Background and Aims

Previous studies have described variable effects of fellow involvement on the adenoma detection rate (ADR), but few have stratified this effect by level of training. We aimed to evaluate the “fellow effect” on multiple procedural metrics including a newly defined adenoma management efficiency index, which may have a role in documenting colonoscopy proficiency for trainees. We also describe the impact of level of training on moderate sedation use.

Methods

We performed a retrospective review of 2024 patients (mean age, 60.9 ± 10 years; 94% men) who underwent outpatient colonoscopy between June 2012 and December 2014 at our Veterans Affairs Medical Center. Colonoscopies were divided into 5 groups. The first 2 groups were first-year fellows in the first 6 months and last 6 months of the training year. Second- and third-year fellows and attending-only procedures accounted for 1 group each. We collected data on doses of sedatives used, frequency of adjunctive agent use, procedural times, and location, size, and histology of polyps. We defined the adenoma management efficiency index as average time required per adenoma resected during withdrawal.

Results

Of the colonoscopies performed, 1675 involved a fellow and 349 were performed by the attending alone. There was no difference in ADR between fellows according to level of training (P = .8) or between fellows compared with attending-only procedures (P = .67). Procedural times decreased consistently during training and declined further for attending-only procedures. This translated into improvement in the adenoma management efficiency index (fellow groups by ascending level of training: 23.5 minutes vs 18.3 minutes vs 13.7 minutes vs 13.4 minutes vs attending group 11.7 minutes; P < .001). There was no difference in the average doses of midazolam and fentanyl used among fellow groups (P = .16 and P = .1, respectively). Compared with attending-only procedures, fellow involvement was associated with higher doses of fentanyl and midazolam and more frequent use of diphenhydramine and glucagon (P < .0001, P = .0002, P < .0001, and P = .01, respectively).

Conclusions

ADR was similar at different stages of fellowship training and comparable with the attending group. Efficiency of detecting and resecting polyps improved throughout training without reaching the attending level. Fellow involvement led to a greater use of moderate sedation, which may relate to a longer procedure duration and an evolving experience in endoscopic technique.

中文翻译：

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进修培训水平对结肠镜检查质量和效率指标的影响

背景和目标

先前的研究描述了同伴参与对腺瘤检出率（ADR）的不同影响，但很少有人通过训练水平将其分层。我们旨在评估包括新定义的腺瘤管理效率指数在内的多个程序指标的“同伴效应”，这可能在记录学员的结肠镜检查熟练程度方面发挥作用。我们还描述了训练水平对中度镇静剂使用的影响。

方法

我们对2012年6月至2014年12月在我们退伍军人事务医疗中心接受门诊结肠镜检查的2024例患者（平均年龄，60.9±10岁； 94％的男性）进行了回顾性研究。结肠镜检查分为5组。前两个组是培训年的前6个月和后6个月的一年级进修生。二年级和三年级进修生和仅参加会议的程序各占1组。我们收集了有关所用镇静剂剂量，辅助剂使用频率，手术时间以及息肉的位置，大小和组织学的数据。我们将腺瘤管理效率指数定义为停药期间切除的每个腺瘤所需的平均时间。

结果

在进行的结肠镜检查中，有1675名参与者参与其中，仅参加者就进行了349次。有根据（训练水平研究员之间在ADR没有差别P 仅具有出席-程序（比较= 0.8）或同伴之间P  = 0.67）。在培训期间，程序时间持续减少，而仅参加程序的程序时间进一步减少。这转化为腺瘤管理效率指数的改善（按培训水平升序的各组：23.5分钟vs 18.3分钟vs 13.7分钟vs 13.4分钟vs参加组11.7分钟；P  <.001）。其他组间使用的咪达唑仑和芬太尼的平均剂量没有差异（P  = .16和P 分别为.1）。与仅参加手术的程序相比，同伴介入与更高剂量的芬太尼和咪达唑仑以及苯海拉明和胰高血糖素的使用频率更高有关（分别为P  <.0001，P  = .0002，P  <.0001和P  = .01） 。

结论

在研究金培训的不同阶段，ADR相似，并且与参会者相当。在整个训练过程中，检出和切除息肉的效率得到了提高，而未达到出席水平。研究员的参与导致更多地使用中度镇静剂，这可能与更长的手术时间和内窥镜技术的发展有关。