Impact of gastroenterologist‐supported endoscopy training for surgical trainees in a regional hospital

The current General Surgery Education and Training (GSET) Program in Australia and New Zealand requires trainees to independently complete 200 gastroscopies and 100 colonoscopies. The Conjoint Committee for the Recognition of Training in Gastrointestinal Endoscopy (CCRTGE) is responsible for certifying and setting the minimal standards for training endoscopy in Australia. These standards require 200 gastroscopies (including 20 interventional procedures) and a total of 200 colonoscopies, with a 90% caecal or terminal ileum intubation rate.1 Recertification for colonoscopies occurs every 3 years requiring 150 colonoscopies with additional targets set for adenoma and sessile serrated adenoma detection rates.2 These benchmarks are intended to ensure procedural competency, with Sedlack et al. suggesting that an average of 250 colonoscopies is often needed to reach this level. Although the GSET program and CCRTGE require fewer colonoscopies, many surgical trainees still find it challenging to meet these targets.3 The demands of balancing service provision with training are a well-recognized issue across both surgical and medical specialties, and surgical endoscopy training is no exception.4 It is not uncommon for trainees to finish their general surgery training without CCRTGE accreditation. The reasons for this are multifaceted, but one primary challenge is the need to attend concurrent operating lists and manage an inpatient surgical service, often at the expense of dedicated endoscopy sessions. A common experience for trainees new to endoscopy is having the scope from taken from them to ‘keep the list moving’. Ultimately, ad-hoc exposure in endoscopy training—without consistent and frequent opportunities—is insufficient to develop competence in such a highly technical skill. Both time and case volume are crucial for achieving competency which is often difficult to achieve for busy surgical trainees.5 Access to interventional endoscopy cases is often limited, particularly in metropolitan hospitals where gastroenterologists typically manage such cases and cover the emergency endoscopy service. However, rural and regional hospitals continue to rely heavily on general surgeons to perform endoscopic management especially in the emergency setting for cases like upper gastrointestinal bleeding.6 Given this reliance, it is imperative for general surgical trainees to develop competence in interventional endoscopic procedures to ensure technical competency is met in order to manage potentially critically unwell patients in these regions. At our regional hospital, we have seen the benefits of a collaborative approach between gastroenterologists, surgeons and surgical trainees. Due to the absence of a gastroenterology advanced trainee, our institution has embraced an environment where surgical trainees are actively encouraged to participate in endoscopy lists run by gastroenterologists. To assess the impact of this collaboration, we reviewed logbooks from four GSET1 trainees who had no prior endoscopic experience over a six-month period. During this time, 45.6% of the 193 gastroscopies they performed were supervised by gastroenterologists, allowing the trainees to complete 38 interventional procedures. Similarly, 45.4% of the 240 colonoscopies were conducted under the guidance of gastroenterologists, with trainees achieving an 88.9% caecal or terminal ileum intubation rate. A total of 31 polypectomies were performed with gastroenterologists and 33 with surgeons. Trainee logbooks did not record adenoma and sessile serrated lesions to add to comparing the quality of the colonoscopies between the two groups. Withdrawal times were comparable between colonoscopies supervised by surgeons and gastroenterologists. Trainees notably commented on the significant benefit in interventional exposure with the gastroenterologists, which included endoscopic mucosal resections and submucosal dissections. Additionally, a broader range of pathologies was encountered, such as cirrhotic patients requiring oesophageal variceal banding, which typically may not be booked on a surgeon's list. These figures highlight the positive impact of shared endoscopy sessions, resulting in increased procedural exposure and broader learning opportunities for surgical trainees. The added exposure and variation to interventional procedures is especially valuable, particularly for those who wish to practice in regional settings and particiate in the emergency endoscopy roster. Future dedicated training opportunities with gastroenterologists would benefit trainees pursuing careers that require advanced endoscopic skills, such as in upper gastrointestinal or colorectal surgery. As healthcare increasingly relies on multidisciplinary collaboration, this spirit of cooperation should extend to training environments as well. The Sarofim brothers highlighted the positive collaboration between surgical and gynaecology trainees, demonstrating its beneficial impact on providing interdisciplinary patient care and promoting joint research opportunities.7 Gastroenterologist-supported endoscopy training for surgical trainees provides a unique and mutually beneficial opportunity to enhance the existing training provided by surgeons. By fostering a cooperative atmosphere, both specialities help develop a more versatile and competent workforce. We urge hospitals and surgical training networks to consider similar collaborations between gastroenterologists and surgeons to help bridge the gap in endoscopy training opportunities across different hospital networks. Special thanks to Dr. Wenman for his guidance, mentorship and patience towards all the surgical trainees that have had the pleasure of passing through Coffs Harbour Health Campus. Ernest Cheng: Conceptualization; writing – original draft; writing – review and editing. Jasmine Mui: Writing – review and editing. Amer Matar: Writing – review and editing. Zachary Bunjo: Writing – review and editing. John Wenman: Conceptualization; supervision. Wilson Petrushnko: Conceptualization; supervision; validation.