Two recent studies illustrate the need for better endoscopic training for fellows:
- AM Banc-Husu et al. JPGN 2017; 64: e88-e91.
- EA Mezoff et al. JPGN 2017; 64: e96-e99.
In the first study from CHOP, the authors performed a retrospective review of their endosocpic database from 2009-2014. Out of 12,737 upper endoscopies, 15 patients underwent 17 upper endoscopies which required a therapeutic intervention to control nonvariceal bleeding (1:750 procedures). therefore, among their 24 fellows, this resulted in less than 1 therapeutic endoscopy per fellow.
In the second study, “a recent study suggests that fellows are largely unable to achieve the prescribed case volume recommended to achieve competence.” The authors found that control of nonvariceal bleeding [and other advanced endoscopy cases] “were performed exclusively but relatively infrequently by members of this advanced endoscopy service. Fellows…participated in relatively few.”
My take: Fortunately, life-threatening nonvariceal bleeding cases are infrequent. The downside of the rarity of these cases is the lack of subspecialty expertise, particularly in recently trained physicians. My recommendations:
- Work with experience physicians (adult and pediatric) until sufficient expertise is developed.
- Even experienced physicians should collaborate on these difficult cases
- Efforts to improve simulation would be welcome –similar to aviation pilots.
Related blog posts:
- Training Not Meeting Procedure Thresholds for Fellows
- All bleeding stops | gutsandgrowth
- All Bleeding Stops (part 2) | gutsandgrowth
- Cutting Edge for Endoscopic Control of Bleeding | gutsandgrowth
- NASPGHAN Postgraduate Course 2014 -Endoscopy… | gutsandgrowth
- Watch the Bleeding Ulcer Stop! | gutsandgrowth
- Transfusion strategy in acute GI bleeding | gutsandgrowth
- Is a Continuous IV Proton Pump Inhibitor Really Necessary for GI Bleeders?