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On Endoscopic Training and Procedural Competence

John Baillie, MB, ChB; and William J. Ravich, MD
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Duke University Medical Center, Durham, NC 27710. The Johns Hopkins Medical Institutions, Baltimore, MD 21205. Requests for Reprints: John Baillie, MB, ChB, Division of Gastroenterology, Duke University Medical Center, Box 3189, Durham, NC 27710.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1993;118(1):73-74. doi:10.7326/0003-4819-118-1-199301010-00014
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Physicians are expected to be competent. However, it is difficult to define competence and determine how it can be achieved. This applies particularly to technical procedures in medicine. A study by Cass and colleagues in this issue of Annals suggests that at least 100 supervised procedures are required to achieve competence in esophagogastroduodenoscopy (EGD) and colonoscopy. This experience greatly exceeds the current requirements of national training bodies. How should we evaluate the cognitive aspects of procedural training and ensure that competence, once achieved, is maintained? Prospective evaluation of physician performance, already a concern of quality assurance programs, may provide the answers. Historically, research into teaching methods and competence has been hindered by lack of funding, and a widely held perception that such pursuits lack academic merit. These attitudes must change.



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