Flexible fiberoptic sigmoidoscopy training for primary care physicians: results of a 5-year experience

The first 5 years of a flexible fiberoptic sigmoidoscopy (FFS) training program for primary care physicians was analyzed in an attempt to assess clinical competence and develop a procedure learning curve. A total of 47 primary care physicians (26 third-year family practice residents, 15 family practitioners, and 6 internists) were successfully trained in 60-cm FFS by five gastroenterologists. Didactic teaching methods included 5 hours of videotapes, slides, endoscopic models, and the use of a photo atlas. Following a patient demonstration, each trainee completed 25 examinations supervised with a teaching attachment. Criteria used to assess trainee competence included unassisted length of scope insertion and examination duration. Mean depth of scope insertion was 35.9 cm for the first five examinations, increasing to a mean of 51.7 cm for the final five examinations. Average examination duration decreased from 19.1 min for examinations 1 through 5 to 17.0 min for examinations 21 through 25. Out of 1236 examinations, one or more polyps were found in 222 patients (18.0%). Carcinoma was found in 15 of 1236 examinations (1.4%). In summary, experienced endoscopists can teach primary care physicians to perform 60-cm FFS. Completion of 25 supervised cases appears to be adequate for achieving technical competence in flexible fiberoptic sigmoidoscopy.