660 Do Breaks in Endoscopy Fellowship Training Decrease Colonoscopy Competency?

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660 Do Breaks in Endoscopy Fellowship Training Decrease Colonoscopy Competency? Jennifer Jorgensen*, Grace H. Elta, Joseph C. Kolars, Joel H. Rubenstein Gastroenterology, University of Michigan, Ann Arbor, MI Background: Some experts believe it is essential to teach endoscopy longitudinally to build and maintain endoscopic skills, fearing that breaks in training will result in loss of skills. However, limited surgical data has demonstrated that concentrated educational experiences can provide lasting improvement in skills. There are no prior studies on the effects of breaks in endoscopy training on competency in colonoscopy. Cecal intubation is frequently used as a surrogate for overall competency in colonoscopy because it is easily measured and objective. Aim: Determine if breaks in gastroenterology fellow endoscopy training cause decrements in cecal intubation rates. Methods: Prospective data on independent extent reached for all colonoscopies performed by our gastroenterology fellows were collected over 16 months. Cumulative summation (CUSUM) learning curves, which identify changes in competency over shorter numbers of procedures than traditional learning curves, were constructed. The changes in the CUSUM slope for the ten colonoscopies after a break in training minus the slope before the break were calculated. The maximum possible difference is /-1.0, with a negative difference signifying improvement. Chi-square test was conducted for the association of length of breaks, fellowship year, and number of colonoscopies performed with the change in the slope of the CUSUM learning curve. Linear regression was conducted to estimate the effect of the length of the break on the change in slope before and after a break and the slope at the end of the rotation, adjusting for fellowship year and number of colonoscopies performed prior to the break. Results: 5,685 colonoscopies were performed by 24 fellows with 57 breaks in training. The median length of a break was 5 weeks (range 2, 36). The mean change of the slope after a break was 0.01 (range -0.57, 0.49). Breaks in endoscopy training of 8 weeks or longer were associated with decrements in cecal intubation competency compared to shorter breaks (46% vs. 19%, p 0.05; mean slope differences 0.07 vs. 0.00). However, breaks in training were not associated with worse cecal intubation competency at the completion of the subsequent rotation, adjusting for number of prior colonoscopies and fellowship year ( 8 weeks vs. 8 weeks: -0.05 slope, p 0.29). Conclusions: Breaks in endsocopy training of at least 8 weeks are associated with decrements in cecal intubation competency. However, these effects are small and do not persist to the end of the subsequent endoscopy rotation. Teaching endoscopy in blocks rather than as a longitudinal experience is probably adequate, especially if it is necessary to balance other clinical and research experiences. However, the effects of longer breaks on competency deserves further study. Funding: ASGE Quality in Endoscopy Research Award