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Gastrointestinal Endoscopy Examination Description

Physicians certifying in Gastrointestinal Endoscopy must successfully complete a computer-based (written) examination. Physicians recertifying in Gastrointestinal Endoscopy are required to successfully complete a computer-based (written) examination.

The Written Examination

The written certification examination consists of 200 multiple-choice items and is administered over a four-hour session. The written recertification examination consists of 100 multiple-choice items and is administered over a two-hour session. Each question has four potential responses, but only one correct answer. Each response to a question is scored as correct or not correct.

The outline below provides details of the subject areas (domains) covered on the examinations and the approximate percentage of items from each area. This domain listing is provided to help candidates prepare for the examination and is based on a comprehensive practice analysis of the key topics and knowledge in the specialty, as identified by practitioners, instructors, and other leaders in interventional pain management. Candidates should review this outline carefully and focus study on the areas listed. Each item on the examination is linked to a specific domain. The information in the outline is meant to serve as a study aid only and not as a guarantee of success in taking the examination.

  1. Review past medical history and current presentation (e.g., surgical history, laboratory results, current symptoms)
  2. Perform a focused physical examination (e.g., vital signs, abdominal exam, rectal exam)
  3. Have knowledge of guidelines for screening and surveillance of cancerous and precancerous conditions of the gastrointestinal tract
  4. Assess risk and contraindications for endoscopic surgery
  5. Assess patient risk for sedation (e.g., ASA score, Mallampati score, respiratory conditions)
  6. Order additional laboratory and imaging studies (e.g., CT, blood tests, barium swallow)
  7. Informed consent ( e.g., review risk, benefits, and alternative, assess patient understanding, signatures, alternates)
  8. Educate patient on how to complete a successful preparation for the endoscopic surgery (e.g., polyethylene glycol-electrolyte solutions, dietary restrictions, bowel stimulants)
  9. Describe the adverse events associated with preparation regimens (e.g., hyperphosphatemia)
    1. Larynx, Hypopharynx
      1. Masses (e.g., vocal cord papilloma)
      2. Normal appearance (occult findings) (e.g., nonerosive laryngopharyngeal reflux)
    2. Esophagus
      1. Recognize mechanical and anatomic abnormalities (e.g., diverticula, web, rings, and strictures)
      2. Recognize symptoms and findings consistent with esophageal eosinophilia, and biopsy procedures for diagnosis
      3. Masses (e.g., squamous cell carcinoma, adenocarcinoma)
      4. Recognize normal and abnormal esophageal squamocolumnar junction (e.g., Barrett’s, reflux, erosive esophagitis, normal)
      5. Infection (e.g., candidiasis, CMV, HIV)
      6. Mallory-Weiss tear
      7. Ulcer
      8. Varices (e.g., red wale signs)
      9. Achalasia
      10. Foreign bodies
      11. Recognize occult disease processes (e.g., nonerosive esophageal reflux disease, dysmotility, functional dyspepsia)
    3. Stomach
      1. Irregular gastroesophageal junction (e.g., hiatal hernia, sliding, paraoesophageal)
      2. Ulcers (e.g., Forrest classification)
      3. Portal hypertensive gastropathy (e.g., gastric varices, gastropathy)
      4. Pyloric stenosis
      5. Gastritis (e.g., acute or chronic with or without intestinal metaplasia)
      6. H. pylori infection
      7. Masses (e.g., focal dysplasia, focal adenocarcinoma, lymphoma)
      8. Submucosal lesions (e.g., GI stromal tumors, lipomas, carcinoid)
      9. Bile reflux (e.g., bile, food particles despite NPO status, gastroparesis)
      10. Foreign bodies (e.g., bezoar)
      11. Arteriovenous malformations
      12. Postsurgical anatomy including postsurgical complications (e.g., Roux en Y, anastomotic ulcers, fistulas, percutaneous endoscopic gastrostomy tube)
      13. Recognize occult upper GI disease processes (e.g., diffuse adenocarcinoma-signet cell, functional dyspepsia, gastroparesis, SIBO)
    4. Duodenum
      1. Duodenitis
      2. Masses (e.g., adenocarcinoma, stromal tumors including carcinoids)
      3. Ulcers
      4. Scalloping (e.g., denuded mucosa with celiac disease)
  1. Anus and Perianal
    1. Recognize and treat normal and abnormal anal and perianal findings pathologies
  2. Colon and Rectum
    1. Masses: Mucosal (e.g., polyps, adenocarcinoma)
    2. Masses: Submucosal (e.g., leiomyoma, carcinoid, lipomas)
    3. Masses: Extra colonic mass effect
    4. Masses: Perirectal abscess
    5. Inflammation: Proctitis (e.g., radiation, inflammation, infectious)
    6. Inflammation: Colitis (e.g., radiation, inflammation, infection, ischemic)
    7. Inflammation: Inflammatory bowel disease (e.g., Crohn’s, ulcerative colitis, ileitis)
    8. Inflammation: Clostridium difficile pseudomembranous
    9. Diverticula (e.g., inverted diverticula, diverticulitis, stigmata of bleeding)
    10. Injury (e.g., perforations, mucosal tears, thermal burns)
    11. Strictures (e.g., Crohn’s, postoperative strictures)
    12. Neoplastic lesion types and appearances: Hyperplasia
    13. Neoplastic lesion types and appearances: Neoplasia progression (e.g., serrated adenoma, tubular adenoma, tubulovillous, villous, adenocarcinoma)
    14. Neoplastic lesion types and appearances: Polyposis syndromes (e.g., FAP, Lynch Syndrome, hyperplastic polyposis syndrome)
    15. Neoplastic lesion types and appearances: Appearances (e.g., flat, sessile, pedunculated)
    16. Melanosis coli
    17. Recognize lower GI occult disease processes (e.g., microscopic colitis, constipation, diarrhea)
  3. Terminal Ilium
    1. Inflammation (e.g., Crohn’s, ileitis)
    2. Masses (e.g., carcinoid tumor)
    3. Recognize Occult disease process (e.g., inflammatory bowel disease in remission)
  1. Endoscope types (e.g., gastroscopes, colonoscopes, pediatric variants)
  2. Biopsy instruments (e.g., forceps and snare types)
  3. Tissue retrieval instruments
  4. Electrocautery instruments (e.g., including power generator, grounding pad)
  5. Ligation instruments
  6. Endoscopic ergonomics (e.g., bed height, monitor position, surgeon position)
  7. Understand the broad categories of endoscopes, importance of awareness of shaft size, and routine mechanical functions (e.g., insufflation, irrigation, suction, light source, troubleshooting)
  8. Mucosal injections (e.g., India ink, saline)
  9. Knowledge of disease spread via endoscopic instruments and prevention techniques
  10. Patient monitoring and sedation
  11. Knowledge of helicobacter pylori testing (e.g., bedside, laboratory, and others)
  1. Perform time-out
  2. Describe monitoring of the patient intraoperatively (e.g., abdominal pain, vasovagal heart rate)
  3. Describe the steps of a colonoscopy (e.g., proper insertion, advancement, cecal intubation, retroflexion, management of looping)
  4. Describe the steps of an esophagogastroduodenoscopy, (e.g., proper insertion, advancement, retroflexion)
  5. Perform polyp removal techniques (e.g., snare, forceps, EMR, and special retrieval systems)
  6. Perform hemostasis using thermal and non-thermal techniques
  7. Identify intraoperative signs and symptoms of adverse events
  1. Recognize and manage procedural complications (e.g., observation, antibiotics, radiologic imaging indications, surgical referral)
  2. Geriatric-specific considerations
  3. Evaluate patient for discharge based on accepted criteria (e.g., sedation recovery criteria, pain assessment)
  4. Communicate findings with the patient, their families, and other healthcare professionals following procedure, immediately and after pathology results
  5. Provide written patient instructions after procedure (e.g., return precautions, follow-up plans, how biopsy results will be communicated, behavior and diet recommendations, therapeutics)
  6. Manage incomplete endoscopic surgery (e.g., radiologic procedures, repeat endoscopy)
  7. Generate complete operative report
    1. Indication
    2. Adequacy of the preparation
    3. Sedation type and medications used
    4. Findings
    5. Interventions with devices used
    6. Pathology specimens sent, and where applicable, expectations for diagnosis
    7. Patient tolerance and completion of endoscopic surgery
    8. Tentative planning pending pathology
    9. Immediate complications
    10. Photographic documentation (e.g., cecal landmarks, significant findings)
  8. Demonstrate familiarity with quality indicators for gastrointestinal endoscopy
    1. Adenoma detection rate (e.g., >25% all screening, >30% male screening, >20% female screening)
    2. Withdrawal times (e.g., >6 minutes)
    3. Perforation rate (e.g., <1/500 for all exams, <1/1000 screening)
    4. Post-polypectomy bleeding rate (e.g., <1%)
    5. Cecal intubation rate (e.g., 90% for all colonoscopies, >95% for screening)
    6. Notification of pathology results and management plan
    7. Frequency with which appropriate recommendations are made
    8. PPI or H2RA prescriptions for gastric or duodenal ulcers, and post-dilation for esophageal strictures
    9. H. Pylori testing for gastric or duodenal ulcers
    1. Manage medications in the peri-operative period (e.g., proton pump inhibitors, beta blockers)
    2. Manage anticoagulant and anti-platelet medications in the peri-operative period
    3. Manage sedation with common medications
      1. Opioids
      2. Benzodiazepines
      3. Propofol
      4. Adjunctive agents
    4. Manage complications of oversedation (e.g., ACLS skills and reversal agents)

 

References

A candidate should focus their examination preparation on the content provided in the examination blueprint. The reference list is not meant to be a list of comprehensive study materials but rather to aid candidates who may wish to prepare more in a specific area of the examination blueprint that they may not be as familiar with. You may wish to use the study materials to prepare for the written certification examination. All items appearing on examinations have been written based on the material presented in these study references.

Click here to Download Study References

Examination Administration

Click here for ABPS Examination Schedule Information

Examination Results

Candidates will receive score reports indicating their pass/fail status on the written examination. Candidates who fail are provided a breakdown of their performance by subject content domains. ABPS sends examination results to candidates within 60 days of the last day of the administration window. Each examination is scored against predetermined standards of acceptable performance, utilizing modified Angoff procedures for establishing the minimum acceptable scores. A candidate who is successful in passing the written examination is then approved to sit for the next administration of the oral certification examination.  A candidate who is successful in passing the written recertification examination is then recertified and retains Diplomate status within ABPS and AAPS.

Retaking Examinations

A candidate may take the written examination as many as three times to attain a passing score. Candidates who are not successful in passing the examination within the number of allowable attempts may reapply for certification by completing a new application and meeting all the eligibility requirements in effect at the time the new application is submitted.

Accommodations for Religious Reasons and Disabilities

Click here to see the complete policy for accommodations.

 

 

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