Division of Gastroenterology, Western University, London, Ontario, Canada.
Lawson Health Research Institute, Western University, London, Ontario, Canada.
JAMA Netw Open. 2022 Aug 1;5(8):e2229538. doi: 10.1001/jamanetworkopen.2022.29538.
Trainees routinely participate in colonoscopy procedures, yet whether their involvement is positively or negatively associated with procedural quality is unknown because prior studies involved small number of trainees and/or supervisors, lacked generalizability, and/or failed to adjust for potential confounders.
To assess the association between trainee participation and colonoscopy quality metrics.
DESIGN, SETTING, AND PARTICIPANTS: This multicenter population-based cohort study was conducted at 21 academic and community hospitals between April 1, 2017, and October 31, 2018, among consecutive adult patients undergoing colonoscopy. Procedures performed by endoscopists who did not supervise trainees were excluded. Statistical analysis was performed from April 3, 2017, to October 31, 2018.
Participation by a trainee, defined as a resident or fellow enrolled in a gastroenterology or general surgery training program.
The primary outcome was the adenoma detection rate (ADR), and secondary outcomes were sessile serrated polyp detection rate (ssPDR), polyp detection rate (PDR), cecal intubation rate (CIR), and perforation rate.
A total of 35 499 colonoscopies (18 989 women [53.5%]; mean [SD] patient age, 60.0 [14.1] years) were performed by 71 physicians (mean [SD] time in practice, 14.0 [9.3] years); 5941 colonoscopies (16.7%) involved trainees. There were no significant differences in the ADR (26.4% vs 27.3%; P = .19), CIR (96.7% vs 97.2%; P = .07), and perforation rate (0.05% vs 0.06%; P = .82) when trainees participated vs when they did not participate, whereas the the ssPDR (4.4% vs 5.2%; P = .009) and PDR (39.2% vs 42.0%; P < .001) were significantly lower when trainees participated vs when they did not. After adjustment for potential confounders, the ADR (risk ratio [RR], 0.97; 95% CI, 0.91-1.03; P = .30), PDR (RR, 0.98; 95% CI, 0.93-1.04; P = .47), and CIR (RR, 0.93; 95% CI, 0.78-1.10; P = .38) were not associated with trainee participation, although the ssPDR remained significantly lower (RR, 0.79; 95% CI, 0.64-0.98; P = .03).
This study suggests that trainee involvement during colonoscopy was associated with reduced ssPDR but not other colonoscopy outcome measures. Extra care should be exercised when examining the right colon when trainees are involved.
受训者经常参与结肠镜检查程序，但他们的参与是否与程序质量呈正相关或负相关尚不清楚，因为之前的研究涉及的受训者和/或监督者数量较少，缺乏普遍性，并且/或者没有调整潜在的混杂因素。
评估受训者参与与结肠镜质量指标之间的关系。
设计、地点和参与者：这项多中心基于人群的队列研究于 2017 年 4 月 1 日至 2018 年 10 月 31 日在 21 家学术和社区医院进行，纳入连续接受结肠镜检查的成年患者。排除由未监督受训者的内镜医生进行的检查。统计分析于 2017 年 4 月 3 日至 2018 年 10 月 31 日进行。
受训者参与，定义为参加胃肠病学或普通外科培训计划的住院医师或研究员。
主要结果是腺瘤检出率（ADR），次要结果是无蒂锯齿状息肉检出率（ssPDR）、息肉检出率（PDR）、盲肠插管率（CIR）和穿孔率。
共进行了 35499 例结肠镜检查（18989 例女性[53.5%]；患者平均[SD]年龄为 60.0[14.1]岁），由 71 名医生（平均[SD]执业时间为 14.0[9.3]年）进行；5941 例结肠镜检查（16.7%）涉及受训者。受训者参与与不参与时，ADR（26.4%比 27.3%；P=0.19）、CIR（96.7%比 97.2%；P=0.07）和穿孔率（0.05%比 0.06%；P=0.82）无显著差异，而 ssPDR（4.4%比 5.2%；P=0.009）和 PDR（39.2%比 42.0%；P<0.001）显著降低。在调整潜在混杂因素后，ADR（风险比[RR]，0.97；95%CI，0.91-1.03；P=0.30）、PDR（RR，0.98；95%CI，0.93-1.04；P=0.47）和 CIR（RR，0.93；95%CI，0.78-1.10；P=0.38）与受训者参与无关，但 ssPDR 仍显著降低（RR，0.79；95%CI，0.64-0.98；P=0.03）。
这项研究表明，结肠镜检查期间受训者的参与与 ssPDR 降低有关，但与其他结肠镜检查结果指标无关。当受训者参与时，应格外注意检查右半结肠。
