1
|
Iqbal U, Diehl DL. Do surgery residents and gastroenterology fellows learn colonoscopy at different rates? Gastrointest Endosc 2022; 96:308-309. [PMID: 35715238 DOI: 10.1016/j.gie.2022.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 04/21/2022] [Indexed: 02/08/2023]
Affiliation(s)
- Umair Iqbal
- Department of Gastroenterology and Nutrition, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - David L Diehl
- Department of Gastroenterology and Nutrition, Geisinger Medical Center, Danville, Pennsylvania, USA
| |
Collapse
|
2
|
Wu PH, Tsai NY, Hsiao CW, Jao SW, Cheng YC. Two-Person Colonoscopy as a Training Approach to Non-sedation Colonoscopy. Am Surg 2020; 87:938-942. [PMID: 33283524 DOI: 10.1177/0003134820952384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Reported learning curves of colonoscopy vary from 94 to 275 cases and focus on one-person colonoscopy. Our aim was to evaluate the learning curve of two-person non-sedation colonoscopy for trainees in a single tertiary care hospital. PATIENTS AND METHODS We conducted a retrospective study in 1264 patients who underwent diagnostic or screening colonoscopies in a single institution from August 2012 to January 2013. Most of the patients (1174/1264) did not receive sedation during the procedure. All procedures were performed under two-person control. Two third-year residents who received previous colonoscopic training via a plastic model were the trainees. RESULTS In comparison to the performance of 5 staff members, the colonoscopic outcomes showed no significant differences in the completion rates (77.2% vs. 79.8%, P = .382), average polyp numbers (.9 ± 1.7 vs. 1.0 ± 1.8, P = .453), polyp detection rates (43.5% vs. 46.3%, P = .434), or intubation lengths (96.4 ± 29.3 vs. 96.3 ± 26.7 cm, P = .939). The total procedure times for the 2 groups were 17.2 ± 10.6 minutes (trainees) and 12.9 ± 7.8 minutes (staff) (P < .001). CONCLUSION Trainees achieved acceptable outcomes over an 81-97 case learning curve under a two-person non-sedation colonoscopy technique, an approach with potential as a transition to single-operator colonoscopy.
Collapse
Affiliation(s)
- Po-Hsien Wu
- Division of Colon and Rectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taiwan
| | - Nien-Ying Tsai
- Department of General Medicine, Tri-Service General Hospital, National Defense Medical Center, Taiwan
| | - Cheng-Wen Hsiao
- Division of Colon and Rectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taiwan
| | - Shu-Wen Jao
- Division of Colon and Rectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taiwan
| | - Yi-Chiao Cheng
- Division of Colon and Rectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taiwan
| |
Collapse
|
3
|
Abstract
BACKGROUND Performing colonoscopies is an integral component of colorectal surgery residency training. There exists a paucity of literature regarding colonoscopy quality metrics with colorectal trainee involvement. OBJECTIVE This study aimed to investigate the effect of colorectal surgery resident participation on quality metrics in screening colonoscopy. DESIGN Screening colonoscopies performed between August 1, 2016, and July 31, 2018, were queried from a prospectively maintained institutional database. Data were cross-checked with resident case logs to verify colonoscopies with resident participation. SETTING This study was conducted by the colorectal surgery department at a tertiary level hospital in the United States. PATIENTS Consecutive, asymptomatic patients aged ≥45 years, undergoing screening colonoscopy, were selected. MAIN OUTCOME MEASURES The quality parameters measured included overall, male, and female adenoma detection rates; total examination time; withdrawal time; cecal intubation rate; quality of bowel preparation; complications; and medication dosage. RESULTS A total of 4594 patients were included in the study with a mean age of 60.5 ± 8.4 years (range, 45-91); 51.7% were women. Overall, 4186 of the colonoscopies were performed without resident participation, and 408 were performed with resident participation. Scope insertion, withdrawal, and total examination times were longer in the resident group. Cecal intubation rate, polypectomy rate, sex-specific and overall adenoma detection rates, and complication rates were similar between the groups. In the multivariate model, trainee involvement had no significant impact on adenoma detection rate. In addition, the trainee group utilized a higher mean dose of fentanyl. LIMITATIONS The retrospective nature of the data with possible coding errors of the database and the inability to quantify the amount of resident participation and to clarify the degree of attending surgeon assistance and oversight were limitations of the study. CONCLUSIONS Colorectal surgery resident participation in screening colonoscopy takes longer and appears safe, while achieving all national quality metrics without compromising adenoma detection rates. Changes in colonoscopy scheduling in regard to length of time may prove beneficial when there is resident participation. See Video Abstract at http://links.lww.com/DCR/B43. PARTICIPACIÓN DE LOS RESIDENTES DE CIRUGÍA COLORRECTAL EN COLONOSCOPIAS DE CRIBADO: ¿CÓMO AFECTA LA CALIDAD?: La realización de colonoscopias es un componente integral del entrenamiento de residencia en cirugía colorrectal. Existe una escasez de literatura con respecto a las medidas de calidad de la colonoscopia con la participación de los aprendices colorrectales.Investigar el efecto de la participación de residentes de cirugía colorrectal en las medidas de calidad en la colonoscopia de cribado.Las colonoscopias de cribado realizadas entre el 1 de agosto de 2016 y el 31 de julio de 2018 se consultaron desde una base de datos institucional mantenida prospectivamente. Los datos se cotejaron con registros de casos de residentes para verificar las colonoscopias con participación de residentes.Departamento de cirugía colorrectal en un hospital de tercer nivel de los Estados Unidos.Pacientes consecutivos, asintomáticos, edad ≥45 años, sometidos a colonoscopia de detección.Parámetros de calidad que incluyen tasas generales de detección de adenoma en hombres y mujeres, tiempo total de examen, tiempo de retiro, tasa de intubación cecal, calidad de la preparación intestinal, complicaciones y dosis de medicamentos.Se incluyeron un total de 4.594 pacientes en el estudio con una edad media de 60,5 ± 8,4 años (rango, 45-91) y 51,7% mujeres. En total 4,186 de las colonoscopias se realizaron sin participación de los residentes y 408 se realizaron con la participación de los residentes. Los tiempos de inserción, retiro y examen total del alcance fueron más largos en el grupo residentes. La tasa de intubación cecal, la tasa de polipectomía, las tasas de detección de adenoma específicos de género y generales, y las tasas de complicaciones fueron similares entre los grupos. En el modelo multivariado, la participación de los aprendices no tuvo un impacto significativo en la tasa de detección de adenoma. Además, el grupo de aprendices utilizó una dosis media más alta de fentanilo.Carácter retrospectivo de los datos con posibles errores de codificación de la base de datos. Incapacidad para cuantificar la cantidad de participación de los residentes y para aclarar el grado de asistencia y supervisión del cirujano.La participación de los residentes de cirugía colorrectal en la colonoscopia de cribado lleva más tiempo y parece segura, mientras se logran todas las medidas de calidad nacionales sin comprometer las tasas de detección de adenoma. Los cambios en la programación de la colonoscopia con respecto al período de tiempo pueden ser beneficiosos cuando hay participación de residentes. Vea el resumen del video en http://links.lww.com/DCR/B43.
Collapse
|
4
|
Siau K, Hodson J, Ravindran S, Rutter MD, Iacucci M, Dunckley P. Variability in cecal intubation rate by calculation method: a call for standardization of key performance indicators in endoscopy. Gastrointest Endosc 2019; 89:1026-1036.e2. [PMID: 30659830 DOI: 10.1016/j.gie.2018.12.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Accepted: 12/29/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS The cecal intubation rate (CIR) is a widely accepted key performance indicator (KPI) in colonoscopy but lacks a universal calculation method. We aimed to assess whether differences in CIR calculation methods could have an impact on perceived trainee outcomes. METHODS A systematic review of CIR calculation methods was conducted on major societal guidelines (United Kingdom, European Society of Gastrointestinal Endoscopy [ESGE] and American Society for Gastrointestinal Endoscopy [ASGE]) and trainee-inclusive studies. Trainees awarded colonoscopy certification between June 2011 and 2016 were identified from the United Kingdom e-portfolio and selected as a validation cohort. For each trainee, both the crude and unassisted CIR were calculated for 50 post-certification procedures using definitions from the 3 international guidelines. The resulting CIRs, and the proportions of endoscopists failing to meet the minimum standard of CIR ≥90%, were then compared across these definitions. RESULTS Across the 3 guidelines and 37 eligible studies identified, differences in CIR calculation methodology were demonstrated. These related to adjustment criteria (18 studies) and whether unassisted CIR was stipulated (18 studies). In the validation cohort of 733 trainees (36,650 procedures), the median crude CIR ranged from 96% (ESGE) to 98% (ASGE) (P < .001) and whether unassisted CIR was specified (ESGE, 94%; ASGE, 96%; P < .001). The proportion of trainees failing to achieve CIR ≥90% varied significantly across the different definitions, from 4.9% for the crude ASGE definition to 18.6% for the unassisted ESGE definition (P < .001). CONCLUSIONS CIR calculation methods vary among guidelines and research studies; this has an impact on trainee performance measures. With CIR used as an example, this study highlights the need for standardized definitions and calculations of KPIs in endoscopy.
Collapse
Affiliation(s)
- Keith Siau
- NIHR Biomedical Research Centre, University of Birmingham, Birmingham, United Kingdom; Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London, United Kingdom
| | - James Hodson
- Institute of Translational Medicine, Institute of Immunology and Immunotherapy and NIHR Birmingham Biomedical Research Centre, University Hospitals NHS Foundation Trust and University of Birmingham, Birmingham, United Kingdom
| | | | - Matthew D Rutter
- Department of Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, United Kingdom; Northern Institute for Cancer Research, Newcastle University, Newcastle, United Kingdom
| | - Marietta Iacucci
- NIHR Biomedical Research Centre, University of Birmingham, Birmingham, United Kingdom; Institute of Translational Medicine, Institute of Immunology and Immunotherapy and NIHR Birmingham Biomedical Research Centre, University Hospitals NHS Foundation Trust and University of Birmingham, Birmingham, United Kingdom
| | - Paul Dunckley
- Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London, United Kingdom; Department of Gastroenterology, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, United Kingdom
| |
Collapse
|
5
|
Eberth JM, Josey MJ, Mobley LR, Nicholas DO, Jeffe DB, Odahowski C, Probst JC, Schootman M. Who Performs Colonoscopy? Workforce Trends Over Space and Time. J Rural Health 2017; 34:138-147. [PMID: 29143383 DOI: 10.1111/jrh.12286] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 09/01/2017] [Accepted: 10/16/2017] [Indexed: 01/18/2023]
Abstract
PURPOSE With the increased availability of colonoscopy to average risk persons due to insurance coverage benefit changes, we sought to identify changes in the colonoscopy workforce. We used outpatient discharge records from South Carolina between 2001 and 2010 to examine shifts over time and in urban versus rural areas in the types of medical providers who perform colonoscopy, and the practice settings in which they occur, and to explore variation in colonoscopy volume across facility and provider types. METHODS Using an all-payer outpatient discharge records database from South Carolina, we conducted a retrospective analysis of all colonoscopy procedures performed between 2001 and 2010. FINDINGS We identified a major shift in the type of facilities performing colonoscopy in South Carolina since 2001, with substantial gains in ambulatory surgery settings (2001: 15, 2010: 34, +127%) versus hospitals (2001: 58, 2010: 59, +2%), particularly in urban areas (2001: 12, 2010: 27, +125%). The number of internists (2001: 46, 2010: 76) and family physicians (2001: 34, 2010: 106) performing colonoscopies also increased (+65% and +212%, respectively), while their annual procedures volumes stayed fairly constant. Significant variation in annual colonoscopy volume was observed across medical specialties (P < .001), with nongastroenterologists having lower volumes versus gastroenterologists and colon and rectal surgeons. CONCLUSIONS There have been substantial changes over time in the number of facilities and physicians performing colonoscopy in South Carolina since 2001, particularly in urban counties. Findings suggest nongastroenterologists are meeting a need for colonoscopies in rural areas.
Collapse
Affiliation(s)
- Jan M Eberth
- Department of Epidemiology and Biostatistics, Statewide Cancer Prevention and Control Program, and South Carolina Rural Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Michele J Josey
- Department of Epidemiology and Biostatistics, Statewide Cancer Prevention and Control Program, and South Carolina Rural Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Lee R Mobley
- Department of Health Management and Policy, School of Public Health, Georgia State University, Atlanta, Georgia
| | - Davidson O Nicholas
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, Missouri.,Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri
| | - Donna B Jeffe
- Division of General Medical Sciences, Washington University School of Medicine, St. Louis, Missouri
| | - Cassie Odahowski
- Department of Epidemiology and Biostatistics, Statewide Cancer Prevention and Control Program, and South Carolina Rural Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Janice C Probst
- Department of Health Services Policy and Management and South Carolina Rural Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Mario Schootman
- Department of Epidemiology, College for Public Health and Social Justice, St. Louis University, St. Louis, Missouri
| |
Collapse
|
6
|
Chaudhry Z, Tarnay CM. Assessing Resident Surgical Volume Before and After Initiation of a Female Pelvic Medicine and Reconstructive Surgery Fellowship. JOURNAL OF SURGICAL EDUCATION 2017; 74:450-454. [PMID: 27988170 DOI: 10.1016/j.jsurg.2016.11.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 10/26/2016] [Accepted: 11/20/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES The effect of fellowship programs on resident training for gynecologic surgery volume has not been clearly defined. The purpose of our study is to assess resident surgical volume for laparoscopic and vaginal hysterectomy before and after initiation of a female pelvic medicine and reconstructive surgery (FPMRS) fellowship. DESIGN A retrospective review of Accreditation Council for Graduate Medical Education Resident Case Logs of obstetrics and gynecology residents who graduated in the 3 years before and after initiation of a FPMRS fellowship was performed. Mean values of vaginal and laparoscopic hysterectomies were compared using two-tailed t-tests with statistical significance set at p < 0.05. SETTING Obstetrics and gynecology resident case logs at the Ronald Reagan University of California Los Angeles (UCLA) Medical Center were assessed. The UCLA Medical Center, located in Los Angeles, CA, is a tertiary referral center with a graduating class of 7 obstetrics and gynecology residents yearly. PARTICIPANTS Obstetrics and gynecology residents who graduated from residency 3 years before and after imitation of a FPMRS fellowship were included. In the 3 years before the start of the fellowship, 20 residents graduated, whereas 21 residents graduated after the start of the fellowship. RESULTS Residents who graduated in the 3 years after the start of the FPMRS fellowship, finished with 4.6 less vaginal hysterectomies compared with residents who graduated before the fellowship (p = 0.022). Residents who graduated in the 3 years after the start of the FPMRS fellowship finished with 3.2 more laparoscopic hysterectomies compared with residents who graduated before the fellowship although this was not significant (p = 0.25). CONCLUSIONS Resident surgical volume was significantly decreased for vaginal hysterectomy after the initiation of a FPMRS fellowship, whereas laparoscopic hysterectomy volume was not significantly changed. Longer follow-up and a national assessment are necessary to determine the broader effect of fellowship training on resident surgical experience.
Collapse
Affiliation(s)
- Zaid Chaudhry
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, California.
| | - Christopher M Tarnay
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, California; Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, California
| |
Collapse
|
7
|
Ekkelenkamp VE, Koch AD, de Man RA, Kuipers EJ. Training and competence assessment in GI endoscopy: a systematic review. Gut 2016; 65:607-15. [PMID: 25636697 DOI: 10.1136/gutjnl-2014-307173] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 01/08/2015] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Training procedural skills in GI endoscopy once focused on threshold numbers. As threshold numbers poorly reflect individual competence, the focus gradually shifts towards a more individual approach. Tools to assess and document individual learning progress are being developed and incorporated in dedicated training curricula. However, there is a lack of consensus and training guidelines differ worldwide, which reflects uncertainties on optimal set-up of a training programme. AIMS The primary aim of this systematic review was to evaluate the currently available literature for the use of training and assessment methods in GI endoscopy. Second, we aimed to identify the role of simulator-based training as well as the value of continuous competence assessment in patient-based training. Third, we aimed to propose a structured training curriculum based on the presented evidence. METHODS A literature search was carried out in the available medical and educational literature databases. The results were systematically reviewed and studies were included using a predefined protocol with independent assessment by two reviewers and a final consensus round. RESULTS The literature search yielded 5846 studies. Ninety-four relevant studies on simulators, assessment methods, learning curves and training programmes for GI endoscopy met the inclusion criteria. Twenty-seven studies on simulator validation were included. Good validity was demonstrated for four simulators. Twenty-three studies reported on simulator training and learning curves, including 17 randomised control trials. Increased performance on a virtual reality (VR) simulator was shown in all studies. Improved performance in patient-based assessment was demonstrated in 14 studies. Four studies reported on the use of simulators for assessment of competence levels. Current simulators lack the discriminative power to determine competence levels in patient-based endoscopy. Eight out of 14 studies on colonoscopy, endoscopic retrograde cholangiopancreatography and endosonography reported on learning curves in patient-based endoscopy and proved the value of this approach for measuring performance. Ten studies explored the numbers needed to gain competence, but the proposed thresholds varied widely between them. Five out of nine studies describing the development and evaluation of assessment tools for GI endoscopy provided insight into the performance of endoscopists. Five out of seven studies proved that intense training programmes result in good performance. CONCLUSIONS The use of validated VR simulators in the early training setting accelerates the learning of practical skills. Learning curves are valuable for the continuous assessment of performance and are more relevant than threshold numbers. Future research will strengthen these conclusions by evaluating simulation-based as well as patient-based training in GI endoscopy. A complete curriculum with the assessment of competence throughout training needs to be developed for all GI endoscopy procedures.
Collapse
Affiliation(s)
| | - Arjun D Koch
- Erasmus MC-University Medical Center, Rotterdam, The Netherlands
| | - Robert A de Man
- Erasmus MC-University Medical Center, Rotterdam, The Netherlands
| | - Ernst J Kuipers
- Erasmus MC-University Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
8
|
Levine JC, Geva T, Brown DW. Competency Testing for Pediatric Cardiology Fellows Learning Transthoracic Echocardiography: Implementation, Fellow Experience, and Lessons Learned. Pediatr Cardiol 2015; 36:1700-11. [PMID: 26123811 DOI: 10.1007/s00246-015-1220-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 06/12/2015] [Indexed: 11/30/2022]
Abstract
UNLABELLED There is currently great interest in measuring trainee competency at all levels of medical education. In 2007, we implemented a system for assessing cardiology fellows' progress in attaining imaging skills. This paradigm could be adapted for use by other cardiology programs. METHODS Evaluation consisted of a two-part exercise performed after years 1 and 2 of pediatric cardiology training. Part 1: a directly observed evaluation of technical skills as fellows imaged a normal subject (year 1) and a patient with complex heart disease (year 2). Part 2: fellows interpreted and wrote reports for two echocardiograms illustrating congenital heart disease. These were graded for accuracy and facility with communicating pertinent data. After 5 years of testing, fellows were surveyed about their experience. In 5 years, 40 fellows were tested at least once. Testing identified four fellows who underperformed on the technical portion and four on the interpretive portion. Surveys were completed by 33 fellows (83 %). Most (67 %) felt that intermittent observation by faculty was inadequate for assessing skills and that procedural volume was a poor surrogate for competency (58 %). Posttest feedback was constructive and valuable for 90, and 70 % felt the process helped them set goals for skill improvement. Overall, fellows felt this testing was fair and should continue. Fellow performance and responses identified programmatic issues that were creating barriers to learning. We describe a practical test to assess competency for cardiology fellows learning echocardiography. This paradigm is feasible, has excellent acceptance among trainees, and identifies trainees who need support. Materials developed could be easily adapted to help track upcoming ACGME-mandated metrics.
Collapse
Affiliation(s)
- Jami C Levine
- Department of Cardiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA. .,Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
| | - Tal Geva
- Department of Cardiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - David W Brown
- Department of Cardiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
9
|
A Flexible Postoperative Debriefing Process Can Effectively Provide Formative Resident Feedback. J Am Coll Surg 2015; 220:959-67. [DOI: 10.1016/j.jamcollsurg.2014.12.048] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 12/26/2014] [Accepted: 12/29/2014] [Indexed: 11/23/2022]
|
10
|
Ward ST, Mohammed MA, Walt R, Valori R, Ismail T, Dunckley P. An analysis of the learning curve to achieve competency at colonoscopy using the JETS database. Gut 2014; 63:1746-54. [PMID: 24470280 PMCID: PMC4215302 DOI: 10.1136/gutjnl-2013-305973] [Citation(s) in RCA: 108] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The number of colonoscopies required to reach competency is not well established. The primary aim of this study was to determine the number of colonoscopies trainees need to perform to attain competency, defined by a caecal intubation rate (CIR) ≥90%. As competency depends on completion, we also investigated trainee factors that were associated with colonoscopy completion. DESIGN The Joint Advisory Group on GI Endoscopy in the UK has developed a trainee e-portfolio from which colonoscopy data were retrieved. Inclusion criteria were all trainees who had performed a total of ≥20 colonoscopies and had performed ≤50 colonoscopies prior to submission of data to the e-portfolio. The primary outcome measure was colonoscopy completion. The number of colonoscopies required to achieve CIR ≥90% was calculated by the moving average method and learning curve cumulative summation (LC-Cusum) analysis. To determine factors which determine colonoscopy completion, a mixed effect logistic regression model was developed which allowed for nesting of patients within trainees and nesting of patients within hospitals, with various patient, trainee and training factors entered as fixed effects. RESULTS 297 trainees undertook 36 730 colonoscopies. By moving average analysis, the cohort of trainees reached a CIR of 90% at 233 procedures. By LC-Cusum analysis, 41% of trainees were competent after 200 procedures. Of the trainee factors, the number of colonoscopies, intensity of training and previous flexible sigmoidoscopy experience were significant factors associated with colonoscopy completion. CONCLUSIONS This is the largest study to date investigating the number of procedures required to achieve competency in colonoscopy. The current training certification benchmark in the UK of 200 procedures does not appear to be an inappropriate minimum requirement. The LC-Cusum chart provides real time feedback on individual learning curves for trainees. The association of training intensity and flexible sigmoidoscopy experience with colonoscopy completion could be exploited in training programmes.
Collapse
Affiliation(s)
- Stephen Thomas Ward
- Centre for Liver Research and NIHR Birmingham Biomedical Research Unit, Level 5 Institute for Biomedical Research, University of Birmingham, Birmingham, UK
| | | | - Robert Walt
- Department of Gastroenterology and GI Surgery, Queen Elizabeth Hospital, Birmingham, UK
| | - Roland Valori
- Department of Gastroenterology, Gloucestershire Royal Hospital, Gloucester, UK
| | - Tariq Ismail
- Department of Gastroenterology and GI Surgery, Queen Elizabeth Hospital, Birmingham, UK
| | - Paul Dunckley
- Department of Gastroenterology, Gloucestershire Royal Hospital, Gloucester, UK
| |
Collapse
|
11
|
Shahidi N, Ou G, Telford J, Enns R. Establishing the learning curve for achieving competency in performing colonoscopy: a systematic review. Gastrointest Endosc 2014; 80:410-6. [PMID: 24973174 DOI: 10.1016/j.gie.2014.04.056] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 04/28/2014] [Indexed: 01/28/2023]
Affiliation(s)
- Neal Shahidi
- Department of Medicine, Division of Gastroenterology, University of British Columbia, Vancouver, BC, Canada
| | - George Ou
- Department of Medicine, Division of Gastroenterology, University of British Columbia, Vancouver, BC, Canada
| | - Jennifer Telford
- Department of Medicine, Division of Gastroenterology, University of British Columbia, Vancouver, BC, Canada
| | - Robert Enns
- Department of Medicine, Division of Gastroenterology, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
12
|
Abstract
Optimization of training and teaching methods in colonoscopy at all levels of experience is critical to ensure consistent high-quality procedures in practice. Competency in colonoscopy may not be achieved until more than 250 colonoscopies are performed by trainees. Such tools as computer-based endoscopic simulators can aid in accelerating the early phases of training in colonoscopy, and magnetic endoscopic imaging technology can guide the position of the colonoscope and aid with loop reduction. Periodic feedback and retraining experienced endoscopists can improve the detection of colonic lesions.
Collapse
Affiliation(s)
- Victoria Gómez
- Department of Gastroenterology, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL 32224, USA
| | | |
Collapse
|