title: Training to competency in colonoscopy: assessing and defining competency standards.
abstract: BACKGROUND
  How to define competency in colonoscopy, how to assess it, and how much training is required are questions that experts in endoscopy have grappled with since the advent of the procedure.
  
  
  OBJECTIVE
  To describe methods to assess core endoscopy skills in trainees and learning curves for these parameters and to define competency thresholds for these skills.
  
  
  METHODS
  A prospective descriptive assessment of trainee colonoscopy performance.
  
  
  METHODS
  Mayo Clinic, Rochester, Minnesota.
  
  
  METHODS
  Gastroenterology fellows undergoing endoscopy training.
  
  
  METHODS
  From July 2007 through June 2010, fellows' core cognitive and motor colonoscopy skills were assessed by using the Mayo Colonoscopy Skills Assessment Tool (MCSAT).
  
  
  METHODS
  Average MCSAT item scores and learning curves are described. Minimal competence thresholds for each MSCAT item are established by using the contrasting groups method.
  
  
  RESULTS
  Forty-one GI fellows performed 6635 colonoscopies; 4103 procedures (62%) were assessed by using the MCSAT. Average scores of 3.5 set the competency bar for each of the core skills and were reached by 275 procedures on average. Independent cecal intubation rates of 85% and cecal intubation times of 16 minutes or less were also achieved at 275 procedures on average.
  
  
  CONCLUSIONS
  Limited to a single center.
  
  
  CONCLUSIONS
  Learning curves for core colonoscopy skills are described. MCSAT scores of 3.5, cecal intubation rates of 85%, and intubation times of less than 16 minutes are recommended as minimal competency criteria. It takes on average 275 procedures to achieve competence in colonoscopy. This is more than previous gastroenterology training recommendations and far more than current training requirements in other specialties.
authors.affiliation: Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Sedlack
mesh_terms: D002983:Clinical Competence / Q000592:standards*; D003113:Colonoscopy / Q000193:education* / Q000592:standards; D004503:Education, Medical, Graduate / Q000592:standards*; D005762:Gastroenterology / Q000193:education* / Q000592:standards; D006801:Humans; D059032:Learning Curve