Problems encountered in teaching the use of the 65 cm flexible sigmoidoscope in a surgical oncology training program

Flexible sigmoidoscopy after age 50 has been recommended by the American Cancer Society for colorectal cancer screening. A questionnaire to assess the difficulties encountered in learning to perform this procedure was given to 19 surgical oncology fellows after a 3-month rotation in the Division of Colorectal Surgery. Sixteen (84%) trainees related that between 10-20 flexible sigmoidoscopies were necessary before they felt competent. The most difficult aspect of learning flexible sigmoidoscopy was the torquing technique followed by the ability to determine the location of the proximal bowel lumen. All 19 trainees rated the ability to recognize pathology as not difficult. In this group of surgical trainees, the mean number of flexible sigmoidoscopy performed before competency was established was 15; torquing the shaft of the sigmoidoscope was the most difficult aspect to learn. The majority of the trainees recorded that following the performance of 15-20 endoscopies, torquing became easier.