In 2022, gastric cancer (GC) was the fifth leading cause of cancer-related mortality worldwide, accounting for more than 660,000 deaths. In the same year, Europe recorded 135,610 new cases and 95,431 deaths attributable to GC; however, several European countries, including Portugal and Lithuania, exhibit higher incidence and mortality rates (International Agency for Research on Cancer. 2022). Although age-standardized incidence and mortality rates of GC have declined globally, population ageing is expected to substantially increase the absolute number of cases and deaths in the coming decades. (Leja et al., 2024).

Gastric cancer in the European Union has a 5-year survival of ~25% and a mortality-to-incidence ratio of 0.63.(Leja et al., 2024). Survival outcomes range from 75% for localized disease to 7% for metastatic disease  (National Cancer Institute, 2023). These data highlight the importance of both primary prevention (e.g., reduced tobacco use) and secondary prevention through screening and early detection. Early detection can reduce physical and psychological suffering, enable less invasive and more effective treatments, and improve health-related quality of life. (Chung et al., 2024).

The Council of the European Union recommended the development of gastric cancer screening programmes in regions with higher incidence and mortality; however, such programmes have not yet been implemented (Leja, et al.2024). In this context, enhancing endoscopists’ upper gastrointestinal endoscopy competencies is crucial to increase GC detection rates, particularly for precancerous and early cancer lesions, according to current guidelines (Bisschops et al., 2016; Luo et al., 2023; Zhang et al., 2015). Nevertheless, studies on upper GI endoscopy curriculum development and assessment remain scarce, particularly for experienced gastroscopists in Europe. Most studies adopt a competency-based approach emphasizing conscious and unconscious competence, respectively, the stage where clinicians can perform a skill consciously and are able to explain each step, and the stage where the skill is executed automatically and fluently (Dubé & Rostom, 2016). These approaches may overlook the role of contextualized reflective competence, a metacompetence involving the ability to recognize and critically reflect on one’s own competence or incompetence, and to actively seek strategies to enhance performance using the surrounding learning or clinical context (Lane & Roberts, 2022).

Aiming to develop competencies and aptitudes of physicians on upper GI endoscopy and improve cancer detection, the “Eucanscreen course on upper GI endoscopy: How to improve your cancer detection rate” is a blended, competency-based course delivered in three editions (2025–2027), with face-to-face sessions in Portugal and Lithuania. The course prioritises active learning through case-based and reflective approaches, aiming to foster a sense of belonging to a community of practice involved in co-creating knowledge and promoting contextualised reflective competence (Alves, Pereira & Dinis-Ribeiro, 2025).

Based on data from needs and resources and first-edition training assessments, this study aims to explore physicians’ motivations and perceived barriers to learning and applying competencies in clinical practice, and examine the role of contextualized reflective competence in supporting these processes. This study is grounded in a socioconstructivist perspective, emphasizing learning as an interactive, socially mediated process (Thomas et al.,2014).

The following research questions will be addressed:

• What motivations lead physicians to participate in a continuing education course on upper gastrointestinal endoscopy?
• What are the perceived barriers to learning and applying knowledge and competencies in upper GI endoscopy?
• In what ways may contextualized reflective competence support physicians in overcoming learning barriers and applying endoscopic competencies in clinical practice?

This research will provide insights into the learning needs and resources, challenges, and reflective practices of physicians, informing the design and optimization of competency-based endoscopy training programmes.

This work was co-funded by the European Union under the grant number 101162959 (EU4H-2023-JA-2-IBA-06), within the EUCanScreen Joint Action.

This research was based on a perspectivism approach that views knowledge as partial, context-dependent, and shaped by historical and cultural factors, highlighting the value of multiple viewpoints and theoretical frameworks (Menezes et al., 2022). The course was delivered through a multimodal curriculum that includes: (i) asynchronous webinars, based on expository teaching; (ii) small-group interactive webinars, focused on peer discussion of clinical challenges, including peer-assessment activities and real-life clinical scenarios; (iii) a face-to-face component, held in Portugal (1st and 3rd editions) and in Lithuania (2nd edition). Adopting a multi-methods design (Menezes et al., 2022), the study was based on data from a needs and resources assessment questionnaire answered before the start of the course, a training assessment questionnaire answered at the end of the course and data collected from reflective discussions promoted in the interactive webinars and face-to-face course. The online needs assessment questionnaire included questions regarding sociodemographic data, motivations, availability for training and previous training on upper endoscopy, readiness for online learning and specific training needs. The training assessment questionnaire included Likert-scale and open-ended questions on reaction to training, participants’ perceptions regarding relevance, applicability, pedagogical quality, and overall satisfaction. Reflective discussion (Phua et al, 2024) was used to facilitate collective reflection among participants, enabling them to share experiences, analyse challenges, and co-construct insights regarding challenges to endoscopic practices and strategies to improve it. In each session, faculty will present results from continuous assessment of participants and discuss the results through guided reflective dialogue. The discussion will aim to generate shared understanding, promote peer learning, and provide formative input for ongoing refinement of both individual competencies and the course curriculum. Microsoft Teams will be used to record and transcribe online sessions, and transcripts will be reviewed by researchers before participant validation. Participants were gastroscopists working in European countries who are actively involved in clinical training and/or hold leadership roles in gastric cancer screening/ early diagnosis. They were invited to participate via email along with information about the course, an informed consent form and the pre-test questionnaire. Among the selected participants (n = 23), 8 were men (35%) and 15 were women (65%). Some participants held active leadership roles (n = 5; 22%), while a substantial proportion were involved in educational activities and clinical training (n = 14; 61%). Qualitative data will be analysed using thematic analysis (Braun & Clarke, 2013). Quantitative data will be analysed using descriptive statistics.

With the overarching goal of improving cancer detection rates across Europe, the EUCanScreen course adopts an educational approach that seeks to promote meaningful changes in professional practice through the enhancement of best-practice knowledge in upper gastrointestinal endoscopy. Grounded in a needs-based curriculum design, the course integrates participants’ motivations, prior experience, and contextual constraints into its pedagogical framework. Findings from the registration and needs assessment questionnaire reveal that participants were primarily motivated by the desire to improve professional competencies, particularly in relation to quality standards and reflective clinical practice. Motivations were also linked to professional development, teaching responsibilities, and engagement in early cancer detection initiatives. Participants further highlighted structural and organisational barriers, including limited access to formal training, specialised staff, and adequate resources, often relying on self-directed learning pathways. The analysis of reflective discussions is expected to reveal how physicians overcome learning and application barriers, how contextualized reflective competence supports critical self-assessment and peer learning, and how these insights can inform curriculum refinement and enhance clinical practice in upper GI endoscopy. Expected outcomes include a deeper understanding of learners’ educational needs and practice environments, enabling the design of targeted educational strategies to overcome identified barriers and support sustainable improvements in professional practice and early cancer detection.

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