title: Fellowship Colonoscopy Training and Preparedness for Independent Gastroenterology Practice.
abstract: OBJECTIVE
  To objectively assess when gastroenterology (GI) fellows achieve technical competency to perform colonoscopy independently.
  
  
  BACKGROUND
  New guidelines to assess the procedural competency of GI fellows in training have been developed. Although comprehensive, they do not account for the quality metrics to which independently practicing gastroenterologists are held.
  
  
  METHODS
  We performed a prospective study examining consecutive colonoscopies performed by GI fellows from November 2013 through March 2014 at an academic medical center. Using a brief postprocedure questionnaire and the online medical record, we measured rates of independent fellow cecal intubation rate (CIR), insertion time to the cecum (cecal IT), and independent polypectomy rate. Our secondary outcomes were adenoma detection rate and polyp detection rate.
  
  
  RESULTS
  A total of 898 colonoscopies performed by 10 GI fellows were analyzed. In the multivariate analysis, CIR [odds ratio (OR)=1.29, P=0.012], cecal IT (β-coefficient=0.19, P=0.006), and rates of unassisted independent snare polypectomy (OR=1.36, P<0.001) all improved significantly with increased number of procedures performed (OR and β-coefficient per 100 colonoscopies performed). After performing 500 colonoscopies, fellows achieved a mean CIR>90%, cecal IT between 7 and 10 minutes, and independent polypectomy rate of 90% with further improvement in cecal IT to <7 minutes, and independent snare polypectomy of >95% after 700 cases.
  
  
  CONCLUSIONS
  Current procedural recommendations for fellowship training may underestimate the technical skill necessary for independent GI practice upon completion of fellowship. Technical proficiency in snare polypectomy may lag behind proficiency in cecal intubation.
authors.affiliation: Departments of *Medicine, Division of Gastroenterology †Emergency Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA.
authors.forename: Vilas R
authors.initials: VR
authors.lastname: Patwardhan
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Feuerstein
authors.forename: Neil
authors.initials: N
authors.lastname: Sengupta
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Lewandowski
authors.forename: Roy
authors.initials: R
authors.lastname: Tsao
authors.forename: Darshan
authors.initials: D
authors.lastname: Kothari
authors.forename: Harry T
authors.initials: HT
authors.lastname: Anastopoulos
authors.forename: Richard B
authors.initials: RB
authors.lastname: Doyle
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Leffler
authors.forename: Sunil G
authors.initials: SG
authors.lastname: Sheth
mesh_terms: D000046:Academic Medical Centers; D000236:Adenoma / Q000175:diagnosis / Q000473:pathology; D000328:Adult; D000368:Aged; D002983:Clinical Competence; D003111:Colonic Polyps / Q000601:surgery; D003113:Colonoscopy / Q000193:education / Q000592:standards*; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000473:pathology; D005257:Fellowships and Scholarships; D005260:Female; D005762:Gastroenterology / Q000193:education / Q000592:standards*; D017408:Guidelines as Topic; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D013997:Time Factors