Comparison Of Endoscopic Experience Obtained In An American And A British Gastroenterology Training Program

Introduction: Endoscopy represents a central part of gastroenterology training but very little is known about the experience gained in training. The recommendations for endoscopic experience by the ASGE, and the joint advisory group (JAG) for endoscopy in Britian, suggest a relatively low volume of experience to become competent. Three year American programs are shorter than British training which has a minimum of four dedicated years. However many British trainees do more and intercalate a higher research degree. There have been concerns that if the intensity and length of British training are shortened then endoscopic training will suffer. Methods: The records of endoscopic experience from 11 trainees completing the gastroenterology program at the University of North Carolina at Chapel Hill were compared with 9 trainees within one year of completion of training in the British region of Wessex. Results: American and British trainees significantly exceeded both British and American recommendations for experience in both upper and lower gastrointestinal endoscopy. British trainess carried out significantly more upper gastrointestinal endoscopy (mean 2429 vs 662 p<0.05; ASGE recommendation 130; JAG guideline 300) and tended to carry out more colonoscopy (mean 664 vs 483 ns; ASGE recommendation 140; JAG guideline 200). The recommendation of 200 ERCP procedures was only reached by some trainees in both America (3/11; mean 172) and Britain (7/8; mean 198). All procedures in America were supervised by a trainer. In Britain supervision was often indirect once competence was demonstrated. Conclusions: In both training programs trainees get extensive experience in both upper and lower gastrointestinal endoscopy. Obtaining appropriate experience in ERCP is not always achieved which has resulted in some programs training only some of its trainees. The reasons why British trainees gain more upper gastrointestinal experience are probably dependent on length of training (including 8/9 having a research degree), differences in endoscopic practice between the two countries, and time spent outside a tertiary referral teaching hospital environment. There is evidence that training in general endoscopy in Britain would be adequate if British training is shortened or made less intense.