Endoscopy competency—technical, cognitive, and integrative—has well-established metrics for gastroenterology trainees, but the evidence base specifically addressing competency among internists (internal-medicine trained physicians who perform endoscopy) is scattered. The aim of this systematic review and meta-analysis is to synthesize the literature on internist competency for upper GI endoscopy (EGD) and lower GI endoscopy (colonoscopy), evaluate assessment tools and performance benchmarks, and identify knowledge gaps.

We performed a systematic search of PubMed/Medline, Embase, Scopus and Web of Science (inferred search window: inception–May 2025) for studies reporting objective competency outcomes (e.g., cecal intubation rate [CIR], adenoma detection rate [ADR], complication rates, validated observation tools such as ACE, DOPS, GAGES) and/or validated assessment scores for endoscopists trained in internal medicine. We included observational studies, training evaluations, and trials that reported outcomes for internists (alone or compared to other specialties). Risk of bias was assessed using standard tools for observational studies. Where comparable numeric outcomes were reported, random-effects meta-analysis was planned.

High-quality validated assessment tools exist (ASGE’s ACE for colonoscopy/EGD; other tools include DOPS, GAGES and several direct-observation tools). Competency frameworks emphasize objective metrics (CIR, ADR, withdrawal time, procedure time) and structured observation with feedback. For colonoscopy, professional guidance indicates ADR benchmarks (≥25% overall screening ADR) and CIR targets (>90%) as key quality indicators. Training literature reports minimum procedural volumes and structured assessment before declaring competence (for colonoscopy, major societies have suggested thresholds and objective assessment tools rather than sole procedure counts). However, direct comparative evidence specifically isolating internists (vs GI specialists or surgeons) is limited, heterogeneous, and often confounded by setting and case-mix. Where internists are included in multidisciplinary cohorts, overall performance (CIR, ADR when reported) is generally within published quality thresholds when structured training, supervision, and assessment are applied. Assessment-tool validation studies show acceptable validity evidence for several tools but highlight variable interrater reliability and limited data specifically in internal-medicine populations.

Internists can achieve recommended endoscopy competency metrics when training follows accepted curricula, uses validated assessment tools (ACE/DOPS/GAGES), and measures quality indicators (ADR, CIR). High-quality, specialty-stratified studies are lacking — future research should prospectively compare internist vs GI-fellow training outcomes using standard assessment tools and report core quality metrics (ADR, CIR, complication rates, and validated global skills scores).