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World J Gastrointest Endosc. Dec 10, 2015; 7(18): 1279-1286
Published online Dec 10, 2015. doi: 10.4253/wjge.v7.i18.1279
Achieving competence in colonoscopy: Milestones and the need for a new endoscopic curriculum in gastroenterology training
Sara B Stanford, Stephanie Lee, Candace Masaquel, Robert H Lee
Sara B Stanford, Stephanie Lee, Candace Masaquel, Robert H Lee, Division of Gastroenterology, University of California Irvine and Long Beach Veterans’ Affairs Hospital, Long Beach, CA 93109, United States
Author contributions: All of the listed authors contributed equally to the writing of this paper.
Conflict-of-interest statement: None of the authors have any financial or commercial conflicts of interest to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Robert H Lee, MD, Division of Gastroenterology, University of California Irvine and Long Beach Veterans’ Affairs Hospital, 5901 E. Seventh St, Mail Code 111D, Long Beach, CA 93109, United States. rlee8@uci.edu
Telephone: +1-562-8265752 Fax: +1-562-8265752
Received: June 18, 2015
Peer-review started: June 28, 2015
First decision: August 14, 2015
Revised: September 5, 2015
Accepted: October 20, 2015
Article in press: October 27, 2015
Published online: December 10, 2015
Abstract

Colonoscopy is considered to be the most effective tool for reducing colorectal cancer (CRC) morbidity and mortality. As a result, certifying trainee competence in the performance of colonoscopy is critical to maximizing CRC screening and prevention efforts. Guidelines on training and accreditation around the world have been revised to emphasize the attainment of milestones in the technical and cognitive skills necessary to perform the procedure. To meet this challenge, new evaluation systems have been developed to measure trainee competence through all aspects of colonoscopy training. These changes stem from increased recognition that procedural numbers alone do not necessarily guarantee trainees’ proficiency in the performance of colonoscopy. Variability in endoscopic practice and in CRC screening outcomes also point to deficiencies in the current approach towards colonoscopy instruction. However, technological innovations hold great promise in training endoscopists to perform high quality colonoscopy. Furthermore, potential advances in the use of feedback as a training tool provide new avenues for research. This review summarizes the latest evidence on the effort to define, evaluate and promote the achievement of competence in colonoscopy among trainees.

Keywords: Competence, Colonoscopy, Colorectal cancer, Core curriculum, Cecal intubation

Core tip: The certification of competence among trainees in the performance of colonoscopy is currently evolving. Recent efforts are shifting the paradigm towards formal evaluation systems that emphasize core skills. Similar innovations in technology and teaching methods provide the push to re-define the future curriculum for colonoscopy training.