executive Committee has instituted The Endoscopy Taskforce that has been charged with moving the issues of endoscopy forward in Canada. The taskforce has gastroenterologist and surgical representation that will tackle obstacles to providing endoscopic services for both specialties. Possibilities of a certification in endoscopy and common training standards will be considered, but this work will take some time. The Executive hopes that the taskforce can offer some relief measures for General Surgeons being adversely affected by the current endoscopy environment, however advocates that all those who perform endoscopy should take part in a quality assurance program to ensure they are providing the highest quality of services available.
[i] Eisen GM, Baron TH, Dominitz JA, et al, for the American Society of Gastrointestinal Endoscopy. Methods of granting hospital privileges to perform gastrointestinal endoscopy. Gastrointest Endosc 2002:55:780-3
If you would like to add something or disseminate a comment on this topic, please send to CAGS@Cags-accg.ca