Postgraduate surgical flexible endoscopic education.

Postgraduate surgical education of residents in flexible gastrointestinal endoscopy is mandated by the American Board of Surgery. In that context, a retrospective analysis was performed of the general medical and endoscopic records of patients who experienced diagnostic and therapeutic flexible endoscopy during an 18-month period at the University of South Alabama Medical Center by surgical residents under the supervision of attending surgical endoscopists. That analysis revealed these procedures to be safe (diagnostic and therapeutic flexible endoscopy: morbidity incidence 0.4% and 2.2%, mortality incidence 0.2% and 1.1%, respectively), accurate (100%), and therapeutically beneficial (19% of the flexible endoscopic procedures were performed with therapeutic intent). Review of cumulative resident case profiles revealed that during the course of their clinical education (5 years), each resident performed approximately 400-500 endoscopic procedures, functioning successively as first assistant, primary endoscopist, and teaching assistant. The authors contend that: supervision by surgical endoscopists ensures safety and efficacy of the procedures during the education of postgraduate surgical residents; the surgical milieu--integration of endoscopic, surgical anatomic, and histopathologic data--provides the most effective educational format to acquire the skills necessary to achieve a high degree of accuracy associated with these endoscopic procedures; and therapeutic flexible endoscopy obviated the necessity for more invasive surgical procedures in approximately one-fifth of this patient population.