title: Adenoma detection rate varies greatly during colonoscopy training.
abstract: BACKGROUND
  The adenoma detection rate (ADR) is considered the most important quality indicator for colonoscopy and varies widely among colonoscopists. It is unknown whether the ADR of gastroenterology consultants can already be predicted during their colonoscopy training.
  
  
  OBJECTIVE
  To evaluate the ADR of fellows in gastroenterology and evaluate whether this predicts their ADR as gastroenterology consultants.
  
  
  METHODS
  Retrospective observational study.
  
  
  METHODS
  Academic and regional centers.
  
  
  METHODS
  Symptomatic patients undergoing colonoscopy.
  
  
  METHODS
  The variance in ADR among 7 gastroenterology fellows during their training (between May 2004 and March 2012) and of the same fellows after they registered as consultants (between October 2011 and April 2014) was evaluated. Multivariate logistic regression was performed to compare the highest detector (endoscopist with highest ADR) with the individual fellows and to evaluate whether an ADR of 20% or higher during the training was predictive of a high ADR as a consultant.
  
  
  RESULTS
  During training, ADRs ranged from 14% to 36% (P < .001). Compared with the highest detector, the OR for detecting an adenoma ranged from 0.64 (95% CI, 0.40-1.03) to 0.29 (95% CI, 0.17-0.48). After registration, ADR ranged from 19.8% to 40.2% (P = .066). Compared with the highest detector during consultancy, the OR ranged from 0.64 (95% CI, 0.34-1.21) to 0.26 (95% CI, 0.13-0.52). Only 2 fellows significantly improved their ADR after completing their training. An ADR lower than 20% during training was associated with a lower ADR as a consultant (OR 0.51; 95% CI, 0.30-0.87).
  
  
  CONCLUSIONS
  Retrospective study.
  
  
  CONCLUSIONS
  Variance in ADR is already present during the endoscopy training of gastroenterology fellows. Most fellows do not improve their ADR after completing their training. These findings suggest that the ADR can be predicted during colonoscopy training, and we suggest that feedback and benchmarking should be implemented early during training of fellows in an effort to improve ADR in future daily practice as a consultant.
authors.affiliation: Department of Gastroenterology and Hepatology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands.
authors.forename: Sascha C
authors.initials: SC
authors.lastname: van Doorn
authors.affiliation: Department of Gastroenterology and Hepatology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands.
authors.forename: Robert B
authors.initials: RB
authors.lastname: Klanderman
authors.affiliation: Department of Gastroenterology and Hepatology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands.
authors.forename: Yark
authors.initials: Y
authors.lastname: Hazewinkel
authors.affiliation: Department of Gastroenterology and Hepatology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands.
authors.forename: Paul
authors.initials: P
authors.lastname: Fockens
authors.affiliation: Department of Gastroenterology and Hepatology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands.
authors.forename: Evelien
authors.initials: E
authors.lastname: Dekker
mesh_terms: D000236:Adenoma / Q000175:diagnosis*; D000328:Adult; D000368:Aged; D002983:Clinical Competence / Q000706:statistics & numerical data*; D003113:Colonoscopy / Q000193:education* / Q000706:statistics & numerical data; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D005257:Fellowships and Scholarships; D005260:Female; D005762:Gastroenterology / Q000193:education*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D012189:Retrospective Studies