Limitations of teaching endoscopy

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Background and aim

Endoscopic procedures of the gastrointestinal tract represent a category of diagnostic tests that considerably rely on skills and dexterity of a human tester. The present analysis aimed to delineate factors that affect the success of teaching endoscopy and potentially limit the acquisition of new skills and knowledge.


The performance of the endoscopist is described in terms of sensitivity and specificity. The outcomes of sequential testing and acquisition of new knowledge are calculated using matrix algebra. Teaching is modeled as an iterative process with an incremental improvement in a fellow’s performance matrix.


As a diagnostician, an endoscopist cannot measure beyond his/her own level of competence. The cognition and endoscopic skills of both the fellow and the attending physician determine how fast the fellow’s endoscopic performance improves over time. The better the fellow’s and the attending’s abilities are to recognize and amend residual deficiencies, the faster the fellow’s endoscopic performance improves. Severe or even complete diagnostic incompetence by either party can draw out the training process or even result in a complete standstill, respectively.


The description of endoscopic performance in terms of test characteristics provides valuable insights into the influence of endoscopic performance characteristics on the outcome of endoscopy and on the constraints of teaching endoscopic skills.

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