title: Colonoscopy training in gastroenterology fellowships: determining competence.
abstract: BACKGROUND
  Although 140 colonoscopies is the recommended minimal requirement for gastroenterology fellows, it is unclear whether this minimum is a surrogate for competence.
  
  
  OBJECTIVE
  To assess whether 140 colonoscopies is an adequate threshold to determine > or =90% colonoscopy performance independence.
  
  
  METHODS
  Retrospective analysis on a database constructed for quality control/improvement.
  
  
  METHODS
  Gastroenterology fellowship training program at a veterans hospital.
  
  
  METHODS
  Consecutive patients who underwent colonoscopy primarily for symptoms, previous polyps, or family history of cancer (a minority were performed for screening only) from April 2007 to September 2008. This study involved 11 gastroenterology fellows who performed 770 colonoscopies during 18 individual month-long rotations.
  
  
  METHODS
  Assessment of various procedure-related parameters.
  
  
  METHODS
  Determining when > or =90% independence in colonoscopy performance was reached.
  
  
  RESULTS
  Total colonoscopy time, time to cecal intubation, withdrawal time, and independent completion rates all significantly improved when first and third years of training were compared (P < .001 for all comparisons). The adenoma detection rate did not change between years of training. Independent completion was achieved in > or =90% of cases for all fellows after 500 colonoscopies, whereas no fellow reached a > or =90% independent colonoscopy completion rate after 140 colonoscopies.
  
  
  CONCLUSIONS
  Number of participants, single center.
  
  
  CONCLUSIONS
  Becoming a competent colonoscopist requires repeated practice. Our study suggests that, although there is variability between a trainee's ability to become colonoscopy independent, 500 colonoscopies are likely required to ensure reliable (> or =90%) independent completion rates. Competency requires more than a single parameter.
authors: Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
authors: Bret J
authors: BJ
authors: Spier
authors: Mark
authors: M
authors: Benson
authors: Patrick R
authors: PR
authors: Pfau
authors: Gregory
authors: G
authors: Nelligan
authors: Michael R
authors: MR
authors: Lucey
authors: Eric A
authors: EA
authors: Gaumnitz
mesh_terms: D000328:Adult; D002983:Clinical Competence / Q000592:standards*; D003113:Colonoscopy / Q000592:standards* / Q000639:trends; D016208:Databases, Factual; D004503:Education, Medical, Graduate / Q000379:methods*; D004521:Educational Measurement; D005257:Fellowships and Scholarships; D005260:Female; D005762:Gastroenterology / Q000193:education; D006801:Humans; D007396:Internship and Residency; D016014:Linear Models; D008297:Male; D011336:Probability; D012189:Retrospective Studies; D017751:Safety Management; D013997:Time Factors