Endoscopy Curriculum
University of Chicago
Contributing Author: Dr. Charles Dye
Written description for Fellows and Training Committee
Last updated 3-12-07
Educational Goals (knowledge, skills, attitudes):
Fellow Year 1:
Exposure to and understanding of:
1. The indications, limitations, and contraindications
of endoscopic procedures.
2. Procedure complications and their management.
3. The principles of safe conscious sedation/analgesia
techniques and patient monitoring and
when to consider alternate forms of anesthesia.
4. Medical, radiological and surgical alternatives
to endoscopic therapy.
5. Issues of informed consent, advanced directives
and medical ethics as pertains to gastrointestinal
endoscopy (as in the evaluation of
gastrostomy and cancer palliation candidates).
Thorough exposure to basic outpatient diagnostic endoscopy
Initial exposure to therapeutic and inpatient endoscopic procedures. Encounters may
include observing or performing non-critical portions of the procedures
Develop patient trust as it relates to procedures and learn management flow for outpatient
encounters
Build endoscopy team relationships and understand the role of endoscopy nurses pre,
during, and post-procedure
Fellow year 2:
Continued exposure to and understanding of the numbered factors listed under fellow
year 1.
Heightened exposure to inpatient and therapeutic procedures with expectation of
progression to performing the entire procedure as skills improve.
Learn to direct endoscopic management for emergency call and consultative services
Develop educational skills focused on residents and students
Discuss recent literature and evaluate its role in current practice
Begin to adopt the role of endoscopy team leader.
Fellow Year 3:
By the last rotations, be prepared to:
1. Appropriately recommend endoscopic procedures
as indicated by the findings of consultative
evaluation, with explicit understanding of
accepted specific indications, contraindications
and diagnostic/therapeutic alternatives.
2. Perform procedures safely, completely and expeditiously,
including possessing a thorough understanding
of the principles of conscious sedation/
analgesia techniques and pre-procedural
clinical assessment and patient monitoring.
3. Correctly interpret endoscopic findings and
integrate them into medical or endoscopic therapy.
4. Identify risk factors for each procedure, understand
how to minimize each and to recognize
and appropriately manage complications when
they occur.
5. Acknowledge the limitations of endoscopic procedures
and personal skills and know when to
request help.
Focus on refining diagnostic endoscopy skills with regard to comfort, efficiency,
successful completion rates.
Complete training in therapeutic procedures
Continue to nurture educational skills for residents and students and integrate recent
literature into practice pattern
Become comfortable in the role of endoscopy team leader
Overview of the Rotation:
Year 1:
Orientation days:
-Orientation to endoscopy, informed consent, report writing, and the procedure unit (1/2
day)
-Sedation training course with sedation module questionnaire (1/2 day)
1st endoscopy rotation:
-Informed consent and complications of Basic procedures from Gastrointestinal Disease;
An Endoscopic Approach
-Written materials for the technique of EGD and Colonoscopy provided from Blackstone
Text
-Equipment overview
-Elective outpatient procedures
-Indications for endoscopy and patient interactions reviewed with each case
-Informed consent, procedure techniques, report writing, and discharge instructions under
the direct supervision of the endoscopy attending
-Scope handling and processing instruction by procedure unit technician.
1st year fellow’s endoscopy course by ASGE:
-Comprehensive 2 day introductory course sponsored by the American Society of
Gastrointestinal Endoscopy
-Includes a formal review of informed consent and complications
-Highlights pre-procedure antibiotic prophylaxis and peri-procedure anticoagulant
management
-Includes hands on lab including experience with therapeutic techniques
Endoscopy rotations and Consultative services:
-Two outpatient endoscopy month long rotations and one-two inpatient consult months
-Ongoing exposure to outpatient and intial exposure to inpatient procedures under the
supervision of endoscopy and consult attending staff
- Four-five Emergency on-call blocks
Weekly 1st year fellow endoscopy clinic:
-Focus on appropriate care and follow-up of patients with gastrointestinal diseases who
have required or require ongoing endoscopic diagnosis and management
-Under the direction of an attending assigned to this clinic
Yearly fellow Hands on Endoscopy Lab in the Carlson Animal Facility at the University
of Chicago using anesthetized pigs under the direction of Dr. Dye (1 day):
-Hemostasis techniques including injection therapy, Bipolar cautery, Argon plasma
coagulation, endoscopic clipping, and variceal band ligation.
-Mucosal resection techniques including submucosal injections, strip technique, ligator
and cap technique
Spring review and overview of objectives for second year training by Dr. Dye:
-Evaluations compiled and discussed with individual fellow
-Strengths and areas for further concentration identified
-Second year objectives reviewed and video selections for independent review discussed
Year 2:
Endoscopy rotations and Consultative services:
-One-two outpatient endoscopy month long rotations and one inpatient consult month at
University of Chicago
- One-two month long rotations performing outpatient and inpatient consultative and
endoscopy services at Weiss Memorial Hospital
-Four-five weeks of emergency endoscopy call
-Ongoing exposure to outpatient and intial exposure to inpatient procedures under the
supervision of endoscopy and consult attending staff
Yearly fellow Hands on Endoscopy Lab in the Carlson Animal Facility at the University
of Chicago using anesthetized pigs under the direction of Dr. Dye (1 day) with time spent
concentrating on skills where further concentration required:
-Hemostasis techniques including injection therapy, Bipolar cautery, Argon plasma
coagulation, endoscopic clipping, and variceal band ligation.
-Mucosal resection techniques including submucosal injections, strip technique, ligator
and cap technique
Spring review and overview of objectives for third year training by Dr. Dye:
-Evaluations compiled and discussed with individual fellow
-Strengths and areas for further concentration identified
-Provation database log reviewed with attention to ASGE suggested core requirements
-Third year objectives reviewed and video selections for independent review discussed.
Year 3:
Endoscopy rotations and Consultative service:
-Two outpatient endoscopy month long rotations and 3 inpatient consult months
-One-two month long rotations performing outpatient and inpatient consultative and
endoscopy services at Weiss Memorial Hospital
-Four-five weeks of emergency endoscopy call
-Ongoing exposure to outpatient and intial exposure to inpatient procedures under the
supervision of endoscopy and consult attending staff
Yearly fellow Hands on Endoscopy Lab in the Carlson Animal Facility at the University
of Chicago using anesthetized pigs under the direction of Dr. Dye (1 day) with time spent
concentrating on skills where further concentration required:
-Hemostasis techniques including injection therapy, Bipolar cautery, Argon plasma
coagulation, endoscopic clipping, and variceal band ligation.
-Mucosal resection techniques including submucosal injections, strip technique, ligator
and cap technique
Spring review and overview of practice plans by Dr. Dye:
-Evaluations compiled and discussed with individual fellow
-Strengths and areas for further concentration identified
-Provation database logs reviewed with attention to ASGE core number requirements
-Video selections for independent review discussed.
-Core requirement deficiencies remedied
Teaching Methods/Clinical Encounters:
1. Daily endoscopy practice on rotations
a. outpatient endoscopy blocks
b. consult service blocks
c. emergency on-call weeks
d. Weiss hospital rotations
2. Weekly 1st year fellow endoscopy clinic followed by fellow continuity clinic in years 2
and 3
3. Monthly endoscopy conference with case management, radiographic review, and
discussion of the literature concentrating on pancreaticobiliary disease, ERCP and EUSled by Dr. Dye
4. Quarterly Quality Assurance conference with review of all procedure related
complications for the section and discussion of literature and practice patterns- led by Dr.
Dye
5. Presentation of cases from an outpatient endoscopy rotation selected on a yearly basis
for GI grand rounds
6. ASGE first year fellow’s endoscopy course- Two day course led by national experts
selected by the American Society for Gastrointestinal Endoscopy
7. Yearly therapeutic endoscopy hands-on Animal Lab- One day practical sessions
8. Majority of exposure to variceal endoscopic management provided on hepatology core
rotations
9. Majority of exposure to PEG procedures provided on nutrition support core rotations
and during month long rotations at Weiss Hospital.
10. ASGE videos in second and third years
Patient Characteristics/Disease Mix:
Inpatient and Outpatient encounters on diverse patients from many ethnicities and
socioeconomic backgrounds requiring diagnostic and therapeutic endoscopy
Procedures and Skills:
Total diagnostic upper endoscopy: at least 130
Total colonoscopy: at least 140
Sigmoidoscopy: at least 25
Enteroscopy beyond the ligament of Treitz: at least 10
Capsule endoscopy: reading at least 10
Routine biopsy: at least 20
Snare polypectomy: at least 20
Dilation of peptic strictures: at least 15 over a guidewire and 10 with balloon dilators
Nonvariceal Hemostasis (include upper and lower): at least 10 active bleeders
Variceal Hemostasis: at least 5 active bleeders
PEG: at least 10 performing endoscopy and 10 performing percutaneous portions
Colon decompression: at least 3 procedures
Tatooing: instruction in hands on lab
Mucosal resection: instruction in hands on lab
Faculty Supervision:
Provided by faculty members with significant endoscopic experience and consultative
experience.
Method of Evaluation:
-Faculty member evaluations
-Director of endoscopic education yearly reviews in conjunction with the director of
fellowship training comprehensive reviews
-Log books documenting endoscopic curriculum compliance and progression
Attitudes/Behaviors:
1) Patient care:
-Demonstrate respect, compassion and empathy for patients
2) Medical knowledge:
-Appropriate understanding of indications for procedures, care of endoscopy
equipment and pre- and post-procedure evaluation of patients
-Interpretation of endoscopic findings and pathologic results in the clinical care of
patients
-Incorporation of endoscopic procedures in the ongoing care of patients including
screening and prevention
3) Practice based learning and improvement:
-Utilization of medical literature, especially relevant clinical guidelines and trials,
to guide practice, recommendations to patients and formulate treatment strategies
4) Interpersonal skills and communication:
-Develop and improve communication skills to patients and families
-Faculty will help foster a team approach to the delivery of endoscopic services
5) Professionalism:
-Demonstrate integrity in practice
-Demonstrate timeliness, respect toward duties, and respect for team members
6) Systems Based Practice:
-Effectively integrate radiographic information and pathologic studies
into diagnostic and management considerations
-Learn the pivotal role of the primary care MD in open-access outpatient
procedure units
-Learn to utilize related consultants, particularly in radiology and surgery
Resources:
Gastrointestinal Disease; An Endoscopic Approach. Dimarino AJ jr., Benjamin SB.
Slack incorporated, 2nd edition, 2002
Endoscopic Interpretation. Blackstone MA. Raven Press Incorporated, 1984.
American Society for Gastrointestinal Endoscopy (ASGE) practice guidelines and
information for program directors: website links
Principles of Training in Gastrointestinal Endoscopy. ASGE standards of training
committees. GI Endoscopy; vol 49(6): 845-853, 1999
Training the gastroenterologist of the future: The Gastroenterology Core Curriculum.
Gastroenterology; 110:1266-1300, 1996
ASGE learning library selected videos:
-Techniques of colonoscopy and polypectomy
-Diagnosis of flat and depressed colorectal cancer
-Endoscopic mucosal resection
-Endoscopy in the bariatric patient
-Management of benign and malignant strictures
-Endoscopic removal of foreign bodies
-Management of variceal and non-variceal upper GI bleeding
-Endoscopic techniques for enteral access
-Evaluation of the small intestine
-Diagnostic ERCP
Conferences:
- Monthly endoscopy conference with attention to pancreaticobiliary diseases, ERCP,
EUS
- Quarterly quality assurance conferences (mandatory) reviewing endoscopic procedure
related complications
- Weekly GI grand rounds where endoscopy oriented cases routinely presented and
fellows are assigned yearly endoscopy cases to discuss