Is the 'driving test' a robust quality indicator of colonoscopy performance?

Area of Science:

• Gastroenterology
• Public Health
• Medical Education

Background:

• Colorectal cancer is a leading cause of death globally and in the UK.
• The National Health Service Bowel Cancer Screening Program aims to improve colonoscopy quality.
• A new "driving test" accreditation process for colonoscopists has been introduced in the UK.

Purpose of the Study:

• To describe the UK's colonoscopist accreditation process.
• To review the evidence supporting the accreditation's effectiveness.
• To compare the UK's system with those in other developed countries.

Main Methods:

• Review of published evidence on colonoscopist accreditation.
• Comparative analysis of the UK's process against international standards.
• Evaluation of the written and practical components of the accreditation.

Main Results:

• The UK's accreditation process is among the most rigorous globally.
• No other countries appear to have similar formal "driving test" assessments for practicing colonoscopists.
• The written component of the UK accreditation shows poor discriminatory power and requires revision or removal.
• Further research is needed to develop effective methods for assessing polypectomy skills.

Conclusions:

• The UK's colonoscopist accreditation system has notable strengths but also significant flaws.
• The written examination component is ineffective and should be improved or discontinued.
• Enhanced methods for evaluating colonoscopist performance, particularly polypectomy skills, are essential.
• Robust systems are necessary to manage colonoscopists who do not meet assessment standards.