Mixed Results on Trainees Involvement With Colonoscopies

Michael Sey, MD, MPH

A new look at colonoscopy outcomes involving trainees participating show some metric outcomes were negatively impacted, while other outcomes were unaffected.

A team, led by Michael Sey, MD, MPH, Division of Gastroenterology, Western University, assessed the association between trainee participation and colonoscopy quality metrics.

Trainees and Colonoscopies

While trainees can routine participant in coloscopy procedures, it is unknown whether their involvement is ultimately positively or negatively associated with procedural quality. This is largely due to prior studies mainly involved only a small number of trainees and/or supervisors, lacked generalizability, and/or failed to adjust for potential confounders.

“During the past decade, there has been a renewed focus on the quality of colonoscopy procedures worldwide, resulting in the establishment of quality assurance benchmarks that correlate directly with clinical outcomes,” the authors wrote. “Of these metrics, the adenoma detection rate (ADR) has become the most important, owing to its direct correlation with postcolonoscopy risk of colon cancer.”

The Study

In the multicenter, population-based, cohort study, the investigators examined patients at 21 academic and community hospitals between April 1, 2017 and October 31, 2018. The team obtained patient characteristics and endoscopy data from a custom-made quality assurance endoscopy reporting form completed following every procedure.

The investigators defined participation by a trainee as a resident or fellow enrolled in a gastroenterology or general surgery training program.

The team sought primary outcomes of the adenoma detection rate (ADR), as well as secondary outcomes of sessile serrated polyp detection rate (ssPDR), polyp detection rate (PDR), cecal intubation rate (CIR), and perforation rate.

Colonoscopies

The analysis included 35,499 colonoscopies with a mean patient age of 60 years. The procedures were performed by 71 physicians for a mean time in practice of 14 years. Of this, 16.7% (n = 5941) involved trainees.

The investigators found no significant differences when trainees participated 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) compared to when trainees did not participate in the colonoscopy.

On the other hand, the ssPDR (4.4% vs 5.2%; P = .009) and PDR (39.2% vs 42.0%; P < .001) were significantly lower when trainees participated compared to when they did not.

The investigators then adjusted for potential confounders and found the ADR (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.

However. 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,” the authors wrote. “Extra care should be exercised when examining the right colon when trainees are involved.”

The study, “Association of Trainee Participation in Colonoscopy Procedures With Quality Metrics,” was published online in JAMA Network Open.