Assessment of screening colonoscopy competency in colon and rectal surgery fellows: A single institution experience

Background: The American Board of Surgery and the American Board of Colorectal Surgery requirements for certification include 80 and 140 colonoscopic procedures, respectively. However, little data support the attainment of colonoscopic competency. The aim of this retrospective study is to report the colonoscopy learning experience for colorectal surgery fellows at a single high-volume training program. Material and Methods: A prospective database recorded the experience of six colorectal fellows over two consecutive academic years. Univariate, moving average curves, and change point analysis were used to assess learning curve trends over time. Screening colonoscopy competency was defined by a significant reduction in total procedure time and 80% cecal intubation rate within 35 min. Results: From 2004 to 2006, a total of 2904 screening colonoscopies were performed, including 1498 (52%) by fellows (mean 249 procedures per fellow). The mean procedure time for fellows was 30.2 ± 15 min. Procedure time decreased significantly up to 120 procedures but not thereafter. Overall, fellows' total procedure time decreased by 7.6 min over the course of the year (P < 0.0001); 66% of fellows were able to complete 80% of the procedure in 40 min in the last 2 mo of training. The combined learning curve of all the fellows and the change point analysis showed a significant change occurs at 94 procedures. Using the moving average curve, we have shown 114 procedures are needed to achieve 80% completion rate in 35 min in majority of the fellows. Conclusions: Colorectal surgery fellows were observed to achieve screening colonoscopy competency approximately between 94 and 114 procedures. In the era of working time restrictions, prospective documentation of individual trainee performance may allow tailored training based on observed competency.