Prospective assessment of colonoscopic intubation skills in trainees.
BACKGROUND
The American Society for Gastrointestinal Endoscopy recommends a minimum of 100 supervised colonoscopies prior to assessment of technical competence. To establish a measurable standard for competence and to assess this recommendation, performance of colonoscopies at a university hospital was studied.


METHODS
Colonoscopic preparation, surgical history, medication usage, technical maneuvers, extent of colon intubated, success rate, and cecal intubation time were prospectively monitored for first-year trainees, second-year trainees, and attendings.


RESULTS
Excluding patients with poor preparations or colonic resections, 496 colonoscopies were studied. First-year trainees (n = 5) required attending assistance in 73 of 79 (92%) procedures. Second-year trainees (n = 7), who had performed a mean of 123 colonoscopies prior to the study, required attending assistance in 37 of 102 (36.3%) procedures. Attendings (n = 7) successfully intubated the cecum in 297 of 315 (94.3%) colonoscopies in a median time of 10.5 minutes. Second-year trainees were less successful than attendings in cecal intubation (success rate = 84%, p < 0.05), and required more time (median = 14.5 minutes, p < 0.01). More technical maneuvers were performed, and a lesser extent of colon was intubated, during trainee colonoscopies.


CONCLUSIONS
We propose a 90% success rate and a median cecal intubation time of less than 15 minutes as reasonable standards for measuring technical competence. Trainees do not achieve this standard after the performance of 100 supervised colonoscopies.
Chak
A
A
Division of Gastroenterology, University Hospital of Cleveland, Case Western Reserve University School of Medicine, OH 44106, USA.
Cooper
G S
GS
Blades
E W
EW
Canto
M
M
Sivak
M V
MV
D002432:Cecum; D002983:Clinical Competence; D003113:Colonoscopy / Q000592:standards*; D004503:Education, Medical, Graduate; D005762:Gastroenterology / Q000193:education; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000592:standards*; D011446:Prospective Studies; D013997:Time Factors