Observational Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 21, 2020; 26(23): 3283-3292
Published online Jun 21, 2020. doi: 10.3748/wjg.v26.i23.3283
Impact of a national basic skills in colonoscopy course on trainee performance: An interrupted time series analysis
Keith Siau, James Hodson, John T Anderson, Roland Valori, Geoff Smith, Paul Hagan, Marietta Iacucci, Paul Dunckley
Keith Siau, John T Anderson, Geoff Smith, Paul Hagan, Paul Dunckley, Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London NW1 4LE, United Kingdom
Keith Siau, Marietta Iacucci, NIHR Biomedical Research Centre, University of Birmingham, Birmingham B15 2TT, United Kingdom
Keith Siau, James Hodson, Marietta Iacucci, Institute of Translational Medicine, University Hospitals Birmingham, Birmingham B15 2TT, United Kingdom
John T Anderson, Roland Valori, Paul Dunckley, Department of Gastroenterology, Gloucestershire Hospitals NHSFT, Cheltenham GL53 7AN, United Kingdom
Geoff Smith, Department of Gastroenterology, Imperial College NHS Foundation Trust, London NW1 4LE, United Kingdom
Paul Hagan, Endoscopy Department, Derby Royal Hospital, Derby GL1 3NN, United Kingdom
Author contributions: Siau K contributed to the study conception, data analysis, initial draft; Hodson J contributed to the data analysis, data visualization, initial draft; Anderson JT, Valori R, Smith G and Hagan P contributed to the study conception, study approval, critical review; Iacucci M contributed to the supervision and critical review; Dunckley P contributed to the study conception, study approval, oversight of manuscript, critical review; study guarantor; all authors read and approved the final manuscript.
Institutional review board statement: This project was approved by the UK Joint Advisory Group Quality Assurance of Training Working Group. No formal ethics approval was required as the study did not involve patient data.
Informed consent statement: No formal ethics approval was required as the study did not involve patient data. On signing up to the JAG electronic training system (JETS) e-portfolio, trainees had agreed for their anonymised training data to be used by the JAG for audit and research purposes.
Conflict-of-interest statement: Valori R and Anderson JT are co-directors of AnderVal Ltd, an endoscopy training company. Siau K, Anderson JT, Smith G, Hagan P, Dunckley P are affiliated with the Joint Advisory Group on Gastrointestinal Endoscopy Quality Assurance of Training Working Group.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Keith Siau, MBChB, MRCP, Doctor, Senior Research Fellow, Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, 11 St Andrew's Place, London NW1 4LE, United Kingdom. keithsiau@nhs.net
Received: January 10, 2020
Peer-review started: January 10, 2020
First decision: April 8, 2020
Revised: May 19, 2020
Accepted: June 12, 2020
Article in press: June 12, 2020
Published online: June 21, 2020
Processing time: 156 Days and 14 Hours
ARTICLE HIGHLIGHTS
Research background

Hands-on endoscopy training courses are increasingly available worldwide to improve endoscopy skills. To our knowledge, no studies have published data on how attendance of hands-on endoscopy courses have improved endoscopy competency in trainees. Moreover, the optimal timing of course attendance is unknown.

Research motivation

The basic skills in colonoscopy (course) is a 3-d, hands-on, training course for which attendance is mandated for United Kingdom colonoscopy certification. The efficacy of the course has not been previously investigated.

Research objectives

We aimed to evaluate the impact of BSC attendance on trainee colonoscopy performance using completion-based metrics, and to determine the optimal timing of course attendance.

Research methods

We performed a national analysis of trainees who attended the BSC. Trainees awarded colonoscopy certification between 2011-2016 were stratified into 3 groups according to tertile of pre-course procedure count (early, intermediate or late attenders). Study outcomes, comprising the unassisted caecal intubation rate (CIR) and the unassisted Performance Indicator of Colonic Intubation (PICI), were compared over the 50 procedures pre and post- course. Interrupted time series analyses were performed to measure step-change change, i.e., the difference in performance directly attributable to the course.

Research results

In total, 369 trainees with pre-course procedure counts of < 70 (n = 118), 70-140 (n = 121) and > 140 (n = 130) were included. Using the outcome of CIR, a significant step-change improvement was seen in the < 70 procedures group, increasing from 46% in the last pre-course procedure, to 51% in the first procedure post-course (P = 0.005). The CIR step-change was not significant in the 70-140 (68% to 71%; P = 0.239) or > 140 (86% to 87%; P = 0.354) groups. For PICI, significant step-change improvements were seen in all three groups, with average increases of 5.6 pp (P < 0.001), 5.4 pp (P = 0.003) and 3.9 pp (P = 0.014) respectively. Based on PICI data, attendance of the BSC was associated with a significant step-change improvement, equivalent to performing an additional 17-30 procedures within the trainee’s usual training environment.

Research conclusions

Attendance of the basic skills course was associated with a significant step-change improvement in PICI, regardless of prior procedural experience. However, CIR data suggest that the optimal timing of course attendance appears to be at earlier stages of training (< 70 procedures).

Research perspectives

The learning curves of trainees naturally increase within their own training environment over procedure count and time. The use of interrupted time-series analyses to measure a step-change represents is valid way of assessing the impact of training courses on trainee outcomes. This method may be used across different training courses for research and quality assurance purposes.