Competence In Colonoscopy Research Articles

Can We Measure the Learning Curve of Colonoscopy Using Polyp Detection Rate?

Can We Measure the Learning Curve of Colonoscopy Using Polyp Detection Rate?

An electronic colonoscopy record system enables detailed quality assessment and benchmarking of an endoscopic service.

Competence in colonoscopy, which is a technically difficult procedure, requires adequate exposure to it and the maintenance of a detailed logbook. Without an electronic record this is difficult to achieve. By implementing an electronic medical record system we aimed to perform a detailed quality assessment audit of colonoscopy, to benchmark our results and generate accurate logbooks for individual endoscopists. We reviewed the prospectively maintained Hybrid Electronic Medical Registry (HEMR). Colonoscopies performed between March 2013 and March 2014 were reviewed, and for competency, quality metrics were derived from the guidelines of the American Society of Gastroenterology. A total of 843 colonoscopies were performed. Seven hundred and seventy procedures were performed by three staff endoscopists who each performed over the required 150 procedures annually (n=197, 338 and 235). The remaining 73 (8.7%) were performed by other staff. In 105 cases (12.5%), bowel preparation was deemed to be inadequate, which caused the procedure to be abandoned in 34 cases. A total of 64 cases were deemed to be incomplete because of obstructing lesions (n=26), extensive diverticulosis (n=4), technical difficulty (n=31) and patient discomfort (n=3). There were two complications recorded: perforation (n=1) and bleeding (n=1). The HEMR system enabled the audit of experiences with colonoscopy in our institution. Our results are broadly compatible with the international literature and with a number of guidelines. The development of an electronic record system is a major advance, as it enables meaningful benchmarking and the generation of accurate procedural logbooks.

Colonoscopy Competency Achieved in 250 to 300 Exams by Gastroenterology Fellows

The Assessment of Competency in Endoscopy (ACE) tool is used by attending physicians to assess trainees performing colonoscopy. Evaluation criteria

Assessment of competency in endoscopy: establishing and validating generalizable competency benchmarks for colonoscopy

The Mayo Colonoscopy Skills Assessment Tool (MCSAT) has previously been used to describe learning curves and competency benchmarks for colonoscopy; however, these data were limited to a single training center. The newer Assessment of Competency in Endoscopy (ACE) tool is a refinement of the MCSAT tool put forth by the Training Committee of the American Society for Gastrointestinal Endoscopy, intended to include additional important quality metrics. The goal of this study is to validate the changes made by updating this tool and establish more generalizable and reliable learning curves and competency benchmarks for colonoscopy by examining a larger national cohort of trainees. In a prospective, multicenter trial, gastroenterology fellows at all stages of training had their core cognitive and motor skills in colonoscopy assessed by staff. Evaluations occurred at set intervals of every 50 procedures throughout the 2013 to 2014 academic year. Skills were graded by using the ACE tool, which uses a 4-point grading scale defining the continuum from novice to competent. Average learning curves for each skill were established at each interval in training and competency benchmarks for each skill were established using the contrasting groups method. Ninety-three gastroenterology fellows at 10 U.S. academic institutions had 1061 colonoscopies assessed by using the ACE tool. Average scores of 3.5 were found to be inclusive of all minimal competency thresholds identified for each core skill. Cecal intubation times of less than 15 minutes and independent cecal intubation rates of 90% were also identified as additional competency thresholds during analysis. The average fellow achieved all cognitive and motor skill endpoints by 250 procedures, with >90% surpassing these thresholds by 300 procedures. Nationally generalizable learning curves for colonoscopy skills in gastroenterology fellows are described. Average ACE scores of 3.5, cecal intubation rates of 90%, and intubation times less than 15 minutes are recommended as minimal competency criteria. On average, it takes 250 procedures to achieve competence in colonoscopy. The thresholds found in this multicenter cohort by using the ACE tool are nearly identical to the previously established MCSAT benchmarks and are consistent with recent gastroenterology training recommendations but far higher than current training requirements in other specialties.

PWE-400 The effect of periodic feedback on screening colonoscopy for colorectal polyp and adenoma detection rate in gastroenterology fellow

Introduction Adenoma detection rate is important quality indicator in screening colonoscopy. The aim of this study was to measure the change in the colorectal polyp and adenoma detection rate before and after monitoring and feedback in first-year gastroenterology fellow. Method We prospectively analysed a total of 3312 screening colonoscopy data including successful cecal intubation rate, cecal intubation time, withdrawal time, polyp and adenoma detection at the Seoul National University Hospital between March 2013 and September 2014. 1959 colonoscopies performed by 7 first-year gastroenterology fellows without feedback (group A). And 1353 screening colonoscopies performed by another 6 first-year fellows who were informed the periodic monitoring and feedback (group B). We sent the results of polyp and adenoma detection rate to all fellows and professor in charge every month by E-mail. Then we compared before and after feedback group outcomes. Results The average age of patients was 59.4 years, and 55.8% were male. The successful cecal intubation rate was improved after 150 cases both group A (90.0%) and group B (91.3%). Before feedback, overall polyp detection rate was 0.51 ± 0.08, adenoma detection rate was 0.36 ± 0.05. After feedback, the overall polyp detection rate was 0.50 ± 0.05, adenoma detection rate was 0.36 ± 0.03. Compared with before and after feedback group, there was not a significant difference in overall polyp and adenoma detection rate (p = 0.901, p = 0.846). After 150 cases, polyp detection rate was 0.50 for group A, whereas 0.56 for group B (p = 0.041). And adenoma detection rate was significantly higher in group A than group B (0.37 vs. 0.42; p = 0.038). Conclusion The minimum threshold number of technical competence in colonoscopy is more than 150 colonoscopies for trainee who initially started learning colonoscopy. The monitoring and feedback program is associated with an increase in polyp and adenoma detection rate after 150 cases. The periodic monitoring and feedback can be effective for trainees who achieved technical competence. Disclosure of interest None Declared.

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

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.

Su1550 Colonoscopy Learning Curves and Competency Benchmarks in GI Fellows

Su1550 Colonoscopy Learning Curves and Competency Benchmarks in GI Fellows

Gastroenterology fellowship programs: the fellows' perspective.

Gastroenterology fellowship programs: the fellows' perspective.

Trainee colonoscopists fulfil quality standards for the detection of adenomatous polyps.

BackgroundThe detection of adenomatous lesions is a major indicator for quality and competence in colonoscopy. Little is known about adenoma detection rates (ADR) of endoscopy trainees. The aim of our study was to investigate the performance of trainee colonoscopists in detecting adenomas and to depict the shape of adenoma detection learning curves during apprenticeship.MethodsWe retrospectively investigated a prospectively maintained database of a single tertiary referral center to reveal colonoscopies performed by trainee endoscopists during 2001 and 2013. Colonoscopy reports were chronologically retrieved and separately analyzed for each trainee. Using cumulative curves, courses of trainee’s Adenoma detection rates (ADR) during apprenticeship were displayed. Additionally, procedural data including cecal intubation rate and occurrence of complications were assessed.ResultsWe retrospectively analyzed 4354 colonoscopies conducted by 10 trainee endoscopists (TE). A median number of 371 investigations were performed by each apprentice. Group ADR was 23%. No significant difference between aggregated ADRs at the beginning (23%) and at the end (22%) of apprenticeship could be determined (p = 0.70). However, individual learning curves showed considerable different slopes. Personal ADR values ranged between 17% and 31%. Overall cecum intubation rate was 99.0 %. Complication rates were low and fulfilled quality requirements recommended in guidelines.ConclusionFrom the beginning of education, trainee colonoscopists are capable to provide high-quality investigations considering the detection of adenomas as a benchmark quality indicator. Nevertheless, performance differs markedly between investigators. Therefore, individual detection rates should be reviewed regularly to reveal further need for training.

Achieving competence in colonoscopy: Milestones and the need for a new endoscopic curriculum in gastroenterology training.

Colonoscopy is considered to be the most effective tool for reducing colorectal cancer (CRC) morbidity and mortality. As a result, certifying trainee competence in the performance of colonoscopy is critical to maximizing CRC screening and prevention efforts. Guidelines on training and accreditation around the world have been revised to emphasize the attainment of milestones in the technical and cognitive skills necessary to perform the procedure. To meet this challenge, new evaluation systems have been developed to measure trainee competence through all aspects of colonoscopy training. These changes stem from increased recognition that procedural numbers alone do not necessarily guarantee trainees' proficiency in the performance of colonoscopy. Variability in endoscopic practice and in CRC screening outcomes also point to deficiencies in the current approach towards colonoscopy instruction. However, technological innovations hold great promise in training endoscopists to perform high quality colonoscopy. Furthermore, potential advances in the use of feedback as a training tool provide new avenues for research. This review summarizes the latest evidence on the effort to define, evaluate and promote the achievement of competence in colonoscopy among trainees.

Simulation-based training for colonoscopy: establishing criteria for competency.

The aim of this study was to create simulation-based tests with credible pass/fail standards for 2 different fidelities of colonoscopy models. Only competent practitioners should perform colonoscopy. Reliable and valid simulation-based tests could be used to establish basic competency in colonoscopy before practicing on patients. Twenty-five physicians (10 consultants with endoscopic experience and 15 fellows with very little endoscopic experience) were tested on 2 different simulator models: a virtual-reality simulator and a physical model. Tests were repeated twice on each simulator model. Metrics with discriminatory ability were identified for both modalities and reliability was determined. The contrasting-groups method was used to create pass/fail standards and the consequences of these were explored. The consultants significantly performed faster and scored higher than the fellows on both the models (P < 0.001). Reliability analysis showed Cronbach α = 0.80 and 0.87 for the virtual-reality and the physical model, respectively. The established pass/fail standards failed one of the consultants (virtual-reality simulator) and allowed one fellow to pass (physical model). The 2 tested simulations-based modalities provided reliable and valid assessments of competence in colonoscopy and credible pass/fail standards were established for both the tests. We propose to use these standards in simulation-based training programs before proceeding to supervised training on patients.

Achieving endoscopic competency in a general surgery residency

BackgroundIn 2006, the Residency Review Committee for Surgery increased the total number of required endoscopy cases for graduating residents. Our goal was to evaluate general surgery resident competency in endoscopy, focusing on quality measures. MethodsA 9-year retrospective review was conducted of 29 residents. Total number of endoscopies performed throughout residency was recorded. Procedures performed as fifth-year residents with indirect supervision were evaluated for quality measures. ResultsAn average of 76 esophagogastroduodenoscopies and 147 colonoscopies were performed through their first 4 years of residency. Chief residents performed an average of 16 esophagogastroduodenoscopies and 22 colonoscopies. Of colonoscopies performed during their fifth year, 191 were performed while the resident had only indirect supervision. During these cases, cecal intubation was achieved in 90.6% of cases, an average of .48 polyps were identified, and average scope withdrawal time was 13.4 ± 7.1 minutes. ConclusionsOur data indicate that surgery residents achieve competency in colonoscopy before performing 140 colonoscopies, supporting the concept that surgery residencies can function as an excellent training ground for endoscopy.

An analysis of the learning curve to achieve competency at colonoscopy using the JETS database

ObjectiveThe number of colonoscopies required to reach competency is not well established. The primary aim of this study was to determine the number of colonoscopies trainees need to perform to...

Endoscopist-related factors contributing to high-quality colonoscopy: results of a Delphi survey.

Education and competency assessment in gastrointestinal endoscopy is important. Concerning colonoscopy, it is not completely clear what the best way is to learn this procedure, what defines competency in colonoscopy, and which factors define a high-quality colonoscopy. The aim of this study was to determine the endoscopist-related factors that define a high-quality colonoscopy. A three-round Delphi survey among expert endoscopists was carried out. In round 1, the panel was invited to identify factors essential for a good colonoscopy. The listed factors were to be ranked during the second round. In the third round, a 5-point Likert scale was added. A reference panel was invited to assess the items as well. 14 expert endoscopists from the Netherlands were invited, of whom eight participated (57 %). A list of 30 items important for colonoscopy was formulated. After the following rounds, consensus was reached on 16 items. Validation was conducted among eight trainees and eight experienced endoscopists (response 100 %). The groups agreed on the importance of all but one factor (p = 0.001). This Delphi survey has made explicit the endoscopist-related factors that are important for optimal colonoscopy. This might provide trainers more support regarding concrete competency assessment of trainees in endoscopy.

ASGE’s assessment of competency in endoscopy evaluation tools for colonoscopy and EGD

ASGE’s assessment of competency in endoscopy evaluation tools for colonoscopy and EGD

OC-001 The Impact of the Introduction of Formalised Polypectomy Assessment on Training in the United Kingdom

<h3>Introduction</h3> Polypectomy is regarded as the most hazardous part of colonoscopy, accounting for the majority of procedure-associated morbidity and yet is a necessary skill for all colonoscopists. Training in polypectomy has, to date, been variable and poorly structured. Anecdotal evidence suggested poor exposure to polypectomy during training. A novel assessment tool, the Directly Observed Polypectomy Skills (DoPYS), was introduced nationally in the United Kingdom in October 2011 with the intention of both improving training and facilitating documentation of competency. <h3>Methods</h3> The aim was to assess the impact of the mandatory introduction of the DOPyS as part of the formal colonoscopy certification process. Applications for certification in the year prior to the introduction of DOPyS were analysed retrospectively and compared with data collected prospectively for those in the following year. Data were collected on the total lifetime number of colonoscopies performed, the number of assessments for both colonoscopy and polypectomy and whether applicants had any evidence of performing polypectomy before certification of competence in colonoscopy. <h3>Results</h3> There were 175 applicants for certification in the first year. The median number of procedures per candidate was 287. Thirty two per cent of candidates had evidence of any observed polypectomy with 7 per cent of candidates referring to training in endoscopic mucosal resection (EMR). The median number of formative colonoscopy assessments was 3 (range 0–16). In the year since DOPyS was introduced there were 150 applications for certification. The median number of procedures per candidate was 206. All of these candidates had evidence of polypectomy assessment with a median number of DOPyS of 7 (range 3–27). 89 per cent of applicants had evidence of assessed EMR. The median number of formative colonoscopy assessments in this cohort was 32 (range 9–199). There was a significant increase in the number of logged polypectomy assessments (p &lt; 0.001), experience of EMR (p &lt; 0.001) and formative colonoscopy assessments (p &lt; 0.001). There was no significant difference in the total number of colonoscopy procedures performed. <h3>Conclusion</h3> These data – the largest in the literature to date – show that structured polypectomy assessment improves trainees’ documented exposure to therapeutic endoscopy as well as providing formal evidence of skills acquisition. As polypectomy plays an increasing role globally in colorectal cancer prevention, the DOPyS provides an effective means of assessing and certifying polypectomy in order to minimise the well-recognised risks associated with this technique. <h3>Disclosure of Interest</h3> None Declared.

PTH-058 Trainee Colonoscopists Acquire Competency at Different Rates, as Determined by Cusum Analysis Of Colonoscopy Data From The Jets Database

IntroductionThe number of colonoscopies required to reach competency is not well established. Nevertheless, a minimal number forms part of UK certification criteria.The Cusum technique is a statistical analysis of sequential...

Do breaks in gastroenterology fellow endoscopy training result in a decrement in competency in colonoscopy?

Skills decay without practice, but the degree is task specific. Some experts believe that it is essential to teach endoscopy longitudinally to build and maintain endoscopic skills. To determine whether breaks in gastroenterology fellow endoscopy training are associated with a decrement in competency in independent intubation of the cecum. Observational cohort of colonoscopies performed by gastroenterology fellows. Academic fellowship program from July 2010 to March 2012. Twenty-four fellows. The adjusted change in the slope of cumulative summation learning curves for cecal intubation after breaks in training and the slope at the end of the subsequent endoscopy rotation. A total of 6485 colonoscopies were performed by 24 fellows with 87 breaks in training. The average break was 6 weeks (range 2-36 weeks). Seventy-five percent of the breaks were 8 weeks or less. For every additional 4 weeks, the slope after the break worsened by 0.022 (P = .06, maximum possible change = -1.0 to +1.0). By the end of the subsequent rotation, there was no association between the slope of the learning curve and the length of the break (P = .68). This was an observational study of only 24 fellows with relatively few long breaks. Cecal intubation is only 1 component of overall competency in colonoscopy. There may be a very small decrement in fellows' abilities to intubate the cecum after a break in endoscopy training. Because these changes are so small, teaching endoscopy in blocks is probably adequate, if necessary to balance other clinical and research experience. However, further research is needed to determine whether a longitudinal endoscopy experience is superior for attaining and maintaining competency, to evaluate the effects of breaks longer than 8 weeks, and to determine whether the effects of breaks depend on the previous volume of experience with colonoscopy.

Mo1072 Intervention of Cap-Assisted Chromoendoscopy After Colonoscopy Competency Increased Adenoma Detection Rate in the Trainees

Mo1072 Intervention of Cap-Assisted Chromoendoscopy After Colonoscopy Competency Increased Adenoma Detection Rate in the Trainees

Polyp Detection Rates: A Possible Surrogate for Colonoscopy Competency in Addition to Cecal Intubation

Polyp Detection Rates: A Possible Surrogate for Colonoscopy Competency in Addition to Cecal Intubation