Does the hands-on, technical training of residents in colonoscopy affect quality outcomes?

David E Pace, MD, Mark Borgaonkar, MD, Nikita Hickey, MD, Brad Evans, BSc, Muna Lougheed, Curtis Marcoux, Darrell Boone, Chris Smith, Jerry McGrath. Memorial University

Introduction: The purpose of this study is to determine if 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 (EMR), 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 20.0 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 7 endoscopists and 3 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 mg vs. 94.9 mg, p=0.066) but there was less use of Versed favoring the trainee group (3.59 mg 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).

Conclusion: The presence of a trainee does not appear to adversely affect quality colonoscopy outcomes. When the polyp and adenoma detection rates of endoscopists are low, the addition of a trainee may improve these detection rates.