Introduction Colonoscopy is the gold standard modality for investigation of colonic disease.1 The procedure can be challenging to perform.1 Complete colonoscopy, defined as intubation of the terminal ileum, neo-terminal ileum, or caecum, should be achieved in greater than 90% of cases on an intention to complete basis.1 Historically trainees have performed colonoscopy on service lists, and ad hoc training lists and may have had incomplete access to training.2 Trainees currently working in our unit perform colonoscopy on dedicated training lists prior to JAG certification of independence. We performed a large retrospective study of colonoscopy completion rate, comparing two groups of gastroenterology trainees with consultant Gastroenterologists.
Methods 5307 consecutive colonoscopies, from a five-year period in a single centre, were triaged by first endoscopist. Groups identified were 1) consultant Gastroenterologists 2) previous trainees (individuals who trained in the unit in the past, performing colonoscopy on service, adhoc training, and dedicated training lists) 3) Current trainees (employed in the unit at time of study, performing colonoscopy on dedicated training lists). Colonoscopy completion rate, as defined above, was determined for each group. Odds ratios and 95% confidence intervals were calculated to compare the completion rate between groups.
Results Results are summarised in the table
Conclusion Consultants were more likely to achieve complete colonoscopy than previous trainees, who did not achieve >90% completion rate. In contrast, there was no statistical difference when consultants were compared to current trainees on dedicated training lists. The observed effect is likely to reflect additional allocated time, and immediate consultant trainer availability.
Procedures were grouped by first endoscopist. Extent of examination by trainee or trainer in each case is not known: assistance may have been required on a greater proportion of procedures performed on training lists.
Colonoscopy completion rate is an important marker of quality. Other indicators include adenoma detection rate, comfort score, and withdrawal time.1 Inclusion of these indices would provide further comparative performance data.
Trainees performing colonoscopy on dedicated training lists delivered comparable completion rates to consultants and outperformed their predecessors. Our data supports dedicated colonoscopy training prior to certification of independence.
Gavin et al. Gut 2013:62:2 242
Bowles et al. Gut 2004:53:2 277
Disclosure of Interest None Declared.
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