An analysis of the learning curve to achieve competency at colonoscopy using the JETS database

Abstract

ObjectiveThe number of colonoscopies required to reach competency is not well established. The primary aim of this study was to determine the number of colonoscopies trainees need to perform to attain competency, defined by a caecal intubation rate (CIR) ≥90%. As competency depends on completion, we also investigated trainee factors that were associated with colonoscopy completion.DesignThe Joint Advisory Group on GI Endoscopy in the UK has developed a trainee e-portfolio from which colonoscopy data were retrieved. Inclusion criteria were all trainees who had performed a total of ≥20 colonoscopies and had performed ≤50 colonoscopies prior to submission of data to the e-portfolio. The primary outcome measure was colonoscopy completion. The number of colonoscopies required to achieve CIR ≥90% was calculated by the moving average method and learning curve cumulative summation (LC-Cusum) analysis. To determine factors which determine colonoscopy completion, a mixed effect logistic regression model was developed which allowed for nesting of patients within trainees and nesting of patients within hospitals, with various patient, trainee and training factors entered as fixed effects.Results297 trainees undertook 36 730 colonoscopies. By moving average analysis, the cohort of trainees reached a CIR of 90% at 233 procedures. By LC-Cusum analysis, 41% of trainees were competent after 200 procedures. Of the trainee factors, the number of colonoscopies, intensity of training and previous flexible sigmoidoscopy experience were significant factors associated with colonoscopy completion.ConclusionsThis is the largest study to date investigating the number of procedures required to achieve competency in colonoscopy. The current training certification benchmark in the UK of 200 procedures does not appear to be an inappropriate minimum requirement. The LC-Cusum chart provides real time feedback on individual learning curves for trainees. The association of training intensity and flexible sigmoidoscopy experience with colonoscopy completion could be exploited in training programmes.

The learning curve to achieve satisfactory completion rates in upper GI endoscopy: an analysis of a national training database

“…It is incumbent upon trainees to submit data from all endoscopic procedures they have performed, allowing trainees to demonstrate their experience and competency progression. We have previously used the JETS database to analyse the learning curve to achieve competency in colonoscopy 11. JETS was rolled out in 2009 and currently contains OGD procedure data for >2300 trainees.…”

“…The aim of this study was to analyse the learning curve to achieve competency in OGD completion using all trainee data submitted to JETS. Two statistical approaches were used – the moving average method and the learning curve cumulative sum (LC-Cusum) method as previously described 11 12…”

Fellowship Colonoscopy Training and Preparedness for Independent Gastroenterology Practice

“…9,10 However, the evidence supporting this number is unclear, with studies reporting numbers ranging from 100 to 500 colonoscopies to achieve basic competency. [11][12][13][14][15] These prior studies have defined competency based primarily on rates of cecal intubation. However, this may not be a reliable indicator of true competency to perform colonoscopy independently, as this does not reflect key measures like ADR and the ability to perform interventions such as polypectomy, independently, safely, and effectively.…”

Assessing fellow skills: practice what you preach, measure what you teach

“…Although the DOPS tool has been in wide use across the United Kingdom for many years as part of a very sophisticated centralized electronic reporting system in high-stakes assessment, only recently have learning curves from these data been reported to make competency benchmarking possible by using this scoring system. 5 The GAGES tool has validity evidence limited to how early surgical trainees (!50 colonoscopies) compare with more advanced endoscopists in select motor skills; however, the foundation of the competency benchmarking process of the tool is defined by the arguable a priori assumption that those with experience with as few as 50 procedures are competent, a tenet not embraced by the GI community. As such, the GAGES tool is not widely used outside the surgical community.…”