Training in therapeutic endoscopy: meeting present and future challenges

Abstract

Medical endoscopy trainees face numerous, often conflicting demands on their time. This can result in suboptimal endoscopy training and in difficulty achieving certification in basic endoscopy within the existing 5-year training programme. Endoscopic management of acute gastrointestinal bleeding and basic polypectomy are integral to basic service provision. Competence in these and other therapeutic procedures, including dealing with complications, is currently acquired opportunistically, or through experiential independent practice. This article proposes several potential solutions that may help with endotherapy training in the current UK training programmes. It also addresses issues relating to speciality training when reduced to 4 years in 2022. Advanced endotherapy training needs to be optimised by understanding how to select individuals with the appropriate skills and how to accelerate therapeutic training at the appropriate time. Training programmes will need to adapt and can learn from countries where the pathway is more developed and established. Future training will include a dedicated subspeciality training programme for advanced therapy with competitive entry. Advanced therapy training will be matched to service needs. Scoring systems for case complexity integrated with regional and supraregional networks, would allow referral of selected cases to the most appropriate specialised units.

Keywords: biliary endoscopy; colonoscopy; diagnostic and therapeutic endoscopy; endoscopic polypectomy; surgical training.

Figure 1

New internal medicine (IMT) pathway from August 2019.

Figure 2

Potential future pathway for advanced therapeutic endoscopy training. ERCP, endoscopic retrograde cholangiopancreatography; EUS, endoscopic ultrasound; FS, flexible sigmoidoscopy; GI, gastrointestinal; LGI, lower GI; UGI, upper GI.