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PTH-058 Trainee Colonoscopists Acquire Competency at Different Rates, as Determined by Cusum Analysis Of Colonoscopy Data From The Jets Database
  1. S T Ward1,2,
  2. M A Mohammed1,
  3. T Ismail2,
  4. R Valori3,
  5. P Dunckley3
  1. 1University of Birmingham
  2. 2Queen Elizabeth Hospital, Birmingham
  3. 3Gloucestershire Hospitals NHS Trust, Gloucester, UK

Abstract

Introduction The number of colonoscopies required to reach competency is not well established. Nevertheless, a minimal number forms part of UK certification criteria.

The Cusum technique is a statistical analysis of sequential data to determine if a process is ‘in control’. The Joint Advisory Group on GI Endoscopy have developed an e-portfolio for users to record their endoscopic experience. The primary aim of this study was to determine the range of experience required by individuals to attain a caecal intubation rate (CIR) ≥90%, as defined by Cusum. A secondary aim was to assess which training factors are associated with attaining competence.

Methods Inclusion criteria were all e-portfolio users who had performed ≤50 (‘baseline’) colonoscopies prior to submission of data to the e-portfolio; termed ‘trainees’. All colonoscopy records for the trainees were retrieved from the e-portfolio database and learning curve-Cusum analysis was performed. This analysis of colonoscopy completion reports the number of procedures required for CIR performance to reach ≥90%. A colonoscopy was defined complete if the caecum or ileum was reached and was performed without assistance.

Trainees who had attained a CIR≥90% were compared to those with a CIR < 90% for differences in previous endoscopic experience, case volume and other trainee factors by univariate (Mann-Whitney, Chi-squared) and multivariate (binomial logistic regression) analysis.

Results The e-portfolio contained 169,515 colonoscopy records entered by 1,572 different users. 265 users (‘trainees’) were confirmed to have performed ≤50 baseline colonoscopies and were included in subsequent analyses. By Cusum method, 39 trainees attained a CIR≥90%; 226 achieved a CIR < 90%.

For those trainees with over 250 procedures, only 47% attained a CIR≥90%.

Factors associated with attaining CIR≥90% were high number of procedures (P < 0.01), high number of colonoscopies per month (P < 0.01), and prior experience of more than 100 sigmoidoscopies (P = 0.017) by univariate and multivariate analysis. Nurse endoscopists attained competency at a higher rate than gastroenterology or surgical trainees by univariate (P = 0.01) but not multivariate analysis.

Conclusion This is the largest study to date by both procedure and trainee numbers assessing colonoscopy competency by Cusum method.

Trainees achieve competency at different rates. A high proportion of trainees will not attain a CIR > 90% even after 250 procedures. High case volume and prior sigmoidoscopy experience are associated with a CIR > 90%. The potential of both these factors to influence the attainment of competency should be exploited within endoscopy training programmes.

Disclosure of Interest None Declared.

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