At the November 1974 meeting of the American College of Chest Physicians in New Orleans, the Committee on Bronchoesophagology appointed an ad hoc subcommittee to consider standards for training in endoscopy and to report back with recommendations.
This subcommittee represents thoracic surgeons, otolaryngologists, and internists. It includes those with interest in endoscopy of the tracheobronchial tree as well as of the gastrointestinal tract.
The ultimate standard of training must be that which permits delivery of optimal quality of health care to each patient, regardless of which physician initiates delivery of that care provided by Canadian Health Care Mall.
There are at least four medical specialties with interest in one or more aspects of peroral endoscopy. The American Boards of Otolaryngology and of Thoracic Surgery and the Internal Medicine Subspecialty Boards of Gastroenterology and of Pulmonary Disease all require some level of training and skill in endoscopy for their respective certification. Anesthesiologists are increasingly involved in bronchoscopy and have traditionally performed laryngoscopy in their practice. In addition to separate or individual areas of expertise, there are qualified physicians with broad and overlapping experience who practice peroral endoscopy.
To attempt definition of “Standards for Training in Endoscopy,” one must recognize these differences and acknowledge differing goals in the various training programs. Recognizing current modes of practice in this country, many training programs will cultivate high levels of skill in a limited area, while other groups or individuals in the same medical community may emphasize other training in all peroral endoscopic procedures, but the trainee should understand the interrelationships of tracheobronchial and upper gastrointestinal diseases and their investigation. The following are standards for training in endoscopy:
1. Training in endoscopy should be under the supervision of a well-qualified preceptor practicing the specialty in question.
2. The trainee should learn indications and contraindications for both rigid open-tube and flexible fiberoptic endoscopy.
3. The trainee should have an opportunity to observe and perform procedures under varying types of anesthesia.
4. The trainee should have graduated responsibility from observing procedures by an experienced preceptor to performing examinations as the primary operator.
5. Procedures should be performed in properly equipped surroundings. Whether this is an operating room, special procedure area, intensive care unit, or some other facility, the primary standard should be patient safety. Support personnel and equipment, resuscitative measures, and the like need to be available in the event of untoward emergencies.
6. Some procedures require fluoroscopic guidance, and all radiographic studies should be conducted in accordance with radiation safety requirements.
7. The duration of training will naturally vary depending on specific goals in a program, case load, and the previous experience of the trainee. This should remain the option of the program director.
8. The number of procedures performed under supervision should be adequate to ensure competence to the satisfaction of the preceptor. Additional specification of numbers should remain the prerogative of each certifying board, peer-review, or credentials committee.
9. Training in pediatric endoscopy presents a special problem. Additional specialized training is necessary.
10. If an individual is preparing to do a limited area of endoscopy (eg, esophagoscopy and upper gastrointestinal endoscopy or only fiberoptic bronchoscopy), there should be adequate alternative resources and personnel available in the hospital or in the medical community to provide suitable complete patient services.
11. Examination of the pharynx and larynx should be included in endoscopic training.
12. Experience in animals is useful in preparation for anyone learning endoscopy. Extensive additional training in foreign body management is desirable.
13. Understanding of the indications, contraindications, and complications of tracheotomy and endotracheal intubation is of great importance for endoscopists.
14. It is suggested that each hospital or medical community designate a multidisciplinary committee to oversee the various aspects of endoscopic practice to assure optimal quality of patient care as a prerequisite to approval of a training program.