720 How Many Cases Would Be Required for a Surgical Resident to Learn Colonoscopy? -Analysis of 90% Competency in Colonoscopy for Seventeen Surgical Residents Supervised by Expert Endoscopists (Gastroenterologists) in the High-Volume Endoscopy Center

Abstract

720 How Many Cases Would Be Required for a Surgical Resident to Learn Colonoscopy? -Analysis of 90% Competency in Colonoscopy for Seventeen Surgical Residents Supervised by Expert Endoscopists (Gastroenterologists) in the High-Volume Endoscopy Center Koji Matsuda*, Daisuke Suenaga, Eri Hayashi, Takahiro Abe, Yosuke Kawahara, Masayuki Kato, Hisao Tajiri Department of Endoscopy, The Jikei University Katsushika Medical Center, Tokyo, Japan; Department of Gastroenterology, St. Marianna University Yokohama-city Seibu Hospital, Yokohama, Japan; Department of Gastroenterology/Endoscopy, The Jikei University School of Medicine, Tokyo, Japan Introduction: It is known that the training period in colonoscopy for surgical residents is unfortunately short, although the potential demands in the real patient practice after their fellowship program would be estimated quite big. And also, the real learning process in colonoscopy was not so much evaluated, especially with sufficient number and time of colonoscopy during their training period supervised by expert endoscopists (gastroenterologists). Purpose: To evaluate the competency (cecal intubation rate and time) of surgical residents in colonoscopy directly supervised by expert endosocpists (gastroenterologist) for six months in the highvolume endoscopy center. Study design: A retrospective analysis from prospectively pooled database. Method and Material: Over 9 years we retrospectively evaluated the procedures of 17 consecutive surgical residents (PGY1:6, PGY3:2, PGY4:3, PGY5:4, PGY10:1) in the academic endoscopy centers in Tokyo. A total of 6825 colonoscopies were assessed. The endoscopic database, Solemio ENDO Ver. 3.3 (Olympus Medical Systems, Tokyo, Japan) was used to collect the data. Each resident had a sixmonth training course. Their previous experience in colonoscopy was less than 50 cases except one (200 cases). The training period was divided into six: phase 1, 2, 3, 4, 5, 6 by month. Each resident was given 15 minutes as the time limitation for cecal intubation. Each procedure was directly supervised by one expert endoscopist (gastroenterologist). If the resident could not reach at cecum within 15 minutes, experience endoscopists followed the procedure. For the evaluation of cecal intubation rate and time, incomplete cases (due to colonic stenosis in which the scope could not be passed through and very bad preparation) and therapeutic cases were excluded. Also, the cecal intubation rate of 90% was estimated using the linear proportional model. The competency was evaluated for colonoscopic training, based on the two objective criteria: (1) adjusted completion rate (O90%) and (2) cecal intubation time (!15 minutes). Result: Finally, a total of 5814 procedures were analyzed for CIR. The average cases for each resident in this analysis were 342.0. The average cecal intubation rate at each phase was 50.0%, 55.5%, 66.3%, 73.3%, 82.3%, 87.3%, respectively. Cecal intubation time within 15minutes was proportionally decreased as the training process proceeded. The cecal intubation rate of 90% was estimated at 350 cases by the linear proportional model. Conclusion: The learning process in seventeen surgical residents was very similar to one in the gastroenterological fellows. This is our impression that the cecal intubation rate of 90% partly represents the competency of 90%, which means that 350 colonoscopy cases would be recommended for colonoscopy training.