Analysis of learning curves in gastroscopy training: the need for composite measures for defining competence

We read with interest and commend the study by Ward and colleagues which explores the learning curve in gastroscopy.1 The authors apply a D2 intubation rate of >95% as a proxy marker of trainee competency, and conclude that 187–200 procedures are sufficient to achieve this, in line with Joint Advisory Group (JAG) certification criteria.2 We would like to debate the following points with the authors.

While we agree that D2 intubation and J-maneouvre reflect procedural completion and rely on motor skill, we argue that this stand-alone measure is insufficient to define competence. Competence is defined by the American Society for Gastrointestinal Endoscopy as the 'minimal level of skill, knowledge and/or expertise derived through training and experience that is required to safely and proficiently perform a task or procedure'.3 Thus, competence is not merely a destination-orientated end point; it is reliant on a combination of technical...

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