Department of Surgery, Mid Cheshire Hospitals NHS Foundation Trust, Crewe, UK.
J Surg Res. 2012 May 1;174(1):e17-23. doi: 10.1016/j.jss.2011.09.048. Epub 2011 Oct 14.
The American Board of Surgery and the American Board of Colorectal Surgery requirements for certification include 80 and 140 colonoscopic procedures, respectively. However, little data support the attainment of colonoscopic competency. The aim of this retrospective study is to report the colonoscopy learning experience for colorectal surgery fellows at a single high-volume training program.
A prospective database recorded the experience of six colorectal fellows over two consecutive academic years. Univariate, moving average curves, and change point analysis were used to assess learning curve trends over time. Screening colonoscopy competency was defined by a significant reduction in total procedure time and 80% cecal intubation rate within 35 min.
From 2004 to 2006, a total of 2904 screening colonoscopies were performed, including 1498 (52%) by fellows (mean 249 procedures per fellow). The mean procedure time for fellows was 30.2 ± 15 min. Procedure time decreased significantly up to 120 procedures but not thereafter. Overall, fellows' total procedure time decreased by 7.6 min over the course of the year (P < 0.0001); 66% of fellows were able to complete 80% of the procedure in 40 min in the last 2 mo of training. The combined learning curve of all the fellows and the change point analysis showed a significant change occurs at 94 procedures. Using the moving average curve, we have shown 114 procedures are needed to achieve 80% completion rate in 35 min in majority of the fellows.
Colorectal surgery fellows were observed to achieve screening colonoscopy competency approximately between 94 and 114 procedures. In the era of working time restrictions, prospective documentation of individual trainee performance may allow tailored training based on observed competency.
美国外科医师学会和美国结直肠外科学会的认证要求分别包括 80 例和 140 例结肠镜检查。然而，几乎没有数据支持获得结肠镜检查能力。本回顾性研究的目的是报告在一个高容量培训计划中单科结直肠外科住院医师的结肠镜学习经验。
前瞻性数据库记录了连续两个学年六名结直肠住院医师的经验。采用单变量、移动平均曲线和变化点分析来评估随时间推移的学习曲线趋势。筛查性结肠镜检查能力的定义为总操作时间显著减少和 80%的盲肠插管率在 35 分钟内。
2004 年至 2006 年，共进行了 2904 例筛查性结肠镜检查，其中 1498 例（52%）由住院医师完成（每位住院医师平均 249 例）。住院医师的平均操作时间为 30.2 ± 15 分钟。操作时间在 120 次操作前显著减少，但之后没有减少。总体而言，住院医师在整个培训年度的总操作时间减少了 7.6 分钟（P < 0.0001）；66%的住院医师在培训的最后 2 个月能够在 40 分钟内完成 80%的操作。所有住院医师的综合学习曲线和变化点分析显示，在第 94 次操作时出现了显著变化。使用移动平均曲线，我们已经表明，大多数住院医师需要 114 次操作才能在 35 分钟内达到 80%的完成率。
结直肠外科住院医师在进行 94 至 114 次结肠镜检查后即可达到筛查性结肠镜检查能力。在工作时间限制的时代，对个体受训者表现的前瞻性记录可能允许根据观察到的能力进行量身定制的培训。
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