The effect of train-the-colonoscopy-trainer course on colonoscopy quality indicators

Abstract

Background Systematic training in colonoscopy is highly recommended; however, we have limited knowledge of the effects of “training-the-colonoscopy-trainer” (TCT) courses. Using a national quality register on colonoscopy performance, we aimed to evaluate the effects of TCT participation on defined quality indicators.

Methods This observational study compared quality indicators (pain, cecal intubation, and polyp detection) between centers participating versus not participating in a TCT course. Nonparticipating centers were assigned a pseudoparticipating year to match their participating counterparts. Results were compared between first year after and the year before TCT (pseudo)participation. Time trends up to 5 years after TCT (pseudo)participation were also compared. Generalized estimating equation models, adjusted for age, sex, and bowel cleansing, were used.

Results 11 participating and 11 nonparticipating centers contributed 18 555 and 10 730 colonoscopies, respectively. In participating centers, there was a significant increase in detection of polyps ≥ 5 mm, from 26.4 % to 29.2 % (P = 0.035), and reduction in moderate/severe pain experienced by women, from 38.2 % to 33.6 % (P = 0.043); no significant changes were found in nonparticipating centers. Over 5 years, 20 participating and 18 nonparticipating centers contributed 85 691 and 41 569 colonoscopies, respectively. In participating centers, polyp detection rate increased linearly (P = 0.003), and pain decreased linearly in women (P = 0.004). Nonparticipating centers did not show any significant time trend during the study period.

Conclusions Participation in a TCT course improved polyp detection rates and reduced pain experienced by women. These effects were maintained during a 5-year follow-up.

• References

• 1 Espedal B, Gooderham P, Evensen HM. The impact of global leadership development programs on social networks and knowledge sharing in multinational enterprises. Human Resources Management and Ergonomics 2012; 6: 45-65
• 2 Campbell NC, Murray E, Darbyshire J. et al. Designing and evaluating complex interventions to improve health care. BMJ 2007; 334: 455-459
• 3 Waschke KA, Anderson J, Valori RM. et al. ASGE principles of endoscopic training. Gastrointest Endosc 2019; 90: 27-34
• 4 Waschke KA, Anderson J, Macintosh D. et al. Training the gastrointestinal endoscopy trainer. Best Pract Res Clin Gastroenterol 2016; 30: 409-419
• 5 Kaminski MF, Anderson J, Valori R. et al. Leadership training to improve adenoma detection rate in screening colonoscopy: a randomised trial. Gut 2016; 65: 616-624
• 6 Anderson J, Valori R. Training for trainers in endoscopy (colonoscopy). In: Francis N, Fingerhut A, Bergamaschi R. et al., eds. Training in minimal access surgery. London: Springer; 2015: 61-78
• 7 Moritz V, Bretthauer M, Holme O. et al. Time trends in quality indicators of colonoscopy. United European Gastroenterol J 2016; 4: 110-120
• 8 Clark BT, Protiva P, Nagar A. et al. Quantification of adequate bowel preparation for screening or surveillance colonoscopy in men. Gastroenterology 2016; 150: 396-405
• 9 Bishay K, Causada-Calo N, Scaffidi MA. et al. Associations between endoscopist feedback and improvements in colonoscopy quality indicators: a systematic review and meta-analysis. Gastrointest Endosc 2020; 92: 1030-1040
• 10 Delgado-Rodriguez M, Llorca J. Bias. J Epidemiol Community Health 2004; 58: 635-641
• 11 Klein JL, Okcu M, Preisegger KH. et al. Distribution, size and shape of colorectal adenomas as determined by a colonoscopist with a high lesion detection rate: influence of age, sex and colonoscopy indication. United European Gastroenterol J 2016; 4: 438-448
• 12 Niv Y. Polyp detection rate may predict adenoma detection rate: a meta-analysis. Eur J Gastroenterol Hepatol 2018; 30: 247-251
• 13 Kirkoen B, Berstad P, Botteri E. et al. Acceptability of two colorectal cancer screening tests: pain as a key determinant in sigmoidoscopy. Endoscopy 2017; 49: 1075-1086
• 14 Holme O, Moritz V, Bretthauer M. et al. [Pain in connection with colonoscopy in Norway]. Tidsskr Nor Laegeforen 2013; 133: 1074-1078
• 15 Kaminski MF, Thomas-Gibson S, Bugajski M. et al. Performance measures for lower gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative. Endoscopy 2017; 49: 378-397
• 16 Hoff G, de Lange T, Bretthauer M. et al. Registration bias in a clinical quality register. Endosc Int Open 2019; 7: E90-E98