[How many procedures are necessary to achieve competency in colonoscopy?].
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.
Thuler
Fernanda Prata Borges Martins
FP
Disciplina de Gastroenterologia da Universidade Federal de São Paulo, UNIFESP.
Di Sena
Veruska Oliveira
VO
Hervoso
Cristina Marfinatti
CM
Della Libera
Ermelindo
E
Ferrari
Angelo Paulo
AP
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