title: Does a Pre-Training Program Influence Colonoscopy Proficiency during Fellowship?
abstract: OBJECTIVE
  The objective of this study was to determine whether a pre-training program influences the entire learning process and overall proficiency of colonoscopy during fellowship.
  
  
  METHODS
  From March 2011 to February 2013, a total of 28 first-year gastrointestinal fellows were trained in colonoscopy at a single tertiary center. Before entering their fellowship training, all fellows were board certified in internal medicine, but had no experience performing a full colonoscopy. Endoscopic quality indices were prospectively measured throughout the first training year and were compared between two groups, "pre-trained" fellows (n = 14), who had more than 100 cases of upper endoscopy experience and colonoscopy observation before starting their fellowship, and the "not pre-trained" group (n = 14), who had less experience.
  
  
  RESULTS
  A total of 15,494 colonoscopies were evaluated and 5,411 were screening colonoscopies. There were no significant differences in the overall quality index between the pre-trained and not pre-trained groups. However, the improvement in the adenoma detection rate (ADR) from the first half of the year to the latter half was significantly higher for the pre-trained group compared to the not pre-trained group (28.6% to 34.5% vs. 36.7% to 28.3%, respectively, P = 0.007). Multivariate analysis showed that pre-training before learning colonoscopy was the only significant factor for high ADR in the second half of the year (11.666 ± 4.251 [B±SE], P = 0.012).
  
  
  CONCLUSIONS
  Sufficient observation of colonoscopy and experience of upper endoscopy before colonoscopy training might facilitate improvement of fellows' manual and cognitive colonoscopic skills during the learning period.
authors.affiliation: Digestive Disease Center, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea.
authors.forename: Duk Hwan
authors.initials: DH
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Soo Jung
authors.initials: SJ
authors.lastname: Park
authors.affiliation: Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Jae Hee
authors.initials: JH
authors.lastname: Cheon
authors.affiliation: Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Tae Il
authors.initials: TI
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Won Ho
authors.initials: WH
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Sung Pil
authors.initials: SP
authors.lastname: Hong
mesh_terms: D003113:Colonoscopy / Q000193:education*; D015179:Colorectal Neoplasms / Q000175:diagnosis; D005257:Fellowships and Scholarships; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015397:Program Evaluation; D062606:Tertiary Care Centers