NEED FOR RENEWED EMPHASIS ON FLEXIBLE ENDOSCOPY: A RETROSPECTIVE REVIEW OF TEN YEARS OF MIS FELLOW CASE NUMBERS AGAINST PROPOSED MINIMUMS
David Morrell*1, Cheyenne C. Sonntag1, Amber Schilling1, Jose M. Martinez2, Jeffrey M. Marks3, Eric Pauli1
1Penn State Health Milton S. Hershey Medical Center, Hershey, PA; 2University of Miami Health System, Miami, FL; 3University Hospitals Cleveland Medical Center, Cleveland, OH
Introduction
Endoscopy remains a critical and ever-growing aspect of surgical practice. Reflecting this importance, the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) recently proposed new flexible endoscopy case minimums for graduates of Minimally Invasive Surgery (MIS) fellowships. This study utilizes the endoscopic case logs of surgical fellows to assess endoscopic exposure against the proposed new minimum criteria.
Methods
A retrospective analysis was performed on case logs of 1,037 surgery fellows who began fellowship training between 2007-2016. All fellows were enrolled in MIS programs accredited by The Fellowship Council. Fellows were grouped by year of fellowship matriculation and further subcategorized by type of fellowship program. Number of flexible endoscopy cases per fellow was calculated by year as well as percentage of fellows meeting proposed case minimum (50) per year.
Results
Of the 1,037 MIS fellows the percentage of fellows meeting the proposed case minimum over the 10 years studied was 56.9% (range 45.6% to 67.6%). The total volume of endoscopy performed increased over the 10-year period (mean 84.5 per fellow in 2007 to 100.8 in 2016). Compliance with proposed minimums peaked in 2013 at 67.6% before dropping over the last 3 years of data collected to 52.7% in 2016. A similar trend was demonstrated in median cases (peak 80 in 2013, 65 in 2016). This largely reflected changes in the Advanced Gastrointestinal (Adv GI) fellowships (623 fellows) with 44.9% meeting minimum in 2007 before peaking in 2013 at 61.5% and then dropping to 40.3% in 2016. All fellows in Adv GI/Bariatric/Flexible Endoscopy (10 fellows, median cases 791.5), Adv GI/Flexible Endoscopy (10 fellows, median[EMP1] cases 205.5), and Adv GI/Foregut (7 fellows, median cases 207) met the minimum in all years. Adv GI/Bariatric (387 fellows) increased from 55.6% meeting the minimum in 2007 to 70% in 2016 (median cases from 54 to 106).
Conclusions
Renewed emphasis on flexible endoscopy is necessary to meet the proposed case minimums for graduates of MIS fellowships, as current trends indicate only a simple majority of fellows meeting the minimum. Increasing median flexible endoscopy cases per year reflect increasing endoscopy performance among some fellowships but does not reflect increasing exposure in all. In addition to the need for increased endoscopy exposure, further attention to improve the fellow case log system is also warranted to better track progress in meeting these proposed minimums.
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