Seeking the Cecum: Assessing Metrics in Fellow Procedural Training

Excerpt

The ability to independently perform colonoscopy is a fundamental milestone of gastroenterology fellowship training due to the need to learn the many technical and cognitive elements required to master the procedure [1‐3]. Although the field has historically relied heavily on the important metric of cecal intubation as a marker of proficiency in the assessment of trainees [3], there are limitations specific to this metric. First, the ability to intubate the cecum may not correlate with multiple other important procedural skills needed for competency, such as polyp identification and resection, in addition to cognitive skills such as those required to achieve safe sedation and ensure patient comfort and safety [4]. Second, there is wide variation in the number of procedures needed for trainees to perform in order to achieve technical proficiency in cecal intubation, as defined by the metric of ≥90 % success [1, 2, 5]. Furthermore, the numerical threshold for competence is the completion of 140 colonoscopies, a figure based on a single study of 35 trainees, which has since been shown to be a gross underestimate of the number of procedures for colonoscopy proficiency. Thus, proposing a “one-size-fits-all” number of procedures for trainees is puzzling. …