Endoscopist training program boosts polyp detection rate

November 29, 2011

BY HEIDI SPLETE NATIONAL HARBOR, MD. (EGMN) – Polyp detection rates were significantly higher among endoscopists who completed a quality-improvement training program, compared with rates of those who did not in a randomized, controlled trial of 15 endoscopists and 2,400 procedures. The findings were presented at the annual meeting of the American College of Gastroenterology.
Adenoma detection rate is a key quality indicator for colonoscopy, and previous studies have shown associations between physicians’ behavior (such as looking behind folds, and the time spent inspecting the colon) and rates of adenoma detection, said Dr. Susan Coe of the Mayo Clinic in Jacksonville, Fla.
However, attempts at improving polyp detection rates, including discussions with low-performing physicians, required withdrawal times, and financial penalties, have proven unsuccessful, she said.
Dr. Coe and her colleagues, including senior investigator Dr. Michael B. Wallace, designed a prospective, randomized educational intervention to determine whether targeted endoscopist training would increase polyp detection rates.
“This is the first study to our knowledge to prospectively show that adenoma detection rate can be significantly improved through an intensive, structured endoscopist training program,” Dr. Coe said.
In the first phase of the study, the endoscopists performed 1,200 colonoscopies to determine their baseline detection rates. The average baseline rate was 36% among endoscopists randomized to both the training and non-training groups.
In the second phase of the study, the endoscopists performed another 1,200 colonoscopies after half of them had completed the training program. Among endoscopists in the training group, the average adenoma detection rate increased significantly to 47%, compared to 35% in the non-training group.
The Endoscopic Quality Improvement Program consisted of two 1-hour small group sessions. The first session included literature, photo, and video examples of polyps, explanations of techniques from high-detecting endoscopists, and information about subtle lesions such as flat and serrated polyps.
The second session consisted of a validated surface pattern recognition exercise. The participants in the training program received monthly feedback on their adenoma detection rates, withdrawal times, and group averages after completing the program.
The baseline characteristics of the endoscopists who underwent training and those who did not were similar overall. Median age in the trained and untrained groups was 45 years and 50 years, respectively.
Dr. Coe noted that the findings were limited by the small number of endoscopists and the single setting, but the study is ongoing to see whether the improvements associated with training persist. Larger studies are also planned, she said.