DOES A FORMAL COLONOSCOPY CURRICULUM IMPROVE COLONOSCOPY PERFORMANCE IN THE FIRST MONTH OF TRAI...

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DOES A FORMAL COLONOSCOPY CURRICULUM IMPROVE COLONOSCOPY PERFORMANCE IN THE FIRST MONTH OF TRAINING?

R Mohamed, M Raman
University of Calgary, Calgary, Alberta
Aims: Colonoscopy teaching has largely followed an apprenticeship model of "see one, do one, teach one". With decreasing acceptance of training on live patients, and recognition of the inter-play between cognitive and motor skills, simulation and formal curricula in the training of colonoscopy has gained popularity. Therefore, we sought to determine whether formal teaching methods improved the cognitive and technical colonoscopy skills of gastroenterology fellows (GIF) compared with general surgery residents (GSR) following an apprenticeship model.
Methods: In this pilot study, four first year GIF were exposed to an endoscopy simulator and taught colonoscopy using a formal 7-step approach integrating cognitive and technical components of colonoscopy in the first month of training. Three GSR received the conventional apprenticeship based teaching. After 4 weeks, the two groups were assessed on colonoscopy technique using a previously validated scoring system (DOPS Assessment). This tool evaluates 4 domains of colonoscopy: i.Assessment/Communication (ACC); ii. Safety and sedation (SS); iii. Endoscopic skill (Endo); and iv. Diagnostic/Therapeutics (Diag). Descriptive statistics were used when appropriate. Data were analyzed using the SPSS© platform and differences were calculated using one-way ANOVA. Data are reported as mean ± standard deviation. P-value <0.05 is considered statistically significant.
Results: Four first year GIF (3 male/1 female) and three GSR (2 male/1 female) completed 3.25 ±1.0 and 2.7 ±0.6 colonoscopies for evaluation (p=0.4). Prior to fellowship, GIF had completed 32.5 ±12.6 colonoscopies compared to 3.67 ±5.5 by GSR (p=0.015). The GIF completed 13.5 ±5.7 simulator sessions and followed the 7-step approach 6 ±2.9 times. After 4 weeks, in the domains of ACC, SS, Endo, Diag, and total score, the GIF compared with GSR scored 83.9 ±2.5% vs. 85.1 ±13.2% (p=0.86), 78.7 ±4.0% vs. 84.0 ±3.2% (p=0.12), 75.0 ±7.1% vs. 72.1 ±14.2% (p=0.73), 83.5 ±9.1% vs. 82.7 ±7.2% (p=0.91) and 80.% ±5.2% vs. 81.0 ±9.2% (p=0.90). Performance did not differ by sex in the 4-domains or in total score (p=1.00). Four participants (57.1%) were assessed by two different evaluators. There was no significant inter-rater difference in the 4 domains, total score, or perception of case difficulty.
Conclusions: GIF performed very well in colonoscopy procedure after 1 month of intervention with the 7-step teaching approach and endoscopy simulator. GSR, given the nature of their specialty, are expected to perform better than GIF early in endoscopy training. In our study, the teaching intervention resulted in equal performance by both groups. Interobserver rating of performance was similar suggesting that a single gastroenterologist is sufficient for evaluation. A larger randomized controlled study in a homogenous population is required to confirm this finding.

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