European Society for Paediatric Gastroenterology, Hepatology and Nutrition Position Paper on Training in Paediatric Endoscopy

Abstract

What Is KnownEndoscopy Training is becoming an integral part of Paediatric Gastroenterology Training within Europe. There is a great degree of variation between European endoscopy training in terms of duration, content, procedural volume, assessment during and at the end of training. What Is New?Achievement of milestones in training more accurately assesses competency compared with procedural number. 'Train the trainers' courses and educational material, such as e-learning and endoscopy simulator training improve a structured approach in endoscopy teaching. Cooperation with the National Paediatric Gastroenterology, Hepatology and Nutrition Societies in Europe will facilitate dissemination, discussion and implementation of results of this position paper. E ndoscopy Training is an integral part of paediatric gastroenterology training within Europe as mentioned in the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) training syllabus (1). National training programmes are often at least partly based on the ESPGHAN syllabus, however, there are a number of countries where endoscopy training is not included in Paediatric Gastroenterology, Hepatology and Nutrition (PGHN) training. There is increasing evidence that achievement of milestones in training more accurately assesses competency compared with procedural number (2,3). The updated ESPGHAN Syllabus has been approved by the European Union of Medical Specialists (UEMS), suggesting that countries with National PGHN society should comply with the syllabus. The ESPGHAN syllabus lists the endoscopic procedures to be fulfilled in order to certify for paediatric gastroenterologist and does not specify procedural volume anymore (4). A group of experts within the ESPGHAN was tasked to define milestones of competency in diagnostic and therapeutic endoscopy by the Endoscopy Special Interest Group (SIG). In addition, other areas of possible

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“…An ESPGHAN position paper on endoscopy training reports that endoscopy competency is achieved following a learning curve of about 200 upper endoscopies and around 400 ileocolonoscopies, hence the significance of consistency and continuity in endoscopy training of future paediatric gastroenterologist ( 12 ).…”

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“…However, training programs did not include endoscopy training in some countries. 86,87 The latest ESGE/ESPGHAN guidelines recommend that ERCP be performed in children by an experienced endoscopist in a high-volume tertiary care center with pediatric involvement, and the procedure must be supervised and coordinated by a pediatrician/pediatric gastroenterologist if the endoscopic procedure is performed by an adult gastroenterologist/surgeon. 30,31,86 The ESPGHAN Endoscopy Special Interest Group also suggests that competence should be assessed based on pediatric-specific competence thresholds of technical and nontechnical endoscopic skills.…”

“…30,31,86 The ESPGHAN Endoscopy Special Interest Group also suggests that competence should be assessed based on pediatric-specific competence thresholds of technical and nontechnical endoscopic skills. 86 The goal of endoscopic training in pediatric biliary and pancreatic diseases would be not only to meet the recommended number of procedures, but also to achieve comprehensive endoscopic competence, through the active use of all methods and modules, such as hands-on courses, e-learning modules, live endoscopy courses, virtual simulator models, and learning in adult centers and large pediatric endoscopy training centers. This should be highlighted more in training programs for advanced endoscopy, such as ERCP and EUS, especially for pediatric gastroenterologists.…”

“…Pediatric gastroenterologists infrequently perform the highly skilled ERCP and EUS independently due to the small number of patients, the shortage of experienced pediatric endoscopists, and the insufficiency of educational opportunities. Although training for endoscopy is becoming an integral part of education in pediatric gastroenterology, 85,86 the lack of a nationwide pediatric endoscopy training program is an issue in training and education.…”

“…In Europe, ESPGHAN has utilized a syllabus for training programs in pediatric gastroenterology. However, training programs did not include endoscopy training in some countries 86,87 . The latest ESGE/ESPGHAN guidelines recommend that ERCP be performed in children by an experienced endoscopist in a high‐volume tertiary care center with pediatric involvement, and the procedure must be supervised and coordinated by a pediatrician/pediatric gastroenterologist if the endoscopic procedure is performed by an adult gastroenterologist/surgeon 30,31,86 …”