Teaching and credentialing in France

M. Barthet, M. Gasmi
2006 Endoscopy  
Scientific publications in the field of endoscopic ultrasonography are raising up since the last 20 years . In a recent paper, the number of articles devoted to EUS between the earliest 1980 and 2002 reached 1259 papers published in 65 journals [1] . The peak of the rate of publications per years seems to be reached in 1998. Out of the 1259 articles, 198 (15.7 %) were related to diseases of the biliary tract or the pancreas, either benign or malignant. In the same period, the number for
more » ... number for indications of EUS investigations grew dramatically. In France, 48 039 EUS were performed in 1999 [2] . In USA, some authors have recently suggested that the currently available EUS resources are not sufficient to meet the hypothetical demand [2] . Therefore, the authors concluded that Endoscopy units able to perform EUS and programm trainings have to be increased [3] . The number of EUS seems to be still growing up in endoscopy unit recently equipped with EUS [4]. Learning curve of EUS and training program Although EUS appears to be a useful tool with a sufficient scientific background, it is reputed to be an operator-dependent procedure with a long-learning curve. The value of EUS is directly proportional to the training , skill and experience of the endosonographer. In a recent series, the lowest annual number of examinations requested per year might be around 200 ± 250 procedures [4] . This estimation is not so far from that found in ERCP series ranging from 200 to 350 procedures per year [5, 6] . It is probable that the learning curve of EUS is close to that of therapeutic ERCP, corresponding to one of the most difficult and constraining endoscopic technique learning. Sivak thought the acquisition of EUS competence to require a minimum 6 months training period in a center performing at least 300 procedures per year [7] . The guidelines of the American Society for Gastrointestinal Endoscopy (ASGE) recommended a minimum of 125 procedures supervised to achieve competence in the diagnosis of mucosal or submucosal abnormalities [8] . For achieving competence in all the fields of EUS, they recommended a minimum of 150 supervised cases, 75 of them being devoted to pancreaticobiliary diseases and 50 to FNA [8]. In another study from ASGE, 115 American respondents to a direct mail survey sent to member of the ASGE, performed a median number of 200 procedures per year and trained an average of 0.4 advanced fellows [9] . Thus, the actual offers for EUS training seems to be insufficient for providing an adequate competence. Many studies have yet confirmed the importance of the learning curve to improve the EUS accuracy. The accuracy of EUS staging of esophageal cancer was significantly improved over an 8-year period for T staging from 64 to 90 % but not for N staging [10] . Considering pancreaticobiliary diseases, a series reported the influence of training on accuracy of EUS-guided FNA of pancreatic masses [11] . After a short training period (2 months), there was a significant improvement in EUS-FNA accuracy from 33 % to 91 %. Even if the exact type and modalities for EUS training remained to be determined, the usefulness of a period of training in a center performing more than 200 procedures per year is confirmed. What is the actual way for learning EUS in France ? In France, EUS diploma has been instituted since 1993. The location of this course was in Paris with theoretical course during four weeks and 20 one-day sessions for practicing with an EUS
doi:10.1055/s-2006-946655 pmid:16802227 fatcat:iua4xh6cd5hrjpe247haauhjaa