Endoscopists with a higher ADR are more likely to be critical of the quality of bowel preparation. Training in judgement processes such as non-acceptance of suboptimal bowel preparation is required in order to ensure universally high standards in screening procedures.

Endoscopy is an important diagnostic and therapeutic procedure that demands high levels of cognitive and technical skill to perform effectively. Surprisingly little is known about how endoscopy is best taught and training is often inadequate. The aims of this study were to explore the learning experiences of endoscopy trainees to improve our understanding of current training. Following the use of an initial focus group to generate appropriate themes semi-structured interviews were performed on 10 trainees to assess their learning experiences. Many different components of the learning experience were identified; one-to-one supervised performance forms the basis for teaching but is often sub-optimal; endoscopy learners experience anxiety and find re-adopting the role of novice difficult; motivation, clear explanation and feedback are crucial to learning; breaking down endoscopy training into segments is seen as valuable and as learners progress a gradual withdrawal of supervision is appreciated. Several of the issues contributing to a positive learning experience relate closely to published evidence and theory relating to skills teaching from other fields. A model identifying the key elements of endoscopy learning is proposed. Further work to apply and test the findings from this study should lead to improved endoscopy training.

Both the sensitivity and the specificity of a pair of endoscopic photographs are too low to be used for reliably documenting colonoscopy completion.