title: Assessing resident performance and training of colonoscopy in a general surgery training program.
abstract: BACKGROUND
  Recently, the adequacy of endoscopy training in general surgery residency programs has been questioned. Efforts to improve resident endoscopic training and to judge competency are ongoing but not well studied. We assessed resident performance using two assessment tools in colonoscopy in a general surgery residency program.
  
  
  METHODS
  Prospectively collected data were reviewed from consecutive colonoscopies by a single surgeon: September 2008 to June 2011. Colonoscopies performed without residents were excluded. Data included patient demographics, procedural data, and outcomes. Following the colonoscopy, residents were graded by the attending surgeon using up two different assessment tools. Descriptive statistics were calculated and outcomes were compared.
  
  
  RESULTS
  Colonoscopies were performed by residents in 100 patients. Average age was 52 (range, 22-79) years. Females made up 66 % of patients, and 63 % were Caucasian. Postgraduate level (PG-Y) 3 level residents performed 72 % of colonoscopies. The average resident participation was 73 % of the procedure. Biopsies were performed in 35 %; adenomatous polyps were found in 17 % and invasive cancer in 1 %. Bowel preparation was deemed good in 76 % of patients. Colonoscopy was completed in 90 % of patients. Reasons for incomplete exam were technical (7 patients), inability to pass a stricture (2 patients), and poor prep (1 patient). For completed full colonoscopies, the average time to reach the cecum was 22 min, and withdrawal time was 13 min. Resident assessments were made in 89 of the colonoscopies using 2 separate assessment tools. There were no mortalities; the morbidity rate was 3 %. Morbidities included a perforation related to a biopsy requiring surgery and partial colectomy, a postpolypectomy bleed requiring repeat colonoscopy with clipping of the bleeding vessel, and a patient with transient bradycardia requiring atropine during the procedure.
  
  
  CONCLUSIONS
  Using objective assessment tools, overall resident skill and knowledge in performing colonoscopy appears to improve based on increasing PG-Y level, although this was not evident with all categories measured. Methods to assess competency continue to evolve and should be the focus of future research.
authors.affiliation: Department of Surgery, New Hanover Regional Medical Center, South East Area Health Education Center, 2131 South 17th Street, PO BOX 9025, Wilmington, NC 28401, USA. hopeww@hotmail.com
authors.forename: William W
authors.initials: WW
authors.lastname: Hope
authors.forename: W Borden
authors.initials: WB
authors.lastname: Hooks
authors.forename: S Nicole
authors.initials: SN
authors.lastname: Kilbourne
authors.forename: Ashley
authors.initials: A
authors.lastname: Adams
authors.forename: Cyrus A
authors.initials: CA
authors.lastname: Kotwall
authors.forename: Thomas V
authors.initials: TV
authors.lastname: Clancy
mesh_terms: D000328:Adult; D001919:Bradycardia / Q000209:etiology; D002983:Clinical Competence; D003113:Colonoscopy / Q000009:adverse effects / Q000193:education*; D003479:Curriculum; D004503:Education, Medical, Graduate; D004521:Educational Measurement; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D007416:Intestinal Perforation / Q000209:etiology; D019359:Knowledge; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D009657:North Carolina; D019106:Postoperative Hemorrhage / Q000209:etiology; D011446:Prospective Studies; D011597:Psychomotor Performance; D055815:Young Adult