An adequate level of training for technical competence in screening and diagnostic colonoscopy: a prospective multicenter evaluation of the learning curve

Suck Ho Lee, Il Kwun Chung, Sun Joo Kim, Jin Oh Kim, Bong Min Ko, Young Hwangbo, Won Ho Kim, Dong Hun Park, Sang Kil Lee, Cheol Hee Park, Il Hyun Baek, Dong Il Park, Seun Ja Park, Jeong Seon Ji, Byung Ik Jang, Yoon Tae Jeen, Jeong Eun Shin, Jeong Sik Byeon, Chang Soo Eun, Dong Soo Han

Research output: Contribution to journalArticle

102 Citations (Scopus)

Abstract

Background: Various training programs in colonoscopy recommend that trainees should perform at least 100 to 200 procedures to be considered technically competent at diagnostic colonoscopy. Objective: Our purpose was to determine the adequate level of training for technical competence in screening and diagnostic colonoscopy. Design: A prospective multicenter trial. Setting: Fifteen tertiary care academic medical centers. Patients: Over 8 months we prospectively evaluated the procedures of 24 first-year GI fellows in 15 tertiary care academic medical centers. A total of 4351 colonoscopies were assessed prospectively with variable clinical factors. Intervention: Cecal intubation was documented by photographing the identified cecal landmarks, including the appendiceal orifice and the ileocecal valve. Main Outcome Measurements: Acquisition of competence (success rate) was evaluated for colonoscopic training on the basis of 2 objective criteria: (1) adjusted completion rate (>90%) and (2) cecal intubation time (<20 minutes). Results: The overall success rate was 83.5% (3635/4351). The mean cecal intubation time was 9.23 ± 4.63 minutes. The success rate significantly improved and reached the requisite standard of competence after 150 procedures (71.5%, 82.6%, 91.3%, 94.4%, 98.4%, and 98.7%, respectively, for every 50 consecutive blocks). The polyp detection rate did not improve significantly during the 8 months and was not correlated with the learning curve. In addition, mean time to cecal intubation decreased significantly, from 11.16 to 8.39 minutes, after 150 procedures. Logistic regression analysis found that prolonged cecal intubation was caused by the following factors: elderly patients, female sex, low body mass index, poor bowel preparation, poor American Society of Anesthesiologists status, abdominal pain as an indication, instructor's supervision, and low case volume. Limitations: We did not record final pathologic reports of detected polyps and withdrawal time. Conclusions: Competence in technically efficient screening and diagnostic colonoscopy generally requires experience with more than 150 cases. Also, factors associated with prolonged cecal intubation for typical trainees did not differ from those for experienced colonoscopists.

Original languageEnglish
Pages (from-to)683-689
Number of pages7
JournalGastrointestinal Endoscopy
Volume67
Issue number4
DOIs
Publication statusPublished - 2008 Apr 1

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Learning Curve
Colonoscopy
Intubation
Mental Competency
Tertiary Healthcare
Polyps
Ileocecal Valve
Abdominal Pain
Multicenter Studies
Body Mass Index
Logistic Models
Regression Analysis
Education

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

Cite this

Lee, Suck Ho ; Chung, Il Kwun ; Kim, Sun Joo ; Kim, Jin Oh ; Ko, Bong Min ; Hwangbo, Young ; Kim, Won Ho ; Park, Dong Hun ; Lee, Sang Kil ; Park, Cheol Hee ; Baek, Il Hyun ; Park, Dong Il ; Park, Seun Ja ; Ji, Jeong Seon ; Jang, Byung Ik ; Jeen, Yoon Tae ; Shin, Jeong Eun ; Byeon, Jeong Sik ; Eun, Chang Soo ; Han, Dong Soo. / An adequate level of training for technical competence in screening and diagnostic colonoscopy : a prospective multicenter evaluation of the learning curve. In: Gastrointestinal Endoscopy. 2008 ; Vol. 67, No. 4. pp. 683-689.
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abstract = "Background: Various training programs in colonoscopy recommend that trainees should perform at least 100 to 200 procedures to be considered technically competent at diagnostic colonoscopy. Objective: Our purpose was to determine the adequate level of training for technical competence in screening and diagnostic colonoscopy. Design: A prospective multicenter trial. Setting: Fifteen tertiary care academic medical centers. Patients: Over 8 months we prospectively evaluated the procedures of 24 first-year GI fellows in 15 tertiary care academic medical centers. A total of 4351 colonoscopies were assessed prospectively with variable clinical factors. Intervention: Cecal intubation was documented by photographing the identified cecal landmarks, including the appendiceal orifice and the ileocecal valve. Main Outcome Measurements: Acquisition of competence (success rate) was evaluated for colonoscopic training on the basis of 2 objective criteria: (1) adjusted completion rate (>90{\%}) and (2) cecal intubation time (<20 minutes). Results: The overall success rate was 83.5{\%} (3635/4351). The mean cecal intubation time was 9.23 ± 4.63 minutes. The success rate significantly improved and reached the requisite standard of competence after 150 procedures (71.5{\%}, 82.6{\%}, 91.3{\%}, 94.4{\%}, 98.4{\%}, and 98.7{\%}, respectively, for every 50 consecutive blocks). The polyp detection rate did not improve significantly during the 8 months and was not correlated with the learning curve. In addition, mean time to cecal intubation decreased significantly, from 11.16 to 8.39 minutes, after 150 procedures. Logistic regression analysis found that prolonged cecal intubation was caused by the following factors: elderly patients, female sex, low body mass index, poor bowel preparation, poor American Society of Anesthesiologists status, abdominal pain as an indication, instructor's supervision, and low case volume. Limitations: We did not record final pathologic reports of detected polyps and withdrawal time. Conclusions: Competence in technically efficient screening and diagnostic colonoscopy generally requires experience with more than 150 cases. Also, factors associated with prolonged cecal intubation for typical trainees did not differ from those for experienced colonoscopists.",
author = "Lee, {Suck Ho} and Chung, {Il Kwun} and Kim, {Sun Joo} and Kim, {Jin Oh} and Ko, {Bong Min} and Young Hwangbo and Kim, {Won Ho} and Park, {Dong Hun} and Lee, {Sang Kil} and Park, {Cheol Hee} and Baek, {Il Hyun} and Park, {Dong Il} and Park, {Seun Ja} and Ji, {Jeong Seon} and Jang, {Byung Ik} and Jeen, {Yoon Tae} and Shin, {Jeong Eun} and Byeon, {Jeong Sik} and Eun, {Chang Soo} and Han, {Dong Soo}",
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Lee, SH, Chung, IK, Kim, SJ, Kim, JO, Ko, BM, Hwangbo, Y, Kim, WH, Park, DH, Lee, SK, Park, CH, Baek, IH, Park, DI, Park, SJ, Ji, JS, Jang, BI, Jeen, YT, Shin, JE, Byeon, JS, Eun, CS & Han, DS 2008, 'An adequate level of training for technical competence in screening and diagnostic colonoscopy: a prospective multicenter evaluation of the learning curve', Gastrointestinal Endoscopy, vol. 67, no. 4, pp. 683-689. https://doi.org/10.1016/j.gie.2007.10.018

An adequate level of training for technical competence in screening and diagnostic colonoscopy : a prospective multicenter evaluation of the learning curve. / Lee, Suck Ho; Chung, Il Kwun; Kim, Sun Joo; Kim, Jin Oh; Ko, Bong Min; Hwangbo, Young; Kim, Won Ho; Park, Dong Hun; Lee, Sang Kil; Park, Cheol Hee; Baek, Il Hyun; Park, Dong Il; Park, Seun Ja; Ji, Jeong Seon; Jang, Byung Ik; Jeen, Yoon Tae; Shin, Jeong Eun; Byeon, Jeong Sik; Eun, Chang Soo; Han, Dong Soo.

In: Gastrointestinal Endoscopy, Vol. 67, No. 4, 01.04.2008, p. 683-689.

Research output: Contribution to journalArticle

TY - JOUR

T1 - An adequate level of training for technical competence in screening and diagnostic colonoscopy

T2 - a prospective multicenter evaluation of the learning curve

AU - Lee, Suck Ho

AU - Chung, Il Kwun

AU - Kim, Sun Joo

AU - Kim, Jin Oh

AU - Ko, Bong Min

AU - Hwangbo, Young

AU - Kim, Won Ho

AU - Park, Dong Hun

AU - Lee, Sang Kil

AU - Park, Cheol Hee

AU - Baek, Il Hyun

AU - Park, Dong Il

AU - Park, Seun Ja

AU - Ji, Jeong Seon

AU - Jang, Byung Ik

AU - Jeen, Yoon Tae

AU - Shin, Jeong Eun

AU - Byeon, Jeong Sik

AU - Eun, Chang Soo

AU - Han, Dong Soo

PY - 2008/4/1

Y1 - 2008/4/1

N2 - Background: Various training programs in colonoscopy recommend that trainees should perform at least 100 to 200 procedures to be considered technically competent at diagnostic colonoscopy. Objective: Our purpose was to determine the adequate level of training for technical competence in screening and diagnostic colonoscopy. Design: A prospective multicenter trial. Setting: Fifteen tertiary care academic medical centers. Patients: Over 8 months we prospectively evaluated the procedures of 24 first-year GI fellows in 15 tertiary care academic medical centers. A total of 4351 colonoscopies were assessed prospectively with variable clinical factors. Intervention: Cecal intubation was documented by photographing the identified cecal landmarks, including the appendiceal orifice and the ileocecal valve. Main Outcome Measurements: Acquisition of competence (success rate) was evaluated for colonoscopic training on the basis of 2 objective criteria: (1) adjusted completion rate (>90%) and (2) cecal intubation time (<20 minutes). Results: The overall success rate was 83.5% (3635/4351). The mean cecal intubation time was 9.23 ± 4.63 minutes. The success rate significantly improved and reached the requisite standard of competence after 150 procedures (71.5%, 82.6%, 91.3%, 94.4%, 98.4%, and 98.7%, respectively, for every 50 consecutive blocks). The polyp detection rate did not improve significantly during the 8 months and was not correlated with the learning curve. In addition, mean time to cecal intubation decreased significantly, from 11.16 to 8.39 minutes, after 150 procedures. Logistic regression analysis found that prolonged cecal intubation was caused by the following factors: elderly patients, female sex, low body mass index, poor bowel preparation, poor American Society of Anesthesiologists status, abdominal pain as an indication, instructor's supervision, and low case volume. Limitations: We did not record final pathologic reports of detected polyps and withdrawal time. Conclusions: Competence in technically efficient screening and diagnostic colonoscopy generally requires experience with more than 150 cases. Also, factors associated with prolonged cecal intubation for typical trainees did not differ from those for experienced colonoscopists.

AB - Background: Various training programs in colonoscopy recommend that trainees should perform at least 100 to 200 procedures to be considered technically competent at diagnostic colonoscopy. Objective: Our purpose was to determine the adequate level of training for technical competence in screening and diagnostic colonoscopy. Design: A prospective multicenter trial. Setting: Fifteen tertiary care academic medical centers. Patients: Over 8 months we prospectively evaluated the procedures of 24 first-year GI fellows in 15 tertiary care academic medical centers. A total of 4351 colonoscopies were assessed prospectively with variable clinical factors. Intervention: Cecal intubation was documented by photographing the identified cecal landmarks, including the appendiceal orifice and the ileocecal valve. Main Outcome Measurements: Acquisition of competence (success rate) was evaluated for colonoscopic training on the basis of 2 objective criteria: (1) adjusted completion rate (>90%) and (2) cecal intubation time (<20 minutes). Results: The overall success rate was 83.5% (3635/4351). The mean cecal intubation time was 9.23 ± 4.63 minutes. The success rate significantly improved and reached the requisite standard of competence after 150 procedures (71.5%, 82.6%, 91.3%, 94.4%, 98.4%, and 98.7%, respectively, for every 50 consecutive blocks). The polyp detection rate did not improve significantly during the 8 months and was not correlated with the learning curve. In addition, mean time to cecal intubation decreased significantly, from 11.16 to 8.39 minutes, after 150 procedures. Logistic regression analysis found that prolonged cecal intubation was caused by the following factors: elderly patients, female sex, low body mass index, poor bowel preparation, poor American Society of Anesthesiologists status, abdominal pain as an indication, instructor's supervision, and low case volume. Limitations: We did not record final pathologic reports of detected polyps and withdrawal time. Conclusions: Competence in technically efficient screening and diagnostic colonoscopy generally requires experience with more than 150 cases. Also, factors associated with prolonged cecal intubation for typical trainees did not differ from those for experienced colonoscopists.

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