What training is recommended for medical professionals to acquire basic skills in endoscopy?

Recommended Training for Basic Endoscopic Skills

Medical professionals seeking to acquire basic skills in endoscopy should undergo a structured training program that includes didactic education, simulator training, cadaver laboratory practice, and supervised clinical experience before performing procedures independently on patients.

Core Training Components

Didactic Education

• Training should begin with theoretical knowledge acquisition through lectures, academic conferences, or independent study covering the definitions of various forms of sedation, pharmacology of sedative medications, and patient assessment 1
• Trainees must complete Advanced Cardiac Life Support (ACLS) certification or equivalent training that includes hands-on airway management 1
• Understanding of airway anatomy through study of anatomic drawings and models is essential 1

Simulation Training

• Virtual reality simulators provide effective alternatives for initial clinical training, allowing trainees to develop basic endoscopic navigation skills in a risk-free environment 2, 3
• Simulator training should include both psychomotor exercises and virtual cases of esophagogastroduodenoscopy (EGD) and colonoscopy 2
• Studies show significant improvement in both time to complete procedures and efficiency of screening after structured simulation training 2, 3

Cadaver Laboratory Training

• Endoscopic training in an anatomic laboratory should be considered compulsory for all medical professionals wishing to perform endoscopic procedures 1
• Cadaver training provides opportunities for manual skill development, anatomic orientation, and surgical simulation 1
• If institutional cadaver laboratories are not available, attendance at international cadaver workshops is recommended 1

Supervised Clinical Experience

• After simulator and cadaver training, trainees should observe procedures performed by experienced colleagues before attempting procedures under supervision 1
• Practical training should be completed in the endoscopy unit under the supervision of experienced instructors 1
• The learning process should follow a progressive approach from observation to supervised practice to independent performance 1

Specific Skills to Master

Technical Skills

• Bimanual techniques involving handling the endoscope in one hand and operating instruments in the other 1
• Navigation and orientation skills within the anatomical space 1
• Recognition of normal and abnormal findings 1

Sedation Management

• Understanding the pharmacology of sedative and analgesic medications, including indications, dosing, and side effects 1
• Knowledge of reversal agents (naloxone, flumazenil) and their appropriate use 1
• Recognition and management of sedation-related complications 1

Airway Management

• Performance of head-tilt maneuver, chin-lift, and jaw-thrust techniques 1
• Placement of nasopharyngeal and oropharyngeal airways 1
• Bag-mask ventilation techniques 1
• Management of hypoxemia with supplemental oxygen 1

Assessment of Competence

• Competence should be assessed through written examinations covering theoretical knowledge 1
• Practical skills should be evaluated through direct observation and performance metrics 2, 4
• Objective assessment tools like the Global Assessment of Gastrointestinal Endoscopic Skills (GAGES) can be used to evaluate technical proficiency 5
• Regular evaluation of outcomes related to sedation, including cardiopulmonary complications and use of reversal agents 1

Common Pitfalls and Considerations

• Trainees often overestimate their own skills compared to evaluations by experienced endoscopists 4
• Focusing solely on procedure volume without attention to quality metrics is insufficient for determining competence 6
• Patient safety must be prioritized, with recognition that anesthesiology assistance may be required for high-risk patients (ASA class 4 or higher) 1
• Structured, progressive training programs yield better results than unstructured experience 5

Duration and Structure

• Training should be structured progressively, with increasing complexity as skills develop 5
• A comprehensive curriculum may require approximately 300 hours, including online lectures (100h), clinical rotations (150h), and hands-on sessions (50h) 5
• Regular practice sessions spaced over time are more effective than massed training in a short period 6