GuidelineGuidelines for privileging, credentialing, and proctoring to perform GI endoscopy
Section snippets
Statement on credentialing, recredentialing, and granting privileges for GI endoscopy
A primary mission of the ASGE is to promote high-quality patient care and safety in the field of GI endoscopy. The purpose of this statement is to provide a suitable framework for determining the competency of practicing endoscopists and for the granting of privileges to perform endoscopic procedures. Guidelines for the granting of privileges for newly developed endoscopic procedures are also provided. As such, this document provides principles and practical guidelines to assist credentialing
Definition of terms
A number of terms related to competency and privileging of procedures are summarized in Table 2. Generally speaking, training in endoscopic techniques must be adequate for each major category of endoscopy for which privileges are requested. The need to seek and attain competency in new procedures may periodically arise for endoscopists over the course of their career. New procedures should be taught by preceptors using a validated curriculum. The preceptor should be responsible for setting
Uniformity of standards
The goal of a credentialing organization in granting privileges to perform endoscopic procedures must be to ensure the delivery of high-quality care for all patients undergoing endoscopic procedures. Uniform standards should be developed that apply to all hospital staff requesting privileges to perform endoscopy, regardless of medical specialty, and to all areas where endoscopy is performed. Criteria must be established that are medically sound and applicable to all wishing to obtain privileges
General principles of credentialing and granting hospital privileges for GI endoscopy
Box 1 lists the basic principles of credentialing and privileging for GI endoscopy. The implementation of credentialing policies and the granting of privileges is the responsibility of individual healthcare organizations.4 Credentialing can only begin after successful completion of a GI endoscopy training program in adult or pediatric gastroenterology or general surgery as described in a previous ASGE document.5 It should be the responsibility of the service chief or an individual in a
Standards of practice documents for credentialing for GI endoscopy
In the following sections, the ASGE has developed credentialing guidelines, using evidence-based, objective measures whenever possible, for the following procedures/skills: moderate sedation, EGD, colonoscopy, flexible sigmoidoscopy, capsule endoscopy, ERCP, EUS, EMR, endoscopic submucosal dissection, ablative techniques, enteral stent placement, deep enteroscopy (DE), and endoscopic enteral tube placement. Table 3 lists an evidence-based or expert consensus–derived minimum number for each
Emerging technologies
The practice of GI endoscopy is dynamic and continues to evolve. Standard endoscopic procedures continually undergo refinement, and new major techniques are introduced. New technologies that have left the experimental and developmental stages with demonstrated efficacy may be ready for adoption into clinical practice. Endoscopists who have not received conventional formal training in newly developed techniques may wish to acquire necessary credentials. The degree of training, direct
Principles of proctoring for endoscopic privileges
Proctoring may represent an important part of granting endoscopic privileges. Proctoring involves an observational assessment of skills by a credentialed endoscopist that may be used in addition to data from a peer-review process. Candidates for proctoring may include applicants for new staff appointments, incumbent staff members trained in additional or novel procedures, and staff members undergoing routine recredentialing processes or remediation.
The role of proctor is to act as an
Recredentialing and renewal of endoscopic privileges
It is the responsibility of each institution to develop and maintain guidelines detailing the methods and frequency required to grant and renew privileges in endoscopic procedures. Recredentialing of endoscopic privileges generally follows regional or state regulations but has been mandated by national accrediting organizations to occur every 2 to 3 years. Individual institutions should have a mechanism in place for addressing instances when minimal competency cannot be assured. These
Recommendations
- 1.
We recommend that training in endoscopic techniques must be adequate for each major category of endoscopy for which privileges are requested. ⊕⊕⊕⊕
- 2.
We recommend that whenever possible competence should be determined by objective criteria and direct observations and that an arbitrary number of procedures does not guarantee competency. However, minimal threshold numbers for initial credentialing may be set below which competency cannot be assessed. ⊕⊕⊕⊕
- 3.
We suggest that uniform standards be developed
Disclosure
The following authors disclosed financial relationships relevant to this publication: V. Chandrasekhara: Consultant for Boston Scientific and Olympus; M. A. Khashab: Consultant for BSCI; V. R. Muthusamy: Consultant for Boston Scientific, research support and honorarium recipient from Covidien GI Solutions; J. Yang: Consultant for Cook; J. M. DeWitt: Consultant for Olympus America. All other authors disclosed no financial relationships relevant to this publication.
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This document was reviewed and approved by the Governing Board of the American Society for Gastrointestinal Endoscopy.