Technical competency in flexible sigmoidoscopy.
BACKGROUND
Family practice residencies offer training in flexible sigmoidoscopy; however, there are no objective recommendations for determining competency in learners. We describe a longitudinal study designed to determine the mean procedure time and depth of insertion for family practice residents.


METHODS
During a 21-month period, data were collected for 421 patients undergoing flexible sigmoidoscopy. Second- or third-year family medicine residents supervised by family medicine faculty did all procedures. The data were analyzed with simple descriptive statistics, t test, and linear and logistic regression.


RESULTS
The mean procedure time was 18+/-9.3 minutes (17.2 - 19.6, 95% confidence interval [CI]). The mean insertion depth was 51.4+/-12.4 cm (50.4 - 52.6 cm, 95% CI). Performing a biopsy was associated with an increase in procedure time (17.0 vs 27.3 minutes, P < .0001). Women with a history of pelvic surgery had less depth of insertion than did those who had no history of pelvic surgery (47 vs 53 cm, P = .002, t test).


CONCLUSIONS
Procedural competency consists of knowledge, technical skills, and attitudes. Knowledge and attitudes can be assessed with other items, such as examinations and observation. Primary care faculty can now use these standards of insertion depth and procedure time when determining technical skill proficiency for their residents in flexible sigmoidoscopy.
Holman
J R
JR
Department of Family Medicine, Naval Hospital, Camp Pendleton, CA 92055, USA.
Marshall
R C
RC
Jordan
B
B
Vogelman
L
L
D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003110:Colonic Neoplasms / Q000175:diagnosis / Q000517:prevention & control; D005194:Family Practice / Q000193:education / Q000592:standards*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007396:Internship and Residency / Q000592:standards; D016014:Linear Models; D008137:Longitudinal Studies; D008297:Male; D012812:Sigmoidoscopy / Q000379:methods / Q000592:standards*; D014861:Washington