Colonoscopy training in gastroenterology fellowships: determining competence
Received 28 January 2009; accepted 4 May 2009. published online 03 August 2009.
Background
Although 140 colonoscopies is the recommended minimal requirement for gastroenterology fellows, it is unclear whether this minimum is a surrogate for competence.
Objective
To assess whether 140 colonoscopies is an adequate threshold to determine ≥90% colonoscopy performance independence.
Design
Retrospective analysis on a database constructed for quality control/improvement.
Setting
Gastroenterology fellowship training program at a veterans hospital.
Patients
Consecutive patients who underwent colonoscopy primarily for symptoms, previous polyps, or family history of cancer (a minority were performed for screening only) from April 2007 to September 2008. This study involved 11 gastroenterology fellows who performed 770 colonoscopies during 18 individual month-long rotations.
Intervention
Assessment of various procedure-related parameters.
Main Outcome Measurements
Determining when ≥90% independence in colonoscopy performance was reached.
Results
Total colonoscopy time, time to cecal intubation, withdrawal time, and independent completion rates all significantly improved when first and third years of training were compared (P < .001 for all comparisons). The adenoma detection rate did not change between years of training. Independent completion was achieved in ≥90% of cases for all fellows after 500 colonoscopies, whereas no fellow reached a ≥90% independent colonoscopy completion rate after 140 colonoscopies.
Limitations
Number of participants, single center.
Conclusions
Becoming a competent colonoscopist requires repeated practice. Our study suggests that, although there is variability between a trainee's ability to become colonoscopy independent, 500 colonoscopies are likely required to ensure reliable (≥90%) independent completion rates. Competency requires more than a single parameter.
Current affiliations: Section of Gastroenterology and Hepatology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
Reprint requests: Eric A. Gaumnitz, MD, Section of Gastroenterology and Hepatology, University of Wisconsin Hospital and Clinics, 600 Highland Ave, H6/516-5124, Madison, WI 53792.
DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.
ABSTRACT
Colonoscopy training in gastroenterology fellowships: determining competence