Post written by Hussein Bitar, MD, from the Section of Digestive Diseases and Nutrition, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
Our study highlighted newly defined colonoscopy performance measures–the adenoma and polyp management efficiency indices. We retrospectively evaluated the performance of these indices at each level of training in assessing colonoscopy skill acquisition for a cohort of gastroenterology fellows compared to an attending reference group. We also assessed the evolution of moderate sedation practices during training.
The ACGME GI fellowship training requirements and ASGE 2012 colonoscopy core curriculum lack well-defined measures of competence and thresholds for conditional independence. Additionally, attaining the quality thresholds determined by the adenoma detection rate ADR may not be sufficient to fully characterize the colonoscopy learning curve. The newly defined indices may help fill that gap by providing more objective measures of competence.
ADR was similar at different stages of fellowship training and comparable to the attending group. Efficiency of detecting and resecting polyps improved throughout training without reaching attending level. Fellow involvement led to greater use of moderate sedation.
We propose the adenoma and polyp management efficiency indices (average time required during withdrawal per adenoma and polyp resected, respectively) as novel quality metrics to track trainee progress during colonoscopy training. Validation studies are warranted.
Figure 3. Adenoma and polyp management efficiency indices (P < .001). SD, Standard deviation.
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