The UK National Endoscopy Training Programme Has Improved Colonoscopy Training Over a Five-Year Period: Closing the Audit Loop

Abstract

A multi-center UK audit in 2002∗ showed that colonoscopy training was poorly structured, with low levels of supervision and high complication rates. Subsequently, the UK National Endoscopy Training Programme introduced centrally funded, accredited courses and new assessment tools to standardize training and raise the quality of practitioners. The aim of this study was to determine if this has had an impact on the standard of colonoscopy within the same region. Method: This was a cross-sectional survey. Questionnaires used in the previous study were updated and emailed to all gastroenterology and GI surgery trainees in the region. Trainees could complete the forms electronically and return them using an anonymous web-based secure upload portal. Results: 37 out of 113 trainees responded (33%). 92% were aware of the national guidelines for training. Significantly more trainees said that they had been formally taught the principles of colonoscopy (89% vs 65%;p = 0.02), polypectomy (76% vs 53%;p = 0.04) and extubation (82% vs 55%;p = 0.02) than in 2002. Trainers are significantly more likely to be present in the room for a trainee's first 100 colonoscopies (77% vs 49%;p = 0.04) and attempt explaining a solution to a problem before taking over (55% vs 23%;p = 0.03). Course attendance significantly increased (76% vs 45%;p = 0.006), and although most had to wait between 4-6 months to attend, all trainees were ‘quite’ or ‘very’ satisfied with the course. There was an increase in trainees who record their complication rate (51% vs 32%) although this was not significant (p = 0.11). Reported complication rates were lower, with 3 of 18 (16%) having had a perforation compared to 8 of 13 (61%) in 2002. 78% of trainees think that their training has been adequate or better than adequate, compared to 25% in 2002. The average caecal intubation rate, a surrogate marker of competence, did not change (90% vs 93%;p = 0.09). Conclusion: There has been a significant improvement in colonoscopy training both at base hospitals and in access to specialist courses compared to 2002, although 83% of trainees believe that training can still be improved further. New technologies such as simulators and the 3-D imager were considered by the majority to have contributed towards the improvement, but most trainees still feel they need greater regular access to dedicated training lists and courses. The central training programme and funding has made a significantly positive impact, and the loss of such investment may have a detrimental effect on future colonoscopy training.∗Thomas-Gibson S, Saunders, BP. CME Journal Gastroenterology, Hepatology and Nutrition 2004;6:44-7.