Marshall J B
Division of Gastroenterology, University of Missouri School of Medicine, Columbia 65212, USA.
Gastrointest Endosc. 1995 Oct;42(4):287-91. doi: 10.1016/s0016-5107(95)70123-0.
We sought to provide an objective measure of the technical progress of trainees learning colonoscopy. GI fellows in our training program perform colonoscopy under supervision throughout their 2 years of fellowship.
The frequency of fellows reaching the cecum in less than 30 minutes was determined by one endoscopy instructor during the last 7 months of their first year of training and during the last 7 months of their second year.
The mean success rate of reaching the cecum for seven first-year fellows was 54% (individual range, 25% to 86%). This compared with 86% for six second-year fellows (individual range, 73% to 93%) and with 97% for the endoscopy instructor when he did procedures without a fellow. First-year fellows during the 7-month "testing" periods believed they had reached the cecum in 5.7% of cases in which they had not. This was not a problem with second-year fellows. Counting colonoscopies done with all instructors in our program, fellows in this series each did an average of 149 colonoscopies during their first-year of training and 328 by the end of their second.
Increasing proficiency in reaching the cecum occurs with experience over time, and continues even after completion of formal training. Individual trainees also seem to learn colonoscopy at different rates. Depending on how one defines competency, it is possible that the minimum threshold number for technical competency in colonoscopy of 100 procedures, as suggested by the ASGE, may be low.
我们试图提供一种客观的方法来衡量接受结肠镜检查培训学员的技术进步情况。在我们的培训项目中，胃肠病学专科住院医师在其两年的专科培训期间都要在监督下进行结肠镜检查。
在第一年培训的最后7个月以及第二年培训的最后7个月，由一名内镜检查教员确定学员在不到30分钟内到达盲肠的频率。
7名第一年住院医师到达盲肠的平均成功率为54%（个体范围为25%至86%）。相比之下，6名第二年住院医师的成功率为86%（个体范围为73%至93%），而内镜检查教员在没有住院医师协助的情况下进行操作时，成功率为97%。在7个月的“测试”期内，第一年住院医师中有5.7%的情况是他们认为自己已到达盲肠，但实际上并未到达。第二年住院医师不存在这个问题。计算本项目中所有教员指导下完成的结肠镜检查数量，本系列住院医师在第一年培训期间平均每人完成149例结肠镜检查，到第二年结束时平均每人完成328例。
随着时间推移和经验积累，到达盲肠的熟练程度会提高，并且即使在正式培训结束后仍会继续提高。个体学员学习结肠镜检查的速度似乎也有所不同。根据对能力的定义方式，美国胃肠内镜学会建议的结肠镜检查技术能力最低阈值数量100例可能偏低。
