Despite the dramatic technologic developments in endoscopy, our understanding of how endoscopic skills are acquired and learnt remains rudimentary. Technical training in any procedure involves three elements: didactic learning, supervised hands-on training, and unsupervised experience. Didactic learning is one of the very important component of endoscopic training and comprises formal discussions, presentations, and the use of audio-visual aids. Although didactic training methods can accelerate the evolution of procedural skills, they cannot substitute for the hands-on experience through which technical skills, including critical hand-eye coordination, develop.
During supervised hands-on training, the trainee performs tasks of increasing difficulty under expert supervision. It is important that expert themselves should be compitant enough to transfer their own extraordinary skill to trainees. Unsupervised experience, a critical element of learning, begins during the training period, with expert help available on an increasingly selective basis. Unsupervised experience obviously strats during training period in endoscopy but continues throughout an individual’s professional career. The period of supervised hands-on training starts with “easy” procedures, gradually progressing to more difficult cases. In the “real world,” endoscopists are faced with an unpredictable mix of cases with varied pathology, from straightforward diagnostic procedures to complex therapeutic ones. In practice, therefore, hands-on training often begins with limited segments of procedures, gradually extending to entire diagnostic procedures and more difficult portions of therapeutic procedures. The therapeutic aspect of endoscopy helps in many surgical field. The hand eue coordination is important in endoscopy to develop just like Laparoscopic Training.
Even when competence of endoscopy is achieved, its persistence cannot be assumed. Some institutes have developed quality assurance programs to monitor competence of their endoscopic physician as part of their recredentialing process. Prospective data for individual endoscopists and are collected regarding indications for endoscopy, extent of examination, endoscopic diagnosis, complications, and effect on therapeutic decisions. This analysis can help identify individuals whose skills fall below the accepted level of competence either through disuse, inadequate offsite training, or personal physical impairment. Sadly, few opportunities currently exist for remedial training because of limited faculty time and available resources that are largely reserved for participants in formal training programs.
A number of “advanced training programs” have already been established in regional centers of excellence in many developed countries to assure competence in highly technical procedures of endoscopy, and others are evolving in many developing countries. This all suggests that the prevailing winds may soon change direction, fostering renewed interest in how competence is best achieved.