title: Leadership training to improve adenoma detection rate in screening colonoscopy: a randomised trial.
abstract: OBJECTIVE
  Suboptimal adenoma detection rate (ADR) at colonoscopy is associated with increased risk of interval colorectal cancer. It is uncertain how ADR might be improved. We compared the effect of leadership training versus feedback only on colonoscopy quality in a countrywide randomised trial.
  
  
  METHODS
  40 colonoscopy screening centres with suboptimal performance in the Polish screening programme (centre leader ADR ≤ 25% during preintervention phase January to December 2011) were randomised to either a Train-Colonoscopy-Leaders (TCLs) programme (assessment, hands-on training, post-training feedback) or feedback only (individual quality measures). Colonoscopies performed June to December 2012 (early postintervention) and January to December 2013 (late postintervention) were used to calculate changes in quality measures. Primary outcome was change in leaders' ADR. Mixed effect models using ORs and 95% CIs were computed.
  
  
  RESULTS
  The study included 24,582 colonoscopies performed by 38 leaders and 56,617 colonoscopies performed by 138 endoscopists at the participating centres. The absolute difference between the TCL and feedback groups in mean ADR improvement of leaders was 7.1% and 4.2% in early and late postintervention phases, respectively. The TCL group had larger improvement in ADR in early (OR 1.61; 95% CI 1.29 to 2.01; p<0.001) and late (OR 1.35; 95% CI 1.10 to 1.66; p=0.004) postintervention phases. In the late postintervention phase, the absolute difference between the TCL and feedback groups in mean ADR improvement of entire centres was 3.9% (OR 1.25; 95% CI 1.04 to 1.50; p=0.017).
  
  
  CONCLUSIONS
  Teaching centre leaders in colonoscopy training improved important quality measures in screening colonoscopy.
  
  
  BACKGROUND
  NCT01667198.
authors: Department of Gastroenterology and Hepatology, Medical Centre for Postgraduate Education and the Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Warsaw, Poland.
authors: Michal F
authors: MF
authors: Kaminski
authors: Department of Gastroenterology, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK.
authors: John
authors: J
authors: Anderson
authors: Department of Gastroenterology, Gloucestershire Royal Hospital, Gloucester, UK.
authors: Roland
authors: R
authors: Valori
authors: Department of Gastroenterology and Hepatology, Medical Centre for Postgraduate Education and the Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Warsaw, Poland.
authors: Ewa
authors: E
authors: Kraszewska
authors: Department of Gastroenterology and Hepatology, Medical Centre for Postgraduate Education and the Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Warsaw, Poland.
authors: Maciej
authors: M
authors: Rupinski
authors: Department of Gastroenterology and Hepatology, Medical Centre for Postgraduate Education and the Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Warsaw, Poland.
authors: Jacek
authors: J
authors: Pachlewski
authors: Department of Gastroenterology and Hepatology, Medical Centre for Postgraduate Education and the Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Warsaw, Poland.
authors: Ewa
authors: E
authors: Wronska
authors: Department of Health Economy and Health Management, University of Oslo, Oslo, Norway Department of Gastroenterology, Oslo University Hospital Rikshospitalet, Oslo, Norway.
authors: Michael
authors: M
authors: Bretthauer
authors: Wolfson Unit for Endoscopy, St. Mark's Hospital, London, UK.
authors: Siwan
authors: S
authors: Thomas-Gibson
authors: Departments of Gastroenterology and Hepatology, and Internal Medicine, Erasmus Medical Centre, Rotterdam, The Netherlands.
authors: Ernst J
authors: EJ
authors: Kuipers
authors: Department of Gastroenterology and Hepatology, Medical Centre for Postgraduate Education and the Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Warsaw, Poland.
authors: Jaroslaw
authors: J
authors: Regula
mesh_terms: D000236:Adenoma / Q000175:diagnosis*; D003113:Colonoscopy / Q000193:education*; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D007857:Leadership; D008297:Male; D008403:Mass Screening; D011044:Poland; D058996:Quality Improvement; D016037:Single-Blind Method
keywords: ADENOMA; CLINICAL TRIALS; COLONOSCOPY; COLORECTAL ADENOMAS; COLORECTAL CANCER SCREENING