Evolution of gastroenterology training

Table 1 Different curricula

	Duration (yr)		Minimal numbers of endoscopy					Exam		Protocols	English protocols
	Internal medicine	GE	Gastro	Colo	Abdominal			Entrance	Final
					ERCP	Echo	EUS
Austria	6	2	Nt	Nt	Nt	Nt	Nt	Nt	Nt	Nt	Nt
Canada	4	2	100	200	200	0	200	No	Yes	Yes	Yes
UK	2.5	2.5	200/yr	100/yr	No	No	No	Yes	No	Yes	Yes
Finland	3	3	Nt	Nt	Nt	Nt	Nt	Yes	No	No	No
Hungary	Nt	2-3	Nt	Nt	Nt	Nt	Nt	Oral	No	No	No
Iran	4	2	> 400	100-150	40-60	No	No	Yes	Yes	No	No
Italy	1	3	300	100	No	300	No	Yes	Yes	Nt	Nt
NL	2	4	300	200	100	No	100	No	No	Yes	No
Romania	2	3	> 150	100	No	No	No	Yes	Yes	No	No
South Africa	4	2	500	75	50	No	No	Yes	No	No	No

No: Not required; Nt: Not known.

Table 2 Standard curriculum

Knowledge

Anatomy, histology, molecular biology, embryology and development of the GI tract

Physiology and pathophysiology

Pharmacology

Epidemiology

Nutrition, metabolism and endocrinology

Diagnose and evaluate patients

Timely surgery and other therapeutic interventions

Cost-effective management

Prevention

Complications and disinfection of endoscopy procedures

Educator of chronic patients and support family

Bioethics

Conduct, write and publish research

Skills

Professional principles: behavior, commitment highest standard, responsive

Effectively and efficiently

Lead multidisciplinary teams

Maintain skills in general medicine

Appropriate communications

Information-science resources

Interpret laboratory data

Interpret radiographic data

Endoscopic skills

Table 3 Endoscopic skills level I

	Numbers
	WGO	UK	NL	USA
Esophagastroduodenoscopies	100	> 200	300	130
Esophagastroduodenoscopies therapeutic interventions	-	> 30	25	-
Treatment of non-variceal bleeding	20/10 active	-	-	25
Treatment of variceal bleeding	15/5 active	-	-	20
Esophageal dilation	15	-	-	20
Lifetime serious complications	-	< 10%	-	-
Flexible sigmoidoscopy	25	-	200	-
Colonoscopy	100	> 200	200	140
Lifetime perforations	-	< 0.5%	-	-
Cecal intubations	-	> 90%	> 90%	-
Ileum intubation (when indicated)	-	-	> 50%	-
Polypectomy	20	> 20%	-	30
Percutaneous endoscopic gastrostomy (PEG)	10	-	-	15
Liver biopsy	20	-	-	-
Paracentesis	50	-	-	-
Foreign body removal	-	-	-	-
Videocapsule endoscopy	-	-	-	25

Table 4 Endoscopic skills level II

	Numbers
	WGO	UK	NL	USA
ERCP	-	> 200	100	200
Sphincterotomy	-	-	25	-
Stone extraction	-	-	-	-
Stenting	-	-	25	-
Complications	-	< 5%	-	-
Satisfactory completion of intended therapeutic procedure	-	> 80%	-	-
Diagnostic laparoscopy	-	-	-	-
EUS	-	-	100	150