An analysis of the learning curve to achieve competency at colonoscopy using the JETS database.
Bottom Line: By LC-Cusum analysis, 41% of trainees were competent after 200 procedures.The current training certification benchmark in the UK of 200 procedures does not appear to be an inappropriate minimum requirement.The LC-Cusum chart provides real time feedback on individual learning curves for trainees.
Affiliation: Centre for Liver Research and NIHR Birmingham Biomedical Research Unit, Level 5 Institute for Biomedical Research, University of Birmingham, Birmingham, UK.Show MeSH
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Mentions: The results of the mixed effects logistic regression model is shown in table 1. In terms of trainee and training factors, an increasing number of procedures performed, a high training intensity, previous experience of more than 100 flexible sigmoidoscopies, a baseline level of colonoscopy experience of >20 procedures and being a surgical trainee were independently associated with colonoscopy completion. With regard to patient factors, female gender and age ≥65 years were significantly associated with colonoscopy incompletion. The relationship between the proportion of colonoscopies completed against measured continuous variables is shown in figure 4. The proportion of completed colonoscopies increased with increasing number of procedures and training intensity. The proportion of completed colonoscopies decreased with increasing age above 60 years. A diagnosis was available for 83% colonoscopies, and submission of a diagnosis was independently associated with completion. The presence of colorectal cancer, diverticular disease and stricture were all significantly associated with incompletion.
Affiliation: Centre for Liver Research and NIHR Birmingham Biomedical Research Unit, Level 5 Institute for Biomedical Research, University of Birmingham, Birmingham, UK.