Technical proficiency of trainees performing colonoscopy: A learning curve,☆☆,,★★,

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Abstract

Background and purpose: We sought to provide an objective measure of the technical progress of trainees learning colonoscopy. GI fellows in our training program perform colonoscopy under supervision throughout their 2 years of fellowship.

Method: The frequency of fellows reaching the cecum in less than 30 minutes was determined by one endoscopy instructor during the last 7 months of their first year of training and during the last 7 months of their second year.

Results: The mean success rate of reaching the cecum for seven first-year fellows was 54% (individual range, 25% to 86%). This compared with 86% for six second-year fellows (individual range, 73% to 93%) and with 97% for the endoscopy instructor when he did procedures without a fellow. First-year fellows during the 7-month “testing” periods believed they had reached the cecum in 5.7% of cases in which they had not. This was not a problem with second-year fellows. Counting colonoscopies done with all instructors in our program, fellows in this series each did an average of 149 colonoscopies during their first-year of training and 328 by the end of their second.

Conclusions: Increasing proficiency in reaching the cecum occurs with experience over time, and continues even after completion of formal training. Individual trainees also seem to learn colonoscopy at different rates. Depending on how one defines competency, it is possible that the minimum threshold number for technical competency in colonoscopy of 100 procedures, as suggested by the ASGE, may be low. (Gastrointest Endosc 1995;42:287-91.)

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MATERIALS AND METHODS

GI fellows at the University of Missouri Hospitals and Clinics and Harry S. Truman VA Hospital do supervised colonoscopy throughout their 2 years of training. For several years, one endoscopy instructor (the author, an ABIM-certified gastroenterologist who completed his fellowship in 1982 and spent 5.5 years in private practice before joining the faculty of the University of Missouri-Columbia; his endoscopic experience through 1994 included over 4600 upper endoscopies and over 2600

RESULTS

Over the entire 24-month period during which the study was conducted (including periods which were not in the so-called 7 month testing periods), the endoscopy instructor did 448 colonoscopies in the Endoscopy Center of University Hospital. Twenty-five of these colonoscopies were excluded from calculations of total colonoscopy because of prior cecal resection (13 cases), obstructing mass (6 cases), severe colitis that contraindicated going further (2 cases), colostomy (2 cases), and emergent

DISCUSSION

Few studies have been published that have objectively evaluated the acquisition of technical skills during endoscopic training. Hawes and colleagues5 reported on how many examinations were required to achieve competency in flexible sigmoidoscopy. Cass et al. 6 reported information on the number of supervised procedures required to achieve initial competency in esophagogastroduodenoscopy.

Some data are also available as regards colonoscopy. A study by Parry and Williams7 of one trainee showed a

Acknowledgements

The author wishes to thank Paul King, MD, for drawing the graph, John Hewett, PhD, and Jane Johnson, MA, for statistical support, and Teresa Roberts.

References (9)

There are more references available in the full text version of this article.

From the Division of Gastroenterology, University of Missouri School of Medicine, Columbia, Missouri.

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Reprint requests: John B. Marshall, MD, Gastroenterology, MA 421, University of Missouri School of Medicine, Columbia, MO 65212.

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