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Do breaks in gastroenterology fellow endoscopy training result in a decrement in competency in colonoscopy?

A study in the latest issue of Gastrointestinal Endoscopy determines whether breaks in gastroenterology fellow endoscopy training are associated with a decrement in competency in independent intubation of the cecum.

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Dr Jennifer Jorgensen and colleagues from Washington, USA analyzed an observational cohort of colonoscopies performed by gastroenterology fellows.

The team evaluated an academic fellowship program from 2010 to 2012.

The doctors assessed the adjusted change in the slope of cumulative summation learning curves for cecal intubation after breaks in training, and the slope at the end of the subsequent endoscopy rotation.

A total of 6485 colonoscopies were performed by 24 fellows with 87 breaks in training.

The average break was 6 weeks.

The team observed that 75% of the breaks were 8 weeks or less.

For every additional 4 weeks, the slope after the break worsened by 0.022.

By the end of the subsequent rotation, there was no association between the slope of the learning curve, and the length of the break.

75% of the breaks were 8 weeks or less
Gastrointestinal Endoscopy

This was an observational study of only 24 fellows with relatively few long breaks.

The team report that cecal intubation is only 1 component of overall competency in colonoscopy.

Dr Jorgensen's team concludes, "There may be a very small decrement in fellows' abilities to intubate the cecum after a break in endoscopy training."

"Because these changes are so small, teaching endoscopy in blocks is probably adequate, if necessary to balance other clinical and research experience."

"However, further research is needed to determine whether a longitudinal endoscopy experience is superior for attaining and maintaining competency, to evaluate the effects of breaks longer than 8 weeks, and to determine whether the effects of breaks depend on the previous volume of experience with colonoscopy."

Gastrointestinal Endos 2013: 78(3) 503-509
06 September 2013

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