2 444

Cited 123 times in

An adequate level of training for technical competence in screening and diagnostic colonoscopy: a prospective multicenter evaluation of the learning curve

Authors
 Suck-Ho Lee  ;  Il-Kwun Chung  ;  Sun-Joo Kim  ;  Jin-Oh Kim  ;  Bong-Min Ko  ;  Young Hwangbo  ;  Won Ho Kim  ;  Dong Hun Park  ;  Sang Kil Lee  ;  Cheol Hee Park  ;  Il-Hyun Baek  ;  Dong Il Park  ;  Seun-Ja Park  ;  Jeong-Seon Ji  ;  Byung-Ik Jang  ;  Yoon-Tae Jeen  ;  Jeong Eun Shin  ;  Jeong-Sik Byeon  ;  Chang-Soo Eun  ;  Dong Soo Han 
Citation
 GASTROINTESTINAL ENDOSCOPY, Vol.67(4) : 683-689, 2008 
Journal Title
GASTROINTESTINAL ENDOSCOPY
ISSN
 0016-5107 
Issue Date
2008
MeSH
Academic Medical Centers ; Clinical Competence/standards* ; Colonic Diseases/diagnosis* ; Colonoscopy/standards* ; Education, Medical, Graduate/standards* ; Educational Measurement/methods* ; Female ; Follow-Up Studies ; Gastroenterology/education* ; Humans ; Internship and Residency ; Male ; Mass Screening/methods* ; Mass Screening/standards ; Middle Aged ; Prospective Studies
Keywords
Academic Medical Centers ; Clinical Competence/standards* ; Colonic Diseases/diagnosis* ; Colonoscopy/standards* ; Education, Medical, Graduate/standards* ; Educational Measurement/methods* ; Female ; Follow-Up Studies ; Gastroenterology/education* ; Humans ; Internship and Residency ; Male ; Mass Screening/methods* ; Mass Screening/standards ; Middle Aged ; Prospective Studies
Abstract
BACKGROUND: Various training programs in colonoscopy recommend that trainees should perform at least 100 to 200 procedures to be considered technically competent at diagnostic colonoscopy.

OBJECTIVE: Our purpose was to determine the adequate level of training for technical competence in screening and diagnostic colonoscopy.

DESIGN: A prospective multicenter trial.

SETTING: Fifteen tertiary care academic medical centers.

PATIENTS: Over 8 months we prospectively evaluated the procedures of 24 first-year GI fellows in 15 tertiary care academic medical centers. A total of 4351 colonoscopies were assessed prospectively with variable clinical factors.

INTERVENTION: Cecal intubation was documented by photographing the identified cecal landmarks, including the appendiceal orifice and the ileocecal valve.

MAIN OUTCOME MEASUREMENTS: Acquisition of competence (success rate) was evaluated for colonoscopic training on the basis of 2 objective criteria: (1) adjusted completion rate (>90%) and (2) cecal intubation time (<20 minutes).

RESULTS: The overall success rate was 83.5% (3635/4351). The mean cecal intubation time was 9.23 +/- 4.63 minutes. The success rate significantly improved and reached the requisite standard of competence after 150 procedures (71.5%, 82.6%, 91.3%, 94.4%, 98.4%, and 98.7%, respectively, for every 50 consecutive blocks). The polyp detection rate did not improve significantly during the 8 months and was not correlated with the learning curve. In addition, mean time to cecal intubation decreased significantly, from 11.16 to 8.39 minutes, after 150 procedures. Logistic regression analysis found that prolonged cecal intubation was caused by the following factors: elderly patients, female sex, low body mass index, poor bowel preparation, poor American Society of Anesthesiologists status, abdominal pain as an indication, instructor's supervision, and low case volume.

LIMITATIONS: We did not record final pathologic reports of detected polyps and withdrawal time.

CONCLUSIONS: Competence in technically efficient screening and diagnostic colonoscopy generally requires experience with more than 150 cases. Also, factors associated with prolonged cecal intubation for typical trainees did not differ from those for experienced colonoscopists.
Full Text
http://www.sciencedirect.com/science/article/pii/S0016510707028623
DOI
10.1016/j.gie.2007.10.018
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Won Ho(김원호) ORCID logo https://orcid.org/0000-0002-5682-9972
Lee, Sang Kil(이상길) ORCID logo https://orcid.org/0000-0002-0721-0364
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/107379
사서에게 알리기
  feedback

qrcode

Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.

Browse

Links