title: An adequate level of training for technical competence in screening and diagnostic colonoscopy: a prospective multicenter evaluation of the learning curve.
abstract: 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.
authors.affiliation: Department of Internal Medicine, Soonchunhyang University, Cheonan, Korea.
authors.forename: Suck-Ho
authors.initials: SH
authors.lastname: Lee
authors.forename: Il-Kwun
authors.initials: IK
authors.lastname: Chung
authors.forename: Sun-Joo
authors.initials: SJ
authors.lastname: Kim
authors.forename: Jin-Oh
authors.initials: JO
authors.lastname: Kim
authors.forename: Bong-Min
authors.initials: BM
authors.lastname: Ko
authors.forename: Young
authors.initials: Y
authors.lastname: Hwangbo
authors.forename: Won Ho
authors.initials: WH
authors.lastname: Kim
authors.forename: Dong Hun
authors.initials: DH
authors.lastname: Park
authors.forename: Sang Kil
authors.initials: SK
authors.lastname: Lee
authors.forename: Cheol Hee
authors.initials: CH
authors.lastname: Park
authors.forename: Il-Hyun
authors.initials: IH
authors.lastname: Baek
authors.forename: Dong Il
authors.initials: DI
authors.lastname: Park
authors.forename: Seun-Ja
authors.initials: SJ
authors.lastname: Park
authors.forename: Jeong-Seon
authors.initials: JS
authors.lastname: Ji
authors.forename: Byung-Ik
authors.initials: BI
authors.lastname: Jang
authors.forename: Yoon-Tae
authors.initials: YT
authors.lastname: Jeen
authors.forename: Jeong Eun
authors.initials: JE
authors.lastname: Shin
authors.forename: Jeong-Sik
authors.initials: JS
authors.lastname: Byeon
authors.forename: Chang-Soo
authors.initials: CS
authors.lastname: Eun
authors.forename: Dong Soo
authors.initials: DS
authors.lastname: Han
mesh_terms: 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