Performance indicators in colonoscopy after certification for independent practice


Post written by Keith Siau, MBChB, MRCP, and Paul Dunckley, MBChB, FRCP, DPhil, from the Joint Advisory Group, Royal College of Physicians, London, the Department of Gastroenterology, Dudley Group Hospitals NHSFT, Dudley, and the Department of Gastroenterology, Gloucestershire Royal Hospital, Gloucester, United Kingdom.

This prospective UK-wide observational study focused on the following:

  • Quality of colonoscopy as endoscopists transition from training (pre-certification) into newly independent practice (post-certification).
  • Rates of drop in performance (DIP), ie, unassisted cecal intubation rate (CIR) falling below 90% in the first 50 post-certification procedures.
  • Factors associated with DIP.

Data on the effectiveness of certification/credentialing systems in endoscopy are lacking. Furthermore, the quality of colonoscopy during the newly-independent period is unclear.

To our knowledge, this is the first study of colonoscopy performance in the post-certification (newly independent) setting. We found that:

1) Trainees improve in a near linear fashion in terms of CIR, polyp detection rates, lower discomfort scores for patients, and lower sedation doses as they approach certification.

2) On average, newly independent trainees met international completion rate standards (completing at least 90% of colonoscopy procedures without assistance).

3) DIP was observed in 18.4% of trainees. Trainees with DIP had lower completion rates and lower number of lifetime colonoscopy counts compared to those who did not. Trainer specialty, but not trainee specialty, was also a significant predictor of DIP.

Overall, our data support the role of certification/credentialing systems to quality assure colonoscopy practice. DIP was found in 18.4%, although this diminished over the subsequent 100 procedures. This study has implications for performance monitoring in independent endoscopists. Further study on the causes of DIP are warranted.


Figure 1. Trainee status in relation to Joint Advisory Group on Gastrointestinal Endoscopy colonoscopy certification.11 PCC, Provisional colonoscopy certification, DOPS, direct observation of procedural skills; DOPyS, direct observation of polypectomy skills; KPI, key performance indicator; CIR, cecal intubation rate.

See linked editorial:

Read the full article online.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.


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