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Effects of Starting a Gastroenterology Fellowship Training Program on Quality Measures of Colonoscopy
Sherif Elhanafi1, Rahul Chhana1, Indika Mallawaarachchi1
1From the Department of Medicine, Division of Gastroenterology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, the Department of Internal Medicine, Division of Gastroenterology, and the Department of Biomedical Sciences, Division of Biostatistics & Epidemiology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, and the Department of Internal Medicine, Gastroenterology and Hepatology Section, Baylor College of Medicine, Houston, Texas.
Objectives:
Adenoma detection rate (ADR) is the most established indicator of the quality of screening colonoscopy. The effect of gastroenterology (GI) fellows on the quality of screening colonoscopies has been evaluated previously; however, the effect of starting a new GI fellowship program on the quality of screening colonoscopies has not been studied. The aim of our study was to assess the effects of starting a GI fellowship program and the participation of fellows in screening colonoscopies on ADR and other measures of quality.
Methods:
This was a retrospective, cross-sectional study of all screening colonoscopies performed 20 months before and 20 months after starting the GI fellowship at our medical center (November 2010-February 2014). Colonoscopy procedure notes and pathology records were reviewed for each patient. Data from the two periods were compared using either the Fisher exact test or the two-sample t test.
Results:
A total of 2127 complete colonoscopies were included in the analysis. The mean age of patients was 58.8 ± 6.6 years. Of the 2127 colonoscopies, GI fellows were involved in 385 (18%), whereas 1742 (82%) were performed solely by GI attendings (attending physicians). Multivariate analysis using relative risk (RR) of regression was done. The after starting the GI fellowship period was significantly associated with an increase in ADR (RR 1.19, 95% confidence interval 1.10-1.30, P < 0.001) and advanced adenoma detection rate (RR 1.17, 95% confidence interval 1.00-1.38, P < 0.001) compared with the before starting the GI fellowship period. In the after starting the GI fellowship period, the polyp detection rate and ADR for colonoscopies performed by the attending physicians with the fellows were significantly higher than colonoscopies performed solely by the same attendings (58.4% vs 44.5%, P = 0.001, 42.0% vs 32.9%, P = 0.017, respectively).
Conclusions:
Starting a GI fellowship program significantly increased the polyp detection rate, ADR, and advanced ADR.
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