title: Equivalence in colonoscopy results between gastroenterologists and general surgery residents following an endoscopy simulation curriculum.
abstract: BACKGROUND
  In 2011, multiple gastroenterology societies published a position statement expressing concern over the American Board of Surgery guidelines regarding endoscopy education. Their position asserted that the American Board of Surgery's guidelines were inadequate to produce competency and the requirements should be similar to those adopted by the American Society for Gastrointestinal Endoscopy. This assertion failed to take into account the increasing use of simulation in surgical and endoscopic education.
  
  
  METHODS
  Surgery residents were required to complete a self-paced endoscopy simulation curriculum. A retrospective review of all patients undergoing colonoscopy at a single institution over a 6-month period was then undertaken. Specifically, the quality measures associated with colonoscopy including the cecal intubation rate and the adenoma detection rate (ADR) were compared between those colonoscopies that were performed by faculty gastroenterologists and general surgery residents.
  
  
  RESULTS
  In total, 818 colonoscopies were performed during the study period-598 were performed by the gastroenterology service (GI) and 220 were performed by general surgery residents on the surgery service (GS). Baseline characteristics of the groups were similar. Cecal intubation rates for GI and GS were 98.4% and 93.5% respectively. ADRs were similar between the groups (GI-29.8% in men and 15.3% in women; GS-26.8% in men and 18.7% in women). GI was found to perform biopsies at a higher rate than GS: 0.92 vs 0.62 (not significant, NS). GS had a higher rate of adenomas biopsied: 0.42 vs 0.32 (NS).
  
  
  CONCLUSIONS
  Following endoscopy simulation training, general surgery residents, under the supervision of surgical staff, are capable of achieving quality measures equivalent to those of staff gastroenterologists at a single institution. The ADRs and cecal intubation rates seen in this study are consistent with those previously identified in the literature.
authors.affiliation: William Beaumont Army Medical Center, El Paso, Texas.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Williams
authors.affiliation: William Beaumont Army Medical Center, El Paso, Texas.
authors.forename: Joanna R
authors.initials: JR
authors.lastname: Crossett
authors.affiliation: William Beaumont Army Medical Center, El Paso, Texas.
authors.forename: Elaine M
authors.initials: EM
authors.lastname: Cleveland
authors.affiliation: William Beaumont Army Medical Center, El Paso, Texas.
authors.forename: Charles P
authors.initials: CP
authors.lastname: Smoot
authors.affiliation: William Beaumont Army Medical Center, El Paso, Texas.
authors.forename: Kanayochukwu J
authors.initials: KJ
authors.lastname: Aluka
authors.affiliation: William Beaumont Army Medical Center, El Paso, Texas.
authors.forename: Lisa C
authors.initials: LC
authors.lastname: Coviello
authors.affiliation: William Beaumont Army Medical Center, El Paso, Texas. Electronic address: kurtdavis88@gmail.com.
authors.forename: Kurt G
authors.initials: KG
authors.lastname: Davis
mesh_terms: D002983:Clinical Competence; D003113:Colonoscopy / Q000193:education*; D003479:Curriculum; D004503:Education, Medical, Graduate / Q000592:standards*; D005260:Female; D005762:Gastroenterology / Q000193:education*; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008875:Middle Aged; D011787:Quality of Health Care; D012189:Retrospective Studies; D000066908:Simulation Training
keywords: Patient Care; Practice-Based Learning and Improvement; Systems-Based Practice; colonoscopy; quality metrics; resident education; simulation