Mahadev Srihari, Jin Zhezhen, Lebwohl Benjamin, Rosenberg Richard M, Garcia-Carrasquillo Reuben J, Ramirez Ivonne, Freedberg Daniel E
Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, New York USA.
Mailman School of Public Health, Columbia University, New York, New York, USA.
Endosc Int Open. 2019 Jan;7(1):E74-E82. doi: 10.1055/a-0770-2646. Epub 2019 Jan 9.
Endoscopy training remains an apprenticeship, and the characteristics that facilitate transfer of high quality procedural skills from role models to trainees are unknown. We sought to determine whether unobserved supervisor performance influences the quality of colonoscopy performed by trainees, by studying how supervisors perform alone and how trainees perform while under those same supervisors. This was a retrospective cross-sectional study conducted among ambulatory adults ≥ 50 years old who underwent colonoscopy for cancer screening or polyp surveillance from 2006 to 2015 at one academic medical center. The primary exposures were the colonoscopy withdrawal time (WT) and adenoma detection rate (ADR) of supervisors while performing colonoscopies alone. The primary outcomes were the WT and ADR of trainees performing colonoscopies under supervision. Data were included from 22 attending gastroenterologist supervisors, 56 gastroenterology fellow trainees, and 2777 adults undergoing 3094 colonoscopy procedures. Among all supervised colonoscopies, mean trainee WT was 12.7 minutes (SD 4.9) and trainee ADR was 33.5 %. The trainee WT was 0.42 minutes longer (standard error = 0.16, = 0.01) per minute increase in supervisor WT. Similarly, trainee ADR was higher under a high ADR supervisor, and the odds ratio of high compared to low supervisor ADR category was 1.28 (95 %CI 1.01 - 1.62, = 0.04) after adjusting for other factors. The unobserved performance characteristics of supervising endoscopists may influence the quality of colonoscopy performed by trainees.
内镜培训仍然是一种学徒式培训，而促进高质量操作技能从榜样向学员传授的特征尚不清楚。我们试图通过研究监督者独自操作时的表现以及学员在同一监督者指导下的操作表现，来确定未被观察到的监督者表现是否会影响学员进行结肠镜检查的质量。
这是一项回顾性横断面研究，研究对象为2006年至2015年在一家学术医疗中心接受结肠镜检查以进行癌症筛查或息肉监测的50岁及以上门诊成年人。主要暴露因素是监督者独自进行结肠镜检查时的结肠镜检查退镜时间（WT）和腺瘤检出率（ADR）。主要结局是学员在监督下进行结肠镜检查的WT和ADR。
数据包括22名胃肠病学主治医生监督者、56名胃肠病学实习学员以及2777名接受3094例结肠镜检查的成年人。在所有有监督的结肠镜检查中，学员的平均WT为12.7分钟（标准差4.9），学员的ADR为33.5%。监督者的WT每增加1分钟，学员的WT就延长0.42分钟（标准误=0.16，P=0.01）。同样，在ADR高的监督者指导下，学员的ADR更高，在调整其他因素后，高ADR监督者组与低ADR监督者组相比的优势比为1.28（95%CI 1.01-1.62，P=0.04）。
内镜检查监督者未被观察到的表现特征可能会影响学员进行结肠镜检查的质量。
