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Abstract
We sought to provide an objective measure of the technical progress of trainees learning
colonoscopy. GI fellows in our training program perform colonoscopy under supervision
throughout their 2 years of fellowship.
The frequency of fellows reaching the cecum in less than 30 minutes was determined
by one endoscopy instructor during the last 7 months of their first year of training
and during the last 7 months of their second year.
The mean success rate of reaching the cecum for seven first-year fellows was 54% (individual
range, 25% to 86%). This compared with 86% for six second-year fellows (individual
range, 73% to 93%) and with 97% for the endoscopy instructor when he did procedures
without a fellow. First-year fellows during the 7-month "testing" periods believed
they had reached the cecum in 5.7% of cases in which they had not. This was not a
problem with second-year fellows. Counting colonoscopies done with all instructors
in our program, fellows in this series each did an average of 149 colonoscopies during
their first-year of training and 328 by the end of their second.
Increasing proficiency in reaching the cecum occurs with experience over time, and
continues even after completion of formal training. Individual trainees also seem
to learn colonoscopy at different rates. Depending on how one defines competency,
it is possible that the minimum threshold number for technical competency in colonoscopy
of 100 procedures, as suggested by the ASGE, may be low.