Introduction Directly Observed Polypectomy Skills (DOPyS) is a validated tool used to assess polypectomy skills (1). DOPyS has 34 parameters measuring technical and non-technical polypectomy skills and an overall polypectomy proficiency score on which a trainee is scored on a grade of 1–4. Trainees are certified as competent in level 1 (<1 cm) and level 2 (1–2 cm) polypectomy if they achieve overall scores 3 or 4 in their last 4 consecutive DOPyS, alongside other key performance indicators. The aim was to determine factors that could be targeted for training in safe and competent polypectomy.
Method DOPyS evaluations documented were analysed to identify low-scoring parameters both during training and after attaining competency. Data from 707 trainees (4965 DOPyS) from Jan 2009 to Sept 2015 was examined. The low scoring parameters (scores 1 or 2) were identified during training (DOPyS overall score 1 or 2) and at competency (DOPyS Overall score 3 or 4). These were further analysed according to site, morphology and size of polyps removed.
Results All 4965 DOPyS were entered into the analysis. 80% (3898) left sided polyps, 63% (3114) sessile polyps. Median size 6 mm and majority (68%) were <1 cm in size. Table 1 shows technical and non-technical parameters at which trainees had persistently low scores, which were independent of size, site and morphology of the polyp. Additionally, trainees had incompetent scores when choosing the appropriate polypectomy technique, using prophylactic haemostatic measures for right sided lesions and at tattoo placement skills for >2 cm polyps.
Conclusion Trainees in the UK consistently underperform on some non-technical skills (choice of technique, checking diathermy settings, photo-documentation) and technical skills (snare control, submucosal injection technique), irrespective of polyp size, site and morphology.
To improve proficiency of polypectomy skills, we suggest targeted interventions to increase the awareness of the required non-technical skills and specific focus during in-vivo training on the identified technical factors. This retrospective analysis of a large database is entirely novel in describing the detail of polypectomy skills that trainees lack during training and at competency. There is currently an ongoing prospective study to examine the learning curve for polypectomy skills.
Guptaet al, GIE (March 2012)
Disclosure of Interest None Declared
- Polypectomy Competency
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