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Evaluation of each trainee's endoscopic skill is commonly done by applying ACGME's core competencies and using their Next Accreditation System that focuses on milestone attainment [35]. However, it is also important that trainees receive timely and routine feedback on their endoscopy skills from their attendings throughout the training period. Assessment of performance in upper endoscopy should include the following cognitive and motor skills [3,35]:

 Understand the appropriate indications and contraindications of upper endoscopy, and diagnostic and/or therapeutic alternatives.

 Understand the risks of upper endoscopy and how to minimize them.

 Safely administer sedation and monitor the patient during endoscopy.

 Perform and document successful intubation to the second portion of the duodenum.

 Conduct a thorough examination of the upper GI tract including retroflexion in the stomach.

 Correctly identify landmarks and parts of the upper GI tract including esophagus, GEJ, cardia, fundus, gastric body, antrum, pylorus, duodenal bulb, and second portion of duodenum.

 Recognize pathology including esophagitis, varices, gastropathy, peptic ulcer disease, and villous blunting in the duodenum.

 Understand when to obtain tissue samples and perform endoscopic mucosal biopsy successfully.

 Perform effective endoscopic therapy including hemostasis, variceal band ligation, foreign body removal, stricture dilation, and PEG tube placement.

 Complete timely and thorough documentation of all endoscopic procedures.

 Integrate endoscopic findings to formulate a plan of care.

The training program director should monitor procedure logs to ensure that the minimal threshold of 130 EGDs is achieved and surpassed [3,35]. Periodic evaluations of trainees should also be submitted to the program director and/or clinical competency committee for review to assess skill proficiency and appropriate clinical judgment as determined by faculty proctors.