Beyond the Scope of Conflict of Interest

75 Sometimes inspiration comes in a flash, sometimes it comes at the end of a rainbow. This viewpoint was no stroke of brilliance, but rather came about from the simple objective of identifying ways to better encourage the best and the brightest general internal medicine (GIM) residents to consider a career in gastroenterology. In our training program at the University of Alberta, we provide an exemplary program of clinical practice in conjunction with intense teaching opportunities, including basic sciences and examination reviews, supported by a mentoring process which helps to match the training program to the trainees’ needs. When a promising trainee who has an interest in gastroenterology is identified, he/she is encouraged to participate in our Undergraduate Teaching Program, to undertake a research project with a member of the Division, to participate in weekly gastrointestinal (GI) Rounds, to attend a monthly City Wide Journal Club, and to be nominated for attendance at the Bright Lites Program sponsored by the Canadian Association of Gastroenterology. There will be instances when these promising young residents believe that they wish to make a career decision for gastroenterology, and although they have watched endoscopic procedures, they have never actually performed these under supervision. Some of the teaching staff carefully select suitable patients, under stable and appropriate circumstances, and the resident who had first seen the patient in consultation is able to watch the complete endoscopy and then spend several minutes of ‘hands on’ experience to better appreciate one of the joys of gastroenterology: being able to actually see the pathology. Unfortunately, there is a divided view among teaching staff in terms of whether this is a suitable teaching activity, a useful way to encourage potential new GI residents, and whether only gastroenterology residents (GI Fellows) should actually touch the endoscope. It is recognized that the Royal College encourages GIM residents to have experience with sigmoidoscopies. This is a skill that we do not teach and, of course cannot do so with the ‘do not touch the endoscope’ rule. At times, controversy is good because it allows us to focus on the issues and reflect upon what is happening in other training programs. With this in mind, I contacted the training program directors of the adult and pediatric gastroenterology training programs across the country, asking them to volunteer information as to whether and at what level endoscopy experience was provided for GIM or pediatric residents. As anticipated, none of the programs provide extensive training to reach a level of competence comparable to that of a GI Fellow, except under the special circumstances where senior GIM residents are going to practice in a remote community where there was an assured employment opportunity requiring endoscopic skills. The purpose of the survey was to learn how other programs deal with this issue of letting GIM residents ‘touch the scope’, with the hope that from this we could better determine whether our policy was common throughout the country. Of course, just because others support a different policy does not make them ‘right’ or us ‘wrong’, but instead simply provides a background, a benchmark, to allow us to better understand what some of our colleagues are thinking and doing. The results are shown in Table 1. This information was gathered and then shared with the Program Directors. Out of this discussion came a proposal that the Endoscopy Committee of the Canadian Association of Gastroenterology should be invited to comment, as also should the Royal College Subspecialty Committee in Gastroenterology Program Directors’ Committee, and a group of academically oriented family physicians with a special interest in gastroenterology, represented by the Canadian Association of Primary Care Gastroenterology (CanGut) Group. These views were solicited, and we are pleased to provide the input from Drs Robert Enns, Bill Depew and Nigel Flook. As you will see, the Accreditation Committee strongly supports that only gastroenterologists should be provided with intensive training in endoscopy (in addition, of course, to our capable surgical colleagues). This is an important view which is to be respected. Of course, this view does not get away from the initial perspective from which this whole subject started; that is, allowing a handful of highly qualified, interested and motivated GIM residents hoping to choose gastroenterology as a life career to have brief, supervised episodes of hands-on experience to allow them to better understand and appreciate part of the thrill of our subspecialty. Please consider carefully their views, and share your views by writing to Dr Lloyd Sutherland, Editor-in-Chief of The Canadian Journal of Gastroenterology. Beyond the scope of conflict of interest