Abstract
Introduction
The training of residents in colonoscopy has become an important topic as more attention is being paid to quality outcomes.
Purpose
To determine whether colonoscopy quality outcomes are adversely affected by allowing residents to perform colonoscopies under supervision.
Methods
This retrospective cohort study was performed on all adults who underwent colonoscopy in the city of St. John’s, NL, from January to June 2012 by an endoscopist who trains residents. Subjects were identified through records from the health authority. Data were extracted from the electronic medical record, including the endoscopy procedure report, the nursing record of the endoscopy, and the pathology report. Data were recorded on a standardized data sheet and entered into SPSS version 19.0 for analysis. A Chi-squared test was used for categorical data and a t test was used for continuous data.
Results
A total of 867 cases involving seven endoscopists and three trainees were studied. The colonoscopy was performed by an endoscopist in 673 cases and performed by a trainee in 194 cases. Mean age [59.3 (SD 12.44) years] and gender (51.7 % female) were similar between groups. There was no difference in cecal intubation rate (90.6 vs. 89.2 %, p = 0.544) between endoscopists and trainees. There was a difference in polyp detection (23.3 vs. 33.5 %, p = 0.004) and adenoma detection (12.8 vs. 22.7 %, p = 0.034) favoring the trainees. There was no difference in the average dose of Fentanyl given (98.4 vs. 94.9 mg, p = 0.066), but there was less use of Versed favoring the trainee group (3.59 vs. 3.31 mg, p = 0.002). There was no difference in the endoscopy nurses’ perception of patient discomfort between groups (28.7 vs. 26.7 %, p = 0.632).
Conclusion
The presence of a trainee does not appear to adversely affect quality outcomes in colonoscopy. When the polyp and adenoma detection rates of endoscopists are low, the addition of a trainee may improve these detection rates.
Similar content being viewed by others
References
Fundamentals of Endoscopic Surgery/Online Didactics. www.fundamantals-didactics.com
The American Board of Surgery (2014) Flexible endoscopy curriculum for general surgery residents. www.absurgery.org/xfer/abs-fec.pdf
Sanaka MR, Deepiner F, Thota PN, Lopez R, Burke CA (2009) Adenomas are detected more often in morning than in afternoon colonoscopy. Am J Gastroenterol 104:1659–1664
Ward ST, Mohammed MA, Walt R, Valori R, Ismail T, Dunckley P (2014) An analysis of the learning curve to achieve competency at colonoscopy using the JETS database. Gut 63:1746–1754
Buchner AM, Shahid MW, Heckman MG, Diehl BS, McNeil RB, Cleveland P, Gill K, Schore A, Ghabril M, Raimondo M, Gross SA, Wallace MB (2011) Trainee participation is associated with small adenoma detection. Gastrointest Endosc 73:1223–1231
Nishizawa T, Suzuki H, Takahashi M, Kaneko H, Fujiyama Y, Komatsu H, Nagumo H, Tanaka S, Hibi T (2011) Trainee participation during colonoscopy adversely affects polyps and adenoma detection rates. Digestion 84:245–246
Oh YS, Collins CL, Virani S, Kim M, Slicker J, Jackson J (2013) Lack of impact on polyp detection by fellow involvement during colonoscopy: a meta-analysis. Dig Dis Sci 58:3414–3421
Fasil T, Varma JS, Tabaqchali MA (2004) Prospective audit of quality of colonoscopy in a surgical coloproctology unit. Surgeon 2:107–111
Eckardt AJ, Swales C, Bhattacharya K, Wassef WY, Phelan NP, Zubair S, Martins N, Patel S, Moquin B, Anwar N, Leung K, Levey JM (2008) Open access colonoscopy in the training setting: which factors affect patient satisfaction and pain? Endoscopy 40:98–105
Peters SL, Hasan AG, Jacobson NB, Austin GL (2010) Level of fellowship training increases adenoma detection rates. Clin Gastroenterol Hepatol 8:439–442
Lee CK, Park DI, Lee SH, Chung IK, Choi HJ, Cha JM, Lee BI, Shin JE (2011) Participation by experienced endoscopy nurses increases the detection of colon polyps during a screening colonoscopy; a multicenter, prospective, randomized study. Gastrointest Endosc 74:1094–1102
Evans B, Borgaonkar M, Pace D, Hickey N, O’Leary M, Fallows G, McGrath J (2014) Predictors of adenoma detection in colonoscopy by gastroenterologists and surgeons. Surg Endosc 28:S431
Barclay RL, Vicari JJ, Doughty AS, Johanson JF, Greenlaw RL (2006) Colonoscopic withdrawal times and adenoma detection during screening colonoscopy. N Engl J Med 355:2533–2541
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Disclosures
Drs. Pace, Borgaonkar, Hickey, Evans, Lougheed, Marcoux, O’Leary, Boone, Smith, and McGrath have no conflicts of interest or financial ties to disclose.
Rights and permissions
About this article
Cite this article
Pace, D., Borgaonkar, M., Hickey, N. et al. Does the hands-on, technical training of residents in colonoscopy affect quality outcomes?. Surg Endosc 30, 1352–1355 (2016). https://doi.org/10.1007/s00464-015-4397-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-015-4397-1