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Colonoscopy training standards considered adequate in UK
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Current benchmarks for achieving competency and meeting colonoscopy certification criteria in the UK appeared to be appropriate, based on analysis by two statistical methods in a recent study.
Researchers defined competency in conducting colonoscopies among trainees in the UK by cecal intubation rates (CIR) that exceeded 90%. They then retrieved colonoscopy data from the Joint Advisory Group (JAG) on Gastrointestinal Endoscopy training system (JETS) e-portfolio to determine how many colonoscopies were required before trainees attained CIR of at least 90%. JAG guidelines require clinicians to perform at least 200 colonoscopies during training.
Trainees — gastroenterologists, gastrointestinal surgeons, nurse endoscopists and general practitioners — who performed at least 20 colonoscopies and 50 or fewer before submitting data to the JETS database met study inclusion. There were 36,730 colonoscopies conducted by 297 trainees during their early training.
Researchers used two methods to determine the number of colonoscopies required to reach a CIR of ≥90: a moving average analysis and a learning curve cumulative sum (LC-Cusum). Based on the moving average analysis, trainees achieved a mean CIR of 90% at 233 procedures. Using the LC-Cusum method, 41% of trainees attained competency after 200 colonoscopies.
Trainees who conducted a greater number of procedures were associated with colonoscopy completion, as were those with more than 100 flexible sigmoidoscopies during training (OR=2.4; 95% CI, 1.8-3), surgeons (OR=1.6; 95% CI, 1.3-2) and those with greater intensity in training (OR=1.1; 95% CI, 1-1.1).
“The current training certification benchmark in the UK of 200 procedures does not appear to be an inappropriate minimum requirement,” the investigators concluded. “Intensity of colonoscopy training and previous flexible sigmoidoscopy experience were independently associated with attaining competency, and it is possible that these could be exploited by training programs.”
Disclosure: The researchers report no relevant financial disclosures.
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