title: [How many procedures are necessary to achieve competency in colonoscopy?].
abstract: BACKGROUND
  Competency for colonoscopy implies technical and cognitive skills. The American Society for Gastrointestinal Endoscopy has suggested 100 supervised procedures might be necessary. There are no specific recommendations in Brazil.
  
  
  OBJECTIVE
  To evaluate technical progress of trainees during a regular colonoscopy training program.
  
  
  METHODS
  Two gastrointestinal fellows at Federal University of São Paulo, SP, Brazil, were prospectively evaluated during first year training. The frequency and time of reaching the cecum, total procedure duration, ability to identify lesions and patient discomfort were recorded.
  
  
  RESULTS
  Two hundred and seventy one colonoscopies were preformed by both fellows (fellow A: 186 and B: 85). Twenty-seven cases were excluded of obstructive lesions or previous surgery, leading 171 and 72 exams, respectively. The mean success rate of reaching the cecum was 82.5% and 56.9%, respectively. For the first 72 exams it was 72.2% and 56.9%. Fellow A reached the cecum in 76% of first 100 colonoscopies, improving to 91.5% after the 101 st. Mean time for trainees to complete the procedure was 17.7 and 23.5 minutes to fellows A and B. Trainee A took 19.8 and 14.7 minutes before and after the 100th colonoscopy.
  
  
  CONCLUSIONS
  Success rate and time taken to reach the cecum progressively improved over the number of procedures with statistical significance. However, because of individual differences, 100 colonoscopies may be insufficient to acquisition of technical skills.
  
  
  CONCLUSIONS
  Although analyzing the learning curve of two fellows only, we could notice a statistically significant improve in reaching the cecum with experience over time. However, depending on individual skills more than 100 procedures may be necessary during training.
authors.affiliation: Disciplina de Gastroenterologia da Universidade Federal de São Paulo, UNIFESP.
authors.forename: Fernanda Prata Borges Martins
authors.initials: FP
authors.lastname: Thuler
authors.forename: Veruska Oliveira
authors.initials: VO
authors.lastname: Di Sena
authors.forename: Cristina Marfinatti
authors.initials: CM
authors.lastname: Hervoso
authors.forename: Ermelindo
authors.initials: E
authors.lastname: Della Libera
authors.forename: Angelo Paulo
authors.initials: AP
authors.lastname: Ferrari
mesh_terms: D002983:Clinical Competence; D003113:Colonoscopy / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D005762:Gastroenterology / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D008297:Male; D011446:Prospective Studies; D013997:Time Factors