Introduction Directly Observed Polypectomy Skills (DOPyS) is a validated tool used to assess polypectomy technique (1). In the UK, 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. It is envisaged that all independent endoscopists should be competent in Level 2 polypectomy (2). The aim was to examine the time taken and the influence of procedure intensity (PI)-Average number of colonoscopies and flexible sigmoidoscopies per month on the time to Level 1 (provisional certification) and Level 2 (full certification) polypectomy competency.
Method Data were extracted from the JETS database (Jan 2009 to Sept 2015) on 131 trainees (1633 DOPyS) from the time of their first DOPyS (1 st DOPyS) up to achieving provisional and full certification. As not all trainees achieved certification, the analysis was performed using survival analysis methods. Cox regression was used to examine PI association with the time to achieving certification. Kaplan-Meier graphs were used to show the proportion of trainees who achieved certification at different points in time.
Results The analysis demonstrates that 38% of trainees had reached provisional certification by one year, 74% by two years, 94% by three years, and 99% by four years of the 1 st DOPyS. 5% of endoscopists had reached full certification after one year, 33% after two years, 50% by three years and 87% by four years from 1 st DOPyS. There was some evidence that PI at 1 st DOPyS (baseline PI) was associated with time to provisional (p=0.06) and time to full certification (p=0.08). A higher baseline PI was associated with a higher probability of obtaining polypectomy competency/certification in a shorter timescale. A five-unit increase in baseline PI was associated with a 25% increase in the chance of obtaining provisional and 17% increase in obtaining full status at any time. A graphical illustration of the results is shown in Image 1
Conclusion In the UK, the majority (94%) of trainees achieve Level 1 polypectomy competency within 3 years of 1 st DOPyS, but only 50% achieve Level 2 polypectomy competency in the same time. Increasing PI to an average of >10 procedures/month may shorten the learning curve to polypectomy competency/full certification. Current data collection only allows the estimation of learning curve by time and DOPyS documented and not the number of polypectomies performed. There is ongoing work to establish the learning curve based on number of polypectomies.
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Disclosure of Interest None Declared