Ensuring Competence in Endoscopy - American College of ...

Introduction
Endoscopic procedures have become standard tools for evaluation and
treatment of gastrointestinal disorders. Diagnostic and therapeutic procedures
are widely available and can be performed safely and competently.
Endoscopists have traditionally been trained in the art and science of endoscopy
as part of fellowship in gastroenterology, pediatric gastroenterology,
or surgery. These procedures have been considered an integral part of the
practice of gastroenterology and surgery. Separate specialty boards have not
been developed for endoscopy as a discipline. Since there are no boards specific
to endoscopy, individuals who have no formal training as part of a specialty
in gastrointestinal diseases often apply for, and in some cases are
granted, privileges in endoscopy. by In hospitals some cases, and the other motivation payers. is In to some provide
services the motivation that would is not to provide otherwise services be available. that would In others, not otherwise it abil-
be
cases,
available. ity to generate In others, income it is the from ability these to generate procedures income that from constitutes these procedures
motivation. that constitutes Even endoscopists the motivation. who have Even completed endoscopists formal who training have com-
pro-
the
pleted grams formal may not training have programs received extensive may not have experience received and extensive training experience in more
and complex training endoscopic in more procedures, complex endoscopic such as therapeutic procedures, biliary such and as therapeutic pancreatic
biliary endoscopy and pancreatic (ERCP, endoscopic endoscopy retrograde (ERCP, endoscopic cholangiopancreatography) retrograde cholangiopancreatography)
endoscopic ultrasonography. and endoscopic Additionally, ultrasonography. new endoscopic Additionally, techniques as new
and
endoscopic are developed, techniques trained endoscopists are developed, may trained require endoscopists additional training may require in the
additional new procedure training prior in to the utilization new procedure in patient prior care. to utilization in patient care.
American Society for Gastrointestinal Endoscopy (ASGE) with the support
of the American College of Gastroenterology (ACG) has long sought to
standardize training in endoscopy, and create guidelines that assist privileging
institutions in determining who is competent to perform endoscopic
procedures. Without specific boards in endoscopy, efforts to help assist hospitals
and endoscopy units in establishing guidelines for determining competence
may be seen as self-serving and restrictive. Yet the goal of these
guidelines is to provide competent endoscopic services to the widest number
of patients possible. Endoscopy by poorly trained personnel is not only
more likely to result in a complication, the information provided may not
be accurate or complete and may, ultimately, lead to misdiagnosis and poor
or inappropriate treatment.
Privileging institutions have a responsibility to their patients to be certain
that services provided by their staff are of the highest quality and safety.
Legal precedent has been established that can hold hospitals and/or endoscopy
centers responsible for granting privileges to unqualified medical staff
performing the procedure (see Hospital Liability Update on page 15).
Establishing guidelines for granting privileges in endoscopy that apply universally
to all members of the medical staff can help safeguard against such
causes of action. By providing this informational packet, ASGE is and continuing
continuing its tradition their of establishing tradition of the establishing highest the standards highest for standards endoscopic for
ACG
are
endoscopic services. services.
Introduction 3