Fellowship Colonoscopy Training and Preparedness for Independent Gastroenterology Practice

Goals: To objectively assess when gastroenterology (GI) fellows achieve technical competency to perform colonoscopy independently. Background: New guidelines to assess the procedural competency of GI fellows in training have been developed. Although comprehensive, they do not account for the quality metrics to which independently practicing gastroenterologists are held. Study: We performed a prospective study examining consecutive colonoscopies performed by GI fellows from November 2013 through March 2014 at an academic medical center. Using a brief postprocedure questionnaire and the online medical record, we measured rates of independent fellow cecal intubation rate (CIR), insertion time to the cecum (cecal IT), and independent polypectomy rate. Our secondary outcomes were adenoma detection rate and polyp detection rate. Results: A total of 898 colonoscopies performed by 10 GI fellows were analyzed. In the multivariate analysis, CIR [odds ratio (OR) = 1.29, P = 0.012], cecal IT (beta-coefficient = 0.19, P = 0.006), and rates of unassisted independent snare polypectomy (OR = 1.36, P < 0.001) all improved significantly with increased number of procedures performed (OR and beta-coefficient per 100 colonoscopies performed). After performing 500 colonoscopies, fellows achieved a mean CIR > 90%, cecal IT between 7 and 10 minutes, and independent polypectomy rate of 90% with further improvement in cecal IT to <7 minutes, and independent snare polypectomy of >95% after 700 cases. Conclusions: Current procedural recommendations for fellowship training may underestimate the technical skill necessary for independent GI practice upon completion of fellowship. Technical proficiency in snare polypectomy may lag behind proficiency in cecal intubation.