Polyp Detection in Colonoscopy Training: A Qualitative Analysis of Resident Challenges and Expert Strategies

Colorectal cancer (CRC) is a leading cause of mortality, with early detection through colonoscopy being crucial for reducing death rates. However, up to 26% of precancerous polyps are missed during procedures, largely due to variability in physician skill. Simulation-based training (SBT) has the potential to improve patient outcomes in colonoscopy by reducing cecal intubation time. Particularly through physical simulator (PS) which offer more realistic experiences than virtual simulators. Despite their realism, PS often lack integrated feedback, limiting their effectiveness in improving polyp detection (PD). This study demonstrated that experts achieved higher polyp detection (PD) and cecal intubation rates compared to residents, identified some of the challenges residents face during colonoscopy particularly in navigation, scope manipulation, and fold inspection-and contrasts them with expert strategies. Experts employ techniques such as thorough fold inspection, lumen centering, re-advancement, and slow withdrawal to enhance PD. These insights emphasize the need for targeted feedback within PS-based training to bridge the skill gap and reduce polyp miss rates. Developing feedback-driven training strategies during PS-based training using these expert strategies may potentially reduce polyp miss rates and improve CRC screening outcomes.