Moska Hamidi, MD, MPH, Jeffrey Hawel, MD, FRCSC, Michael Ott, MD, MSc, FRCSC. London Health Sciences Centre
Background: Colonoscopy is an important diagnostic and therapeutic procedure in the management of colonic disease; achieving competence during residency is an integral part of performing high-quality colonoscopy in-practice, regardless of specialty. There is debate and controversy however, regarding what, if any, number of procedures achieves said proficiency. Furthermore, there is significant heterogeneity in the current guidelines and studies published to-date on the definition of competence in colonoscopy.
Objective: To determine individualized learning curves as an alternative to 'number of procedures' for assessing colonoscopy competence.
Methods and Procedures: This is a multi-institutional prospective cohort study involving eleven surgical trainees (novice endoscopists). The main outcome, colonoscopy competence, was assessed by determining the independent colonoscopy completion rate (ICCR), the number of procedures required to reach 90% independent colonoscopy completion and polyp detection rate. Individual and overall ICCR were calculated using moving average analysis.
Results: Eleven second-year general surgery residents performed a mean [SD] 229  colonoscopies. The individual and average learning curves follow a logarithmic pattern. By moving average analysis, the residents reached an ICCR of 90% at 338 procedures. The mean ICCR was 65.9%, 84.2% and 87.1% after 100, 200 and 300 procedures, respectively. The polyp detection rate was 19.94 [4.76] %. The mean [SD] percentage of colonoscopies with polyps removed by the resident was 25.66 [0.0962] %. Four of eleven (36%) residents reached a 90% ICCR before 200 procedures, while 5/11 (45%) reached this rate overall.
Limitations: Only assessed surgical trainees, lacks comparison with gastroenterology fellows.
Conclusions: While a benchmark for a minimum number of procedures may be necessary to allow supervisors to adequately assess performance, it is difficult to determine what number is optimal. There appears to be significant heterogeneity in both overall number of colonoscopies completed by each resident, as well as the mean ICCR and the number of procedures required to reach the current benchmark for competency. The use of learning curves allows real-time tracking of progress and training tailored to the individual, as we move forward in the era of competency-based medical education.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88520
Program Number: P307
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster