Training mid-career internists to perform high-quality colonoscopy: a pilot training programme to meet increasing demands for colonoscopy

Abstract

Background Colorectal cancer (CRC) is the second leading cause of cancer deaths in the USA. Despite a recent rise in CRC screening there remains an increasing demand for colonoscopy, yet a limited supply of gastroenterologists who can meet this need. Objective To determine if a mid-career general internist (GIN) could be trained to perform high-quality colonoscopes via an intensive training programme. Design A GIN trained 2-3 days/week, 4-5 hours/day, for 7 months with an experienced gastroenterologist. Their independent performance was then compared with that of a gastroenterology attending (GA), with and without a gastroenterology fellow (GF). Main measures The primary outcome was to compare caecal intubation rates, adenoma detection rates (ADRs), interval CRC rates and complications between the three groups. Key results 989 patients were initially included in the study, and 818 were included in the final analysis. Caecal intubation rates were 95%, 94% and 93% for the GIN, GA+GF and GA, respectively ( p=0.31). The overall polyp detection rates were 68%, 39% and 44% among the GIN, GA+GF and GA, respectively ( p<0.0001). The ADRs were 56%, 33% and 34% for the GIN, GA+GF and GA, respectively ( p<0.0001). Three complications occurred, all within the GA group. No interval cancers were diagnosed within a 5-year surveillance period, across all three groups. Conclusions The GIN attained high success rates in all quality measures. Training mid-career GINs to perform high-quality screening colonoscopes, through a standardised curriculum, may be a reasonable approach to address the growing demand for colonoscopists. BACKGROUND

You are not lab rats at teaching hospitals: A systematic review of resident and fellow participation leads to improved colonoscopy

“…The forest plot of OR estimates and 95% CIs extracted from individual studies 22,25–28,30,32 and the results of the overall meta‐analysis are presented in Figure 2D. Fellow/trainee involvement was associated with a statistically significant higher rate of polyp detection, and the pooled OR for PDR was 1.29 (95% CI = 1.02–1.63, p = 0.020; I 2 = 89.1%).…”

“…Seventeen articles with 18 datasets 8,9,19–33 (the study by Chalifoux et al 22 . contained two sets of data) regarding the association between fellow/trainee involvement and the detection rate of adenoma were included for meta‐analysis.…”

“…Seventeen studies 8,9,[19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] involving colonoscopy outcomes were included in this meta-analysis. These articles were published between 2009 and 2022 and included 16 observational studies, and one RCT.…”

Training in basic gastrointestinal endoscopic procedures: a European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA) Position Statement

“…While some studies do not specifically report trainee involvement in procedures [163][164][165], most large retrospective studies carried out in teaching hospitals show no association between trainee involvement and AEs [24,[166][167][168][169][170][171][172][173][174][175][176]. Furthermore, in prospective studies examining the benefit of simulators in training programs, no AEs were registered [133,166,177,178]. We identified only two studies that reported any risk at all in this setting (i. e. slightly increased risk of inconsequential, short-term, and reversible changes in vital function parameters, such as transient hypoxia [169,179]).…”

A novel summary report of colonoscopy: timeline visualization providing meaningful colonoscopy video information

“…Polyps and observation of polypectomy sites and bleeding regions are important findings on colonoscopy [26]. Given that the purpose of colonoscopy itself is to detect polyps, it would be meaningful to find them in colonoscopy videos through image processing techniques [27]. In particular, assistance by image processing techniques can be of great help, since the detection of polyps in the colonoscopy process can vary due to many factors such as physician condition, surroundings conditions, concentration, and intestinal clearance [18][19][20]25].…”