Elsevier

Gastrointestinal Endoscopy

Volume 78, Issue 3, September 2013, Pages 503-509
Gastrointestinal Endoscopy

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

https://doi.org/10.1016/j.gie.2013.03.1331Get rights and content

Background

Skills decay without practice, but the degree is task specific. Some experts believe that it is essential to teach endoscopy longitudinally to build and maintain endoscopic skills.

Objective

To determine whether breaks in gastroenterology fellow endoscopy training are associated with a decrement in competency in independent intubation of the cecum.

Design

Observational cohort of colonoscopies performed by gastroenterology fellows.

Setting

Academic fellowship program from July 2010 to March 2012.

Subjects

Twenty-four fellows.

Main Outcome Measurements

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.

Results

A total of 6485 colonoscopies were performed by 24 fellows with 87 breaks in training. The average break was 6 weeks (range 2-36 weeks). Seventy-five percent of the breaks were 8 weeks or less. For every additional 4 weeks, the slope after the break worsened by 0.022 (P = .06, maximum possible change = −1.0 to +1.0). By the end of the subsequent rotation, there was no association between the slope of the learning curve and the length of the break (P = .68).

Limitations

This was an observational study of only 24 fellows with relatively few long breaks. Cecal intubation is only 1 component of overall competency in colonoscopy.

Conclusions

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.

Section snippets

Methods

Data on the maximal colonoscopic insertion that was independently reached by the gastroenterology fellows at our institution was collected prospectively from July 2010 until March 2012 for quality assurance. We then retrospectively analyzed the data for this study. Inclusion criteria included colonoscopies in which a fellow participated. Exclusion criteria included colonoscopies performed when the intended extent was distal to the cecum (such as sigmoidoscopies or purposefully truncated

Results

During the study period, there were 6485 colonoscopies performed by 24 gastroenterology fellows with 87 breaks in training. Breaks occurred throughout the 3-year fellowship program. Figure 3 illustrates the distribution of when the breaks occurred. The median length of a break was 6 weeks (range 2 to 36 weeks). Seventy-five percent of the breaks were 8 weeks or less in length. During nonendoscopy rotations, the fellows completed on average 0.5 colonoscopies per week (interquartile range 0.0,

Discussion

To our knowledge, there have not been any studies describing the variations in schedules among fellowship programs for teaching endoscopy. Anecdotally, we are aware of some fellowship programs that teach endoscopy longitudinally with a half day or day of endoscopy per week, whereas others, like our program, teach endoscopy in blocks. Some programs also have longer research blocks in the second and/or third year. In our program, this research block can be from 4 weeks to 9 months depending on

References (17)

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    Jorgensen et al. studied whether breaks in GI endoscopy training affect performance. In an observational study of 24 GI trainees performing over 6000 colonoscopies, it was noted that there may be a slight decrease in a trainee's performance as defined by their CIR after prolonged breaks in endoscopy training, with performance decreasing marginally after every subsequent 4-week break [40]. As described earlier, CIR is only one means of measuring trainee performance, and thus, this single study ought to be interpreted cautiously.

  • In-training gastrointestinal endoscopy competency assessment tools: Types of tools, validation and impact

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    Research has shown that there is wide variation in skill among endoscopists with similar levels of experience [25,26]. Additionally, the rate at which trainees learn is influenced by a host of factors, including training intensity [25], the presence of breaks during training [27], use of training aids (e.g., magnetic endoscopic imagers [28]), quality of instruction received, and a trainees' innate ability. Furthermore, the accuracy of log books used to record procedural numbers has been questioned and these records do not provide learners and educators with specific information about the nature of learning achieved [29].

  • Training and Assessment in Pediatric Endoscopy

    2016, Gastrointestinal Endoscopy Clinics of North America
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    However, research on adult endoscopists has shown that there is wide variation in the rate at which trainees acquire skills.50,51 Furthermore, in addition to procedural volume, there are many other factors that affect skill acquisition, including training intensity,50 presence of disruptions in training,52 use of training aids (eg, simulation19,20), quality of teaching and feedback received, and a trainees’ innate ability.53 Procedural number requirements, therefore, do not ensure competence.

  • Effects of breaks in colonoscopy training

    2014, Gastrointestinal Endoscopy
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DISCLOSURE: The authors disclosed no financial relationships relevant to this publication. This study was funded by the American Society for Gastrointestinal Endoscopy Quality in Endoscopy Research Award.

If you would like to chat with an author of this article, you may contact Dr Jorgensen at [email protected].

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