Impact Of Fellowship Training Level On Quality Metrics In Veterans Undergoing Screening Colonoscopy

INTRODUCTION: Colonoscopy is the recommended modality for colorectal cancer (CRC) screening. Adenoma detection rate (ADR) has emerged as a leading quality metric for screening colonoscopy. The rates of interval CRC and mortality decrease when ADR is improved. The cognitive and fine motor skills required for identification of polyps is a learned skill, which may differ between early and advanced trainees. This could have an impact on the quality of the procedure, even when supervised by faculty. The aim of this study is to compare metrics of screening colonoscopies performed at a teaching hospitals involving early (first year) and advanced (second and third year) gastroenterology fellowship trainees. METHODS: A retrospective review was performed of patients between age 50 and 75 years, with average familial cancer risk, who underwent a first-time screening colonoscopy by a gastroenterology fellowship trainee at Clement J. Zablocki Veterans Affairs Medical Center between January 2018 and June 2019. Patients with inadequate bowel preparation were excluded. Data were analyzed using Chi Square, Fishers' Exact Test, and One-Way ANOVA, as appropriate. A binomial test was used to compare rates of polyp identification against the minimum standard of 25%. All analyses were conducted using SAS 9.4. RESULTS: 280 patients were included in the study. Patient demographics are outlined in Table 1. Procedure-related parameters are outlined in Table 2. When early trainees were involved in a procedure, the time to reach cecum (12.2 vs. 7.1 minutes, P < 0.0001), and the total procedure time (35.8 vs 28.8 minutes, P < 0.0001) were longer. The overall withdrawal time was not different (23.5 vs 21.8 minutes, P = 0.168), however, a second exam of the right colon was less likely to be performed when an early trainee was involved (81.8% vs 96.8%, P < 0.0001). A statistically significant high ADR was achieved by both groups (46.8% vs 50.6%, P = 0.078). There were no emergency room visits, hospital admissions, or deaths attributable to colonoscopy. There were more unrelated 30 day emergency room visits in the early trainee group (8.7% vs. 3.9%, P = 0.0498). CONCLUSION: A high ADR was achieved irrespective of level of trainee involved in the procedure. Trainee level did not adversely affect key quality metrics in screening colonoscopy when performed under supervision. Extra time should be allotted when first year fellowship trainees are involved in the procedure.Table 1.: DemographicsTable 2.: Procedure CharacteristicsTable 3.: Polyp Characteristics