An adequate level of training for technical competence in screening and diagnostic colonoscopy: a prospective multicenter evaluation of the learning curve.
BACKGROUND
Various training programs in colonoscopy recommend that trainees should perform at least 100 to 200 procedures to be considered technically competent at diagnostic colonoscopy.


OBJECTIVE
Our purpose was to determine the adequate level of training for technical competence in screening and diagnostic colonoscopy.


METHODS
A prospective multicenter trial.


METHODS
Fifteen tertiary care academic medical centers.


METHODS
Over 8 months we prospectively evaluated the procedures of 24 first-year GI fellows in 15 tertiary care academic medical centers. A total of 4351 colonoscopies were assessed prospectively with variable clinical factors.


METHODS
Cecal intubation was documented by photographing the identified cecal landmarks, including the appendiceal orifice and the ileocecal valve.


METHODS
Acquisition of competence (success rate) was evaluated for colonoscopic training on the basis of 2 objective criteria: (1) adjusted completion rate (>90%) and (2) cecal intubation time (<20 minutes).


RESULTS
The overall success rate was 83.5% (3635/4351). The mean cecal intubation time was 9.23 +/- 4.63 minutes. The success rate significantly improved and reached the requisite standard of competence after 150 procedures (71.5%, 82.6%, 91.3%, 94.4%, 98.4%, and 98.7%, respectively, for every 50 consecutive blocks). The polyp detection rate did not improve significantly during the 8 months and was not correlated with the learning curve. In addition, mean time to cecal intubation decreased significantly, from 11.16 to 8.39 minutes, after 150 procedures. Logistic regression analysis found that prolonged cecal intubation was caused by the following factors: elderly patients, female sex, low body mass index, poor bowel preparation, poor American Society of Anesthesiologists status, abdominal pain as an indication, instructor's supervision, and low case volume.


CONCLUSIONS
We did not record final pathologic reports of detected polyps and withdrawal time.


CONCLUSIONS
Competence in technically efficient screening and diagnostic colonoscopy generally requires experience with more than 150 cases. Also, factors associated with prolonged cecal intubation for typical trainees did not differ from those for experienced colonoscopists.
Lee
Suck-Ho
SH
Department of Internal Medicine, Soonchunhyang University, Cheonan, Korea.
Chung
Il-Kwun
IK
Kim
Sun-Joo
SJ
Kim
Jin-Oh
JO
Ko
Bong-Min
BM
Hwangbo
Young
Y
Kim
Won Ho
WH
Park
Dong Hun
DH
Lee
Sang Kil
SK
Park
Cheol Hee
CH
Baek
Il-Hyun
IH
Park
Dong Il
DI
Park
Seun-Ja
SJ
Ji
Jeong-Seon
JS
Jang
Byung-Ik
BI
Jeen
Yoon-Tae
YT
Shin
Jeong Eun
JE
Byeon
Jeong-Sik
JS
Eun
Chang-Soo
CS
Han
Dong Soo
DS
D000046:Academic Medical Centers; D002983:Clinical Competence / Q000592:standards*; D003108:Colonic Diseases / Q000175:diagnosis*; D003113:Colonoscopy / Q000592:standards*; D004503:Education, Medical, Graduate / Q000592:standards*; D004521:Educational Measurement / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005762:Gastroenterology / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008403:Mass Screening / Q000379:methods* / Q000592:standards; D008875:Middle Aged; D011446:Prospective Studies