title: Early Splenic Flexure Intubation Competency Predicts Early Cecal Intubation Competency in Gastroenterology Fellows.
abstract: Trainees learn colonoscopy skills at varying speeds. We hypothesized that a fellow's ability to reliably reach the splenic flexure early in training could predict the number of procedures required to achieve competency in intubating the cecum.
  
  
  
  This was a retrospective analysis of prospectively collected data. The most proximal site in the colon reached independently by GI fellows was recorded on consecutive colonoscopies. The number of procedures required to achieve splenic flexure intubation rate (SFIR) ≥ 90 % by cumulative summation learning curve and cecal intubation rate (CIR) ≥ 90 % by rolling average was calculated. Fellows were then dichotomized into "Early" versus "Late" learners based on the median number of procedures required to achieve SFIR ≥ 90 %. The number of procedures required to achieve CIR ≥ 90 % was then compared between the groups.
  
  
  
  Fellows achieved SFIR ≥ 90 % at a median of 37 colonoscopies. Fellows who achieved SFIR competency early achieved CIR ≥ 90 % at a mean of 208 procedures versus 352 procedures in the fellows who achieved SFIR competency late (p = 0.03).
  
  
  
  Data from a single academic medical center show that whether a trainee will learn endoscopy quickly compared to his/her peers can be predicted early in their endoscopy training by tracking SFIR. This knowledge could be used to customize endoscopy curriculum.
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, USA. sean.t.mccarthy@osumc.edu.
authors.forename: Sean T
authors.initials: ST
authors.lastname: McCarthy
authors.affiliation: Division of Gastroenterology, Wenatchee Valley Hospital and Clinics, Wenatchee, WA, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Jorgensen
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Grace H
authors.initials: GH
authors.lastname: Elta
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Kolars
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Sheryl
authors.initials: S
authors.lastname: Korsnes
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Valbona
authors.initials: V
authors.lastname: Metko
authors.affiliation: Information Technology and Services, University of Michigan Health System, Ann Arbor, MI, USA.
authors.forename: James
authors.initials: J
authors.lastname: Stout
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.|Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI, USA.
authors.forename: Joel H
authors.initials: JH
authors.lastname: Rubenstein
mesh_terms: D002432:Cecum; D002983:Clinical Competence; D044684:Colon, Transverse; D003113:Colonoscopy / Q000193:education*; D005257:Fellowships and Scholarships; D005762:Gastroenterology / Q000193:education*; D006801:Humans; D059032:Learning Curve; D012189:Retrospective Studies
keywords: CUSUM; Colonoscopy; Training