Canadian credentialing guidelines for endoscopic privileges: An overview

GI endoscopy comprises a variety of endoscopic procedures that include both diagnostic and therapeutic or interventional components. The ability to perform these procedures proficiently requires both technical and cognitive skills, which are generally acquired through formal training with subsequent consolidation or improvement of skills in clinical practice. Documentation of these skills is the basis of acquiring credentials for one or more endoscopic procedures and it is these credentials that permit the granting of privileges such that an endoscopist may undertake these procedures in clinical practice. The CAG has developed a series of guidelines for credentialing in endoscopic procedures to aid practitioners and institutions in the process of acquiring or granting privileges; however, it is the individual institution or facility, not the CAG, who grants these privileges. The guidelines are consistent with those developed by other national professional bodies and, like other endoscopic credentialing guidelines, they are based predominantly on the application of expert opinion regarding the numbers of procedures required to achieve competence. As such, the current guidelines provide a consistent basis for all institutions that may wish to grant privileges for endoscopic procedures and it is hoped that this will lead to a greater degree of uniformity in evaluating credentials and granting privileges. However, it should also be recognized that there are a number of deficiencies in the current process. There is a need for a more standardized and comprehensive evaluation process to document the competence of trainees at the completion of their training program; this process should include formal documentation of trainees' technical skills in completing procedures proficiently and performing appropriate therapeutic interventions, as well as their cognitive skills in determining appropriate indications, lesion recognition and management consequences. There is also a need for continuing evaluation processes, which will allow practicing endoscopists to document maintenance of competence as a basis for renewed granting of privileges at the same or another institution. Development of these evaluation processes is no small undertaking but it is critical to the continued development of a safe and effective endoscopic practice in Canada, particularly with the prospect of widespread colorectal cancer screening and surveillance, and the continued development of new endoscopic techniques and standards. ©2007 Pulsus Group Inc. All rights reserved.