CC BY-NC-ND 4.0 · Endosc Int Open 2019; 07(01): E74-E82
DOI: 10.1055/a-0770-2646
Original article
Owner and Copyright © Georg Thieme Verlag KG 2019

Trainee colonoscopy quality is influenced by the independent and unobserved performance characteristics of supervising physicians

Srihari Mahadev
1   Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, New York USA
,
Zhezhen Jin
2   Mailman School of Public Health, Columbia University, New York, New York, USA
,
Benjamin Lebwohl
2   Mailman School of Public Health, Columbia University, New York, New York, USA
3   Division of Digestive and Liver Disease, Department of Medicine, Columbia University, New York, New York, USA
,
Richard M. Rosenberg
3   Division of Digestive and Liver Disease, Department of Medicine, Columbia University, New York, New York, USA
,
Reuben J. Garcia-Carrasquillo
3   Division of Digestive and Liver Disease, Department of Medicine, Columbia University, New York, New York, USA
,
Ivonne Ramirez
3   Division of Digestive and Liver Disease, Department of Medicine, Columbia University, New York, New York, USA
,
Daniel E. Freedberg
3   Division of Digestive and Liver Disease, Department of Medicine, Columbia University, New York, New York, USA
› Author Affiliations
Further Information

Publication History

submitted 03 May 2018

accepted after revision 30 August 2018

Publication Date:
09 January 2019 (online)

Abstract

Background Endoscopy training remains an apprenticeship, and the characteristics that facilitate transfer of high quality procedural skills from role models to trainees are unknown. We sought to determine whether unobserved supervisor performance influences the quality of colonoscopy performed by trainees, by studying how supervisors perform alone and how trainees perform while under those same supervisors.

Methods This was a retrospective cross-sectional study conducted among ambulatory adults ≥ 50 years old who underwent colonoscopy for cancer screening or polyp surveillance from 2006 to 2015 at one academic medical center. The primary exposures were the colonoscopy withdrawal time (WT) and adenoma detection rate (ADR) of supervisors while performing colonoscopies alone. The primary outcomes were the WT and ADR of trainees performing colonoscopies under supervision.

Results Data were included from 22 attending gastroenterologist supervisors, 56 gastroenterology fellow trainees, and 2777 adults undergoing 3094 colonoscopy procedures. Among all supervised colonoscopies, mean trainee WT was 12.7 minutes (SD 4.9) and trainee ADR was 33.5 %. The trainee WT was 0.42 minutes longer (standard error = 0.16, P = 0.01) per minute increase in supervisor WT. Similarly, trainee ADR was higher under a high ADR supervisor, and the odds ratio of high compared to low supervisor ADR category was 1.28 (95 %CI 1.01 – 1.62, P = 0.04) after adjusting for other factors.

Conclusions The unobserved performance characteristics of supervising endoscopists may influence the quality of colonoscopy performed by trainees.

 
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