Robert Enns, MD and Neal Shahidi, MD from the University of British Columbia in Vancouver, British Columbia, Canada discuss their article “Establishing the learning curve for achieving competency in performing colonoscopy: a systematic review” from the September issue.
The focus of our systematic review was to establish training requirements for achieving competency in performing colonoscopy among gastroenterology and surgical trainees.
As colonoscopy has become an essential tool in the diagnosis and management of intestinal diseases, ensuring that trainees are provided with the adequate amount of training to allow for the acquisition of procedural competence is critical. Unfortunately, notable heterogeneity exists among current guidelines regarding the number of colonoscopies recommended before competency should be assessed. This may leave trainees vulnerable as they may not be receiving the sufficient training required to be able to perform high-quality colonoscopy once in independent clinical practice.
In our systematic review, 18 studies with 19 unique evaluations were included. This encompassed 37,700 colonoscopies performed by 247 trainees. When assessing the 11 evaluations which reached competence, 100% required >50 colonoscopies, 82% required >140 colonoscopies and 64% required >200 colonoscopies to achieve competence. After stratifying evaluations by their markers of competence we found that as procedural competence has evolved from solely assessing independent cecal intubation rate to utilizing more comprehensive estimates of competence, the number of colonoscopies needed to achieve competence supersedes current minimum training requirements across all specialties.
With this in mind, endoscopy training programs, specialty societies, and hospital privileging committees need to reassess the amount of training required to adequately prepare future endoscopists. Moreover, further research is needed to look at promising competency assessment tools such as the Mayo Colonoscopy Skills Assessment Tool (MCSAT), the ASGE’s Assessment of Competency in Endoscopy (ACE) evaluation tool, the Gastrointestinal Endoscopy Competency Assessment Tool (GiECAT), and the Part-Task Training Box in an attempt to solidify objective competency criteria and establish a globally accepted endoscopic assessment tool.
Find the article online or on pages 410–416 of the print journal.
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