Use of a Simple 6-Item Questionnaire in the Endoscopy Reporting Software Captures Important Milestones for Gastroenterology Trainees Performing Colonoscopy

Abstract

Independently performing a high-quality colonoscopy is an essential competency to be achieved during a 3-year gastroenterology fellowship. Assessment of competency is best evaluated immediately after the colonoscopy. We aimed to assess the feasibility of a simple survey with objective metrics of fellow endoscopic performance that is incorporated into the endoscopy reporting software (Provation®). We conducted a prospective study of colonoscopies performed with a gastroenterology fellow over a 3-year period. Only colonoscopies with attendings (n=14) who were substantially involved in the training of fellows were included. Fellow endoscopic skill was measured with a 6-item questionnaire in Provation® that appeared when the attending went to sign the procedure report (Figure 1). The attending could still sign the procedure without completing the questionnaire. The responses were not visible to the patient and did not appear in the electronic medical record. Fellows were then stratified into 6-month increments of training. Out of 2,352 colonoscopies performed with fellow involvement, the optional survey was filled out 75.2% of the time. There was a higher rate of survey completion in attendings who had more frequent fellow involvement. The rate of fellows independently reaching the cecum improved throughout their fellowship training (p<0.001). The rates of independent cecal intubation were 48.7% (first 6 months of fellowship), 74.1% (months 7-12), 83% (months 13-18), 82.5% (months 19-24), 89.3% (25-30) and 92.3% (months 31-36). The rate of independent resection of all polyps during a colonoscopy by fellows also improved during training (p<0.001). In the first 6 months, fellows resected all polyps independently 44.1% of the time, increasing to 71.9% by months 7-12, and to 89.2% by months 31-36. When the fellow was not able to resect all polyps independently, one or more reasons were identified by the attendings on the survey 92.4% of the time (Table 1). Water immersion was associated with higher independent cecal intubation rates during first year (p<0.001) but not during the second (p=0.46) and third years (p=0.65). An optional simple 6-item questionnaire that measured important milestones for gastroenterology fellows was completed at a high rate. The tool validates the expected increased competency of being able to independently reach the cecum and resect all polyps encountered during a colonoscopy during a 3-year gastroenterology fellowship.TableReasons Provided for Inability to Resect All Polyps Independently by Fellows During ColonoscopyLarge PolypDifficult LocationAttending WithdrawalTimeInadequate expertiseTotal Number of Colonoscopies in which Polypectomy Performed0-6 months2.1%7.6%15.2%26.9%11.0%1457-12 months2.1%10.3%2.1%13.7%0.7%14613-18 months1.8%8.8%6.1%14.0%0.0%11419-24 months1.4%6.6%4.3%12.3%0.9%21125-30 months1.3%3.8%0.0%5.7%0.0%15831-36 months1.1%4.5%1.1%3.4%0.0%176 Open table in a new tab