Background

Robust real-world performance data of newly independent colonoscopists are lacking. In the United Kingdom, provisional colonoscopy certification (PCC) marks the transition from training to newly independent practice. We aimed to assess changes in key performance indicators (KPIs) such as cecal intubation rate (CIR) in the periods pre- and post-PCC, particularly regarding rates and predictors of trainees exhibiting a drop in performance (DIP), defined as CIR <90% in the first 50 procedures post-PCC.

Methods

A prospective United Kingdom–wide observational study of Joint Advisory Group on Gastrointestinal Endoscopy Electronic Training System (JETS) e-portfolio colonoscopy entries (257,800) from trainees awarded PCC between July 2011 and 2016 was undertaken. Moving average analyses were used to study KPI trends relative to PCC. Pre-PCC trainee, trainer, and training environment factors were compared between DIP and non-DIP cohorts to identify predictors of DIP.

Results

Seven hundred thirty-three trainees from 180 centers were awarded PCC after a median of 265 procedures and 3.1 years. Throughout the early post-PCC period, average CIRs surpassed the national 90% standard. Despite this, not all trainees achieved this standard post-PCC, with DIP observed in 18.4%. DIP was not influenced by trainer presence and diminished after 100 additional procedures. On multivariable analysis, pre-PCC CIRs and trainer specialty were predictive of DIP. Trainees with DIP incurred higher post-PCC rates of moderate to severe discomfort despite requiring higher analgesic dosages and were more likely to require trainer assistance in failed procedures.

Conclusions

The current PCC requirements are appropriate for diagnostic colonoscopy. It is possible to identify predictors of underperformance in trainees, which may be of value to training leads and could improve the patient experience.

中文翻译：

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获得独立执业证书后，结肠镜检查中的性能指标：结果和能力预测指标

背景

缺乏新近独立的结肠镜检查员的可靠的实际性能数据。在英国，临时结肠镜检查认证（PCC）标志着从培训到新独立实践的过渡。我们旨在评估PCC前后的关键绩效指标（KPI）的变化，例如盲肠插管率（CIR），尤其是关于表现出绩效下降（DIP）的受训人员的比率和预测指标，定义为CIR < PCC之后的前50个程序中有90％。

方法

在2011年7月至2016年期间，由获得PCC培训的受训者对胃肠道内窥镜电子训练系统（JETS）电子组合结肠镜检查条目（257,800）联合咨询小组进行了一项全英国范围的前瞻性观察研究。使用移动平均分析来研究相对于PCC的KPI趋势。在DIP和非DIP队列之间比较了PCC之前的受训者，培训者和培训环境因素，以确定DIP的预测因素。

结果

经过265道手术和3.1年的中位数培训，来自180个中心的733名受训者获得了PCC奖励。在整个PCC后期初期，平均CIR超过了国家90％的标准。尽管如此，并非所有受训者都在PCC之后达到了这一标准，DIP率为18.4％。DIP不受培训师在场的影响，并且在进行了100次附加手术后，DIP降低了。在多变量分析中，PCC之前的CIR和培训师的专业知识可以预测DIP。尽管需要更高的镇痛剂量，但接受DIP培训的学员在PCC后的中度至重度不适感发生率更高，并且在失败的手术过程中更有可能需要教练协助。

结论

当前的PCC要求适用于诊断性结肠镜检查。可以确定受训人员表现不佳的预测因素，这可能对培训线索很有用，并可以改善患者体验。