title: Does the hands-on, technical training of residents in colonoscopy affect quality outcomes?
abstract: BACKGROUND
  The training of residents in colonoscopy has become an important topic as more attention is being paid to quality outcomes.
  
  
  OBJECTIVE
  To determine whether colonoscopy quality outcomes are adversely affected by allowing residents to perform colonoscopies under supervision.
  
  
  METHODS
  This retrospective cohort study was performed on all adults who underwent colonoscopy in the city of St. John's, NL, from January to June 2012 by an endoscopist who trains residents. Subjects were identified through records from the health authority. Data were extracted from the electronic medical record, including the endoscopy procedure report, the nursing record of the endoscopy, and the pathology report. Data were recorded on a standardized data sheet and entered into SPSS version 19.0 for analysis. A Chi-squared test was used for categorical data and a t test was used for continuous data.
  
  
  RESULTS
  A total of 867 cases involving seven endoscopists and three trainees were studied. The colonoscopy was performed by an endoscopist in 673 cases and performed by a trainee in 194 cases. Mean age [59.3 (SD 12.44) years] and gender (51.7% female) were similar between groups. There was no difference in cecal intubation rate (90.6 vs. 89.2%, p = 0.544) between endoscopists and trainees. There was a difference in polyp detection (23.3 vs. 33.5%, p = 0.004) and adenoma detection (12.8 vs. 22.7%, p = 0.034) favoring the trainees. There was no difference in the average dose of Fentanyl given (98.4 vs. 94.9 mg, p = 0.066), but there was less use of Versed favoring the trainee group (3.59 vs. 3.31 mg, p = 0.002). There was no difference in the endoscopy nurses' perception of patient discomfort between groups (28.7 vs. 26.7%, p = 0.632).
  
  
  CONCLUSIONS
  The presence of a trainee does not appear to adversely affect quality outcomes in colonoscopy. When the polyp and adenoma detection rates of endoscopists are low, the addition of a trainee may improve these detection rates.
authors.affiliation: Memorial University, St. John's, Canada. dpace@mun.ca.
authors.forename: David
authors.initials: D
authors.lastname: Pace
authors.affiliation: Memorial University, St. John's, Canada.
authors.forename: Mark
authors.initials: M
authors.lastname: Borgaonkar
authors.affiliation: Memorial University, St. John's, Canada.
authors.forename: Nikita
authors.initials: N
authors.lastname: Hickey
authors.affiliation: Memorial University, St. John's, Canada.
authors.forename: Brad
authors.initials: B
authors.lastname: Evans
authors.affiliation: Memorial University, St. John's, Canada.
authors.forename: Muna
authors.initials: M
authors.lastname: Lougheed
authors.affiliation: Memorial University, St. John's, Canada.
authors.forename: Curtis
authors.initials: C
authors.lastname: Marcoux
authors.affiliation: Memorial University, St. John's, Canada.
authors.forename: Jerry
authors.initials: J
authors.lastname: McGrath
authors.affiliation: Memorial University, St. John's, Canada.
authors.forename: Darrell
authors.initials: D
authors.lastname: Boone
authors.affiliation: Memorial University, St. John's, Canada.
authors.forename: Meghan
authors.initials: M
authors.lastname: O'Leary
authors.affiliation: Memorial University, St. John's, Canada.
authors.forename: Chris
authors.initials: C
authors.lastname: Smith
mesh_terms: D000328:Adult; D000359:Aftercare; D003108:Colonic Diseases / Q000601:surgery*; D003113:Colonoscopy / Q000193:education*; D004503:Education, Medical, Graduate / Q000592:standards*; D005260:Female; D005762:Gastroenterology / Q000193:education*; D006801:Humans; D007396:Internship and Residency / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
keywords: Education; Endoscopy; Quality control