Technical proficiency of trainees performing colonoscopy: A learning curve☆,☆☆,★,★★,♢
Section snippets
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.
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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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0016-5107/95/4204-0287$5.00 + 0
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GASTROINTESTINAL ENDOSCOPY
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