Response to 'Analysis of learning curves in gastroscopy training: the need for composite measures for defining competence by Siau et al

We are thankful for the letter of Siau et al1 in response to our article describing the learning curve to satisfactory completion rates in upper GI endoscopy.2

We agree that D2 intubation and successful J manoeuvre are insufficient to define competence. Our article's title stated that we focused on completion rates. We specifically mentioned in our discussion that it is necessary to comply with a host of other measures to be competent. For example, procedural completion and successful J manoeuvre do not ensure complete inspection of the mucosa, nor do they result in correct identification of pathology. We welcome the introduction by Joint Advisory Group of assessment of endoscopic non-technical skills and support direct observation of procedural skills for trainees. Competency assessment should be broad and assess all necessary skills required of high-quality independent endoscopists.

Nevertheless, it is likely that a minimum number of procedures will remain part of...

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