Colonoscopy training in gastroenterology fellowships: determining competence

Quality assurance in colonoscopy for colorectal cancer diagnosis

“…Achieving and maintaining an adequate volume of procedures is essential, however the number of procedures required may vary according to national guidelines. Although endoscopy training programs recommend only 100 complete colonoscopies and 50 polypectomies, 500 colonoscopies are likely required to ensure reliable independent completion rates (54,55).…”

Maintaining Quality in Endoscopy

“…Several studies have attempted to better define the learning curve that unquestionably accompanies colonoscopic training. Lee et al demonstrated achievement of the basic competencies (in terms of caecal intubation rate and polyp detection rate) after 150 colonoscopies (Lee, Chung et al 2008), however this was disputed by Spier et al, who showed that over 500 colonoscopies were necessary before their gastroenterological fellows could perform > 90% of colonoscopies independently (Spier, Benson et al 2010;Spier, Durkin et al 2010). Simulator training has been suggested as an alternative or adjunct to colonoscopic experience on live patients; Haycock et al demonstrated no significant difference between the performance novice colonoscopists trained on a simulator or live patients when assessed on live cases (Haycock, Koch et al 2010), suggesting that use of the simulator may shorten the learning curve to competency on live patients.…”

Seeking the Cecum: Assessing Metrics in Fellow Procedural Training

“…The ability to independently perform colonoscopy is a fundamental milestone of gastroenterology fellowship training due to the need to learn the many technical and cognitive elements required to master the procedure [1][2][3]. Although the field has historically relied heavily on the important metric of cecal intubation as a marker of proficiency in the assessment of trainees [3], there are limitations specific to this metric.…”

“…First, the ability to intubate the cecum may not correlate with multiple other important procedural skills needed for competency, such as polyp identification and resection, in addition to cognitive skills such as those required to achieve safe sedation and ensure patient comfort and safety [4]. Second, there is wide variation in the number of procedures needed for trainees to perform in order to achieve technical proficiency in cecal intubation, as defined by the metric of C90 % success [1,2,5]. Furthermore, the numerical threshold for competence is the completion of 140 colonoscopies, a figure based on a single study of 35 trainees, which has since been shown to be a gross underestimate of the number of procedures for colonoscopy proficiency.…”