Prospective Assessment of Learning Curve and Impact of Intensive Versus Progressive Training in Colonoscopy Competence Among French Residents

Author:

Wintzer-Wehekind Léonard1,Moulis Lionel1,Camus Marine2,Vanbiervliet Geoffroy3,Benamouzig Robert4,Duflos Claire1,Caillo Ludovic5,Assenat Eric1,Barthet Marc6,Gonzalez Jean-Michel6,Debourdeau Antoine1

Affiliation:

1. CHU de Montpellier, Montpellier Univ, MUSE

2. Saint-Antoine Universitary Hospital, Assistance Publique des Hôpitaux de Paris AP-HP

3. Centre Hospitalier Universitaire

4. Avicenne Universitary Hospital, Assistance Publique des Hôpitaux de Paris AP- HP

5. CHU de Nîmes, Montpellier Univ, MUSE

6. North Universitary Hospital, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille University

Abstract

Abstract

Backgrounds : There are no existing data in the literature on the learning curve of French interns in colonoscopy or on the comparison between different frequencies of colonoscopy training modalities. We aimed to assess the number of procedures required for French residents in hepatogastroenterology to achieve competency in colonoscopy. Methods: The primary outcome was achieving greater than 90% cecal intubation rate (CIR90) competency using the Learning Curve-Cumulative Summation (LC-CUSUM) method. Participants with over 80 procedures were categorized into intensive and progressive training groups. We compared the proportion of residents reaching competency, the number of colonoscopies to reach it, and the speed of competency. Results: The study included 81 residents, totaling 6,259 procedures. 29 did more than 80 procedures: 12 in the progressive group and 17 in the intensive group. 204 colonoscopies were needed for reaching CIR90 competency (21% of residents). Achievement rates were similar across groups: 50% in the progressive and 65% in the intensive group (p=0.50). LC competency was reached by 8.6% of residents after an average of 225 procedures, with no significant difference between groups (p=0.21). Survival analysis showed no significant difference in the speed of competency acquisition between groups (p=0.77 and p=0.14, respectively). The Polyp Detection Rate (PDR) averaged 40%. Conclusion: The study supports a 200-colonoscopy threshold for competency. Given that only 21% reached CIR90, efforts are needed to increase the number of colonoscopies during training.

Publisher

Springer Science and Business Media LLC

Reference14 articles.

1. Livre Blanc de l’hépatogastroentérologie [Internet]. https://www.cnp-hge.fr/wp-content/uploads/2020/03/LIVRE-BLANC_HGE.pdf

2. Performance measures for lower gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative;Kaminski M;Endoscopy,2017

3. The frequency of total colonoscopy and terminal ileal intubation in the 1990s;Marshall JB;Gastrointest Endosc,1993

4. The Blue Book of European Section. and Board of Gastroenterology and Hepatology [Internet]. https://www.eubogh.org/blue-book/

5. An analysis of the learning curve to achieve competency at colonoscopy using the JETS database;Ward ST;Gut,2014

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