Endoscopic surgical skill qualification system in Japan: Five years of experience in the gastrointestinal field

Introduction: To reduce the complications of endoscopic surgery, the Japan Society for Endoscopic Surgery formed a committee that established the Endoscopic Surgical Skill Qualification System (ESSQS). Here we report on the methods employed and results obtained with the ESSQS over five years in the field of gastrointestinal surgery. Methods: The first ESSQS review was performed in 2004, and examinations have been conducted once a year since then. Applicants must submit a list of patients on whom they have performed surgery (including complications) and an unedited video showing one of the relevant surgical procedures. To assess the applicants' videos, the judging committee prepared "common criteria'' (60 points) and "procedure-specific criteria'' (40 points). Assessment of videos was done independently by two judges, and the applicant passed the test if both judges assigned a score of 70 points or more. Results: There have been 1369 applicants, and 641 (46.8%) have been successful. The main problem with this system has been a relatively low rate of agreement between the two judges (k value: 0.29-0.40). However, the incidence of complications is significantly lower in patients treated by successful applicants (4.3 +/- 6.8%) than in those treated by failed applicants (5.6 +/- 8.4%) (P = 0.0096). Conclusion: Although the ESSQS could be further improved, this system promotes training and decreases complications.