Ensuring Competence in Endoscopy - American College of ...

Certification in Gastroenterology. The American Board of Internal Medicine
(ABIM) sets the requirements for board certification in gastroenterology.
It alone decides which candidates are eligible for admission to the
subspecialty examination. The requirements to sit for the exam include:
(a) certification in internal medicine, which entails a minimum of three
years of training in a program accredited by the Accreditation Council
for Graduate Medical Education (ACGME), the Royal College of
Physicians and Surgeons of Canada, or the Professional Corporation
of Physicians of Quebec, as well as substantiation of the candidate’s
clinical competence and moral and ethical behavior by the program
director; 62 and
(b) a minimum of three additional years of training with experience in
proctoscopy and/or flexible sigmoidoscopy; diagnostic upper
gastrointestinal endoscopy; colonoscopy, including biopsy and
polypectomy; esophageal dilation; therapeutic upper and lower gastrointestinal
endoscopy; and liver biopsy. 63
Thus, candidates for board certification must demonstrate (1) superior and
current medical knowledge of the relevant disease areas, (2) refined diagnostic
and procedural skills, and (3) high moral, ethical, and professional
standards. Superior and current medical knowledge includes:
knowledge of common and uncommon gastroenterologic disease including
cancer of the digestive system; the natural history of digestive diseases in adults
and children; factors involved in managing nutritional problems; surgical procedures
employed in relation to digestive system disorders; and judicious use of
special instruments and tests in the diagnosis and management of gastroenterologic
disorders. 64
As to diagnostic and procedural skills, ABIM has required that, at the completion
of their residency, candidates for certification demonstrate satisfactory
procedural skills in, at least, the following procedures: (1) proctoscopy
and/or flexible sigmoidoscopy; (2) esophagograstroduodenoscopy; (3)
colonoscopy, including biopsy and polypectomy; (4) esophageal dilation
procedures; (5) therapeutic upper and lower gastrointestinal endoscopy;
and (6) percutaneous aspiration liver biopsy. 65 Successful mastery of these
skills included “an understanding of their indications, contraindications,
62. Clinical competence encompasses (1) patient care (medical interviewing, physical examination,
and procedural skills), (2) medical knowledge, (3) practice-based learning and improvement,
(4) interpersonal and communication skills, (5) professionalism, and (6) systems-based
practice.
63. See AMERICAN BOARD OF INTERNAL MEDICINE, POLICIES AND STANDARDS FOR CERTIFICA-
TION (2004), at www.abim.org (hereinafter ABIM POLICIES AND STANDARDS).
64. AMERICAN BOARD OF INTERNAL MEDICINE, Memorandum at 5, at http://www.utmem.edu/
ID/documents/SSGENERI.pdf.
65. Id. at 8. While ABIM emphasized the need for residents to demonstrate a high degree of competence
in, at least, these procedures, it also dispensed with the requirement of a minimum
number of procedure repetitions. The ABIM Memorandum stated:
The Board does not prescribe the number of times a procedure must be done to ensure
competency. It recognizes that trainees’ manual dexterity and confidence vary, and procedures
should be applied for the patient’s benefit and not to fulfill some arbitrary quota.
Id. at 5.
24 Ensuring Competence in Endoscopy