Background
Robust real-world performance data of newly independent colonoscopists are lacking.
In the United Kingdom, provisional colonoscopy certification (PCC) marks the transition
from training to newly independent practice. We aimed to assess changes in key performance
indicators (KPIs) such as cecal intubation rate (CIR) in the periods pre- and post-PCC,
particularly regarding rates and predictors of trainees exhibiting a drop in performance
(DIP), defined as CIR <90% in the first 50 procedures post-PCC.
Methods
A prospective United Kingdom–wide observational study of Joint Advisory Group on Gastrointestinal
Endoscopy Electronic Training System (JETS) e-portfolio colonoscopy entries (257,800)
from trainees awarded PCC between July 2011 and 2016 was undertaken. Moving average
analyses were used to study KPI trends relative to PCC. Pre-PCC trainee, trainer,
and training environment factors were compared between DIP and non-DIP cohorts to
identify predictors of DIP.
Results
Seven hundred thirty-three trainees from 180 centers were awarded PCC after a median
of 265 procedures and 3.1 years. Throughout the early post-PCC period, average CIRs
surpassed the national 90% standard. Despite this, not all trainees achieved this
standard post-PCC, with DIP observed in 18.4%. DIP was not influenced by trainer presence
and diminished after 100 additional procedures. On multivariable analysis, pre-PCC
CIRs and trainer specialty were predictive of DIP. Trainees with DIP incurred higher
post-PCC rates of moderate to severe discomfort despite requiring higher analgesic
dosages and were more likely to require trainer assistance in failed procedures.
Conclusions
The current PCC requirements are appropriate for diagnostic colonoscopy. It is possible
to identify predictors of underperformance in trainees, which may be of value to training
leads and could improve the patient experience.
Abbreviations:
CIR (cecal intubation rate), DIP (drop in performance), JETS (Joint Advisory Group on Gastrointestinal Endoscopy Training System), KPI (key performance indicator), PCC (provision colonoscopy certification), PDR (polyp detection rate), SAE (serious adverse event)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Gastrointestinal EndoscopyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Quality assurance of training.Best Pract Res Clin Gastroenterol. 2011; 25: 397-407
- Increased rate of adenoma detection associates with reduced risk of colorectal cancer and death.Gastroenterology. 2017; 153: 98-105
- Adenoma detection rate and risk of colorectal cancer and death.N Engl J Med. 2014; 370: 1298-1306
- Maximising benefit and minimising harm of screening.BMJ. 2008; 336: 480-483
- UK key performance indicators and quality assurance standards for colonoscopy.Gut. 2016; 65: 1923-1929
- Performance measures for lower gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy (ESGE) quality improvement initiative.United Eur Gastroenterol J. 2017; 5: 309-334
- Establishing the learning curve for achieving competency in performing colonoscopy: a systematic review.Gastrointest Endosc. 2014; 80: 410-416
- Training to competency in colonoscopy: assessing and defining competency standards.Gastrointest Endosc. 2011; 74: 355-366
- Colonoscopy training in gastroenterology fellowships: determining competence.Gastrointest Endosc. 2010; 71: 319-324
- An analysis of the learning curve to achieve competency at colonoscopy using the JETS database.Gut. 2014; 63: 1746-1754
- JAG trainee certification process: colonoscopy (provisional and full).(Available at:) (Accessed January 15, 2018)
- Changes in scoring of direct observation of procedural skills (DOPS) forms and the impact on competence assessment.Endoscopy. 2018; 50: 770-778
- The validity and reliability of a direct observation of procedural skills assessment tool: assessing colonoscopic skills of senior endoscopists.Gastrointest Endosc. 2012; 75: 591-597
- Patient comfort and quality in colonoscopy.World J Gastroenterol. 2013; 19: 2355-2361
- UK key performance indicators and quality assurance standards for colonoscopy.Gut. 2016; 65: 1923-1929
Biswas S, Alrubaiy L, China L, et al. Trends in UK endoscopy training in the BSG trainees’ national survey and strategic planning for the future. Frontline Gastroenterol. Epub 2017 Sept 23.
- Analysis of administrative data finds endoscopist quality measures associated with postcolonoscopy colorectal cancer.Gastroenterology. 2011; 140: 65-72
- A new composite measure of colonoscopy: the performance indicator of colonic intubation (PICI).Endoscopy. 2018; 50: 40-51
- The national colonoscopy audit: a nationwide assessment of the quality and safety of colonoscopy in the UK.Gut. 2013; 62: 242
- The learning curve to achieve satisfactory completion rates in upper GI endoscopy: an analysis of a national training database.Gut. 2017; 66: 1022-1030
- Ensuring competence in endoscopy.(Available at:) (Accessed January 15, 2018)
Article Info
Publication History
Published online: August 01, 2018
Accepted:
July 25,
2018
Received:
May 23,
2018
Footnotes
DISCLOSURE: The following author disclosed financial relationships relevant to this publication: K. Siau: Research fellow on behalf of the Joint Advisory Group; R.M. Valori, Co-Director, AnderVal Ltd; P. Dunckley, Advisory Committee, Joint Advisory Group. All other authors disclosed no financial relationships relevant to this publication.
See CME section; p. 625.
If you would like to chat with an author of this article, you may contact Dr Siau [email protected] .
Identification
Copyright
© 2019 by the American Society for Gastrointestinal Endoscopy
ScienceDirect
Access this article on ScienceDirectLinked Article
- The path to quality colonoscopy continues after graduationGastrointestinal EndoscopyVol. 89Issue 3
- PreviewThe effort over the past decade to improve quality in colonoscopy was marked by several essential steps forward. These included definition of quality indicators,1,2 the development and validation of objective skills assessment tools such as the American Society for Gastrointestinal Endoscopy assessment of competency in endoscopy tool, the direct observation of procedural skills (DOPS),3,4 and the investment in infrastructure to track and benchmark performance for key indicators such as the GI quality improvement consortium (GIQuIC)5 and the Joint Advisory Group on GI Endoscopy - Endoscopy Training System eportfolio in the United Kingdom.
- Full-Text
- Preview
