Prospective assessment of learning curve and impact of intensive versus progressive training in colonoscopy competence among French residents

Abstract

Abstract Backgrounds There are no existing data in the literature on the learning curve of French interns in colonoscopy or on the comparison between different frequencies of colonoscopy training modalities. We aimed to assess the number of procedures required for French residents in hepatogastroenterology to achieve competency in colonoscopy. Methods The primary outcome was achieving greater than 90% cecal intubation rate (CIR90) competency using the Learning Curve-Cumulative Summation (LC-CUSUM) method. Participants with over 80 procedures were categorized into intensive and progressive training groups. We compared the proportion of residents reaching competency, the number of colonoscopies to reach it, and the speed of competency. Results The study included 81 residents, totaling 6,259 procedures. 29 did more than 80 procedures: 12 in the progressive group and 17 in the intensive group. 204 colonoscopies were needed for reaching CIR90 competency (21% of residents). Achievement rates were similar across groups: 50% in the progressive and 65% in the intensive group (p = 0.50). LC competency was reached by 8.6% of residents after an average of 225 procedures, with no significant difference between groups (p = 0.21). Survival analysis showed no significant difference in the speed of competency acquisition between groups (p = 0.77 and p = 0.14, respectively). The Polyp Detection Rate (PDR) averaged 40%. Conclusion Given that only 21% reached CIR90, efforts are needed to increase the number of colonoscopies during training. Clinical trial number Not applicable.

Keywords

• Colonoscopy
• Gastroenterology
• Clinical competence
• Internship and residency
• Prospective studies
• Learning curve