Association of trainee participation with adenoma and polyp detection rates

Table 1 Characteristics of patients undergoing screening colonoscopy (n = 7503), by gastroenterology fellow participation; Grady Memorial Hospital, Atlanta, Georgia, July 1, 2009 – July 1, 2015

Characteristic	Attending alone (n = 2464, 32.8%)	Attending with fellow (n = 5039, 67.2%)	P value1
Age in years (mean ± SD)	57.9 ± 7.1	58.3 ± 7.1	0.02
Female sex, n (%)	1572 (63.8)	3161 (62.7)	0.37
Race, n (%)
White	120 (4.9)	261 (5.2)	0.15
Black	2198 (89.2)	4423 (87.8)
Other	146 (5.9)	355 (7.1)
Preparation quality, n (%)
Good	2199 (89.3)	4469 (88.7)	0.02
Fair-adequate	152 (6.2)	382 (7.6)
Fair-inadequate	113 (4.6)	188 (3.7)
Fellow training level, n (%)
1st 6 mo	N/A	627 (12.4)
2nd 6 mo	N/A	651 (12.9)
2nd year	N/A	1413 (28.0)
3rd year	N/A	2348 (46.6)
≥ 1 adenoma (ADR), n (%)	756 (30.7)	1736 (34.5)	0.001
≥ 1 advanced adenoma (AADR), n (%)	215 (8.7)	416 (8.3)	0.49
≥ 1 polyp (PDR), n (%)	988 (40.1)	2244 (44.5)	0.0003
≥ 1 adenoma in right colon (RT-ADR), n (%)	521 (21.1)	1212 (24.1)	0.005
≥ 1 adenoma in left colon (LT- ADR), n (%)	365 (14.8)	862 (17.1)	0.01
Mean number of APC	0.61	0.68	0.03
Mean number of PPC	0.86	0.96	0.01

¹P value from χ² test for categorical variables, and student t test for continuous variables. ADR: Adenoma detection rate; PDR: Polyp detection rate; AADR: Advanced adenoma detection rate; APC: Adenomas per colon; PPC: Polyps per colon.

Table 2 Associations of gastroenterology fellow training level with adenoma detection rate, polyp detection rate, and advanced adenoma detection rate; Grady Memorial Hospital, Atlanta, Georgia, July 1, 2009 – July 1, 2015

Outcome	Fellowship training level	Detection rate	Trend P value1	aOR2	95%CI	P value
≥ 1 adenoma (ADR)	Attending alone (reference)	30.7%	0.0003	1.00	-
	Fellow in 1st 6 mo	32.4%		1.07	0.89-1.3	0.47
	Fellow in 2nd 6 mo	33.3%		1.16	0.96-1.39	0.13
	Fellow in 2nd year	34.4%		1.15	1.00-1.32	0.06
	Fellow in 3rd year	35.4%		1.23	1.09-1.39	0.001
≥ 1 polyp (PDR)	Attending alone (reference)	40.1%	< 0.0001	1.00	-
	Fellow in 1st 6 mo	42.4%		1.10	0.92-1.32	0.28
	Fellow in 2nd 6 mo	42.7%		1.14	0.96-1.36	0.14
	Fellow in 2nd year	44.4%		1.17	1.02-1.33	0.02
	Fellow in 3rd year	45.7%		1.25	1.12-1.41	0.0001
≥ 1 advanced adenoma (AADR)	Attending alone (reference)	8.7%	0.7	1.00	-
	Fellow in 1st 6 mo	4.8%		0.52	0.35-0.76	0.001
	Fellow in 2nd 6 mo	9.1%		1.06	0.78-1.44	0.71
	Fellow in 2nd year	9.3%		1.05	0.83-1.31	0.7
	Fellow in 3rd year	8.3%		0.93	0.76-1.15	0.51
≥ 1 adenoma in right colon (RT-ADR)	Attending alone (reference)	21.1%		1.00	-
	Fellow in 1st 6 mo	22.3%	0.002	1.05	0.85-1.3	0.64
	Fellow in 2nd 6 mo	23.4%		1.16	0.94-1.42	0.17
	Fellow in 2nd year	23.9%		1.14	0.98-1.34	0.1
	Fellow in 3rd year	24.8%		1.22	1.06-1.39	0.005
≥ 1 adenoma in left colon (LT-ADR)	Attending alone (reference)	14.8%	0.01	1.00	-
	Fellow in 1st 6 mo	16.1%		1.16	0.87-1.41	0.42
	Fellow in 2nd 6 mo	16.4%		1.15	0.91-1.46	0.24
	Fellow in 2nd year	16.8%		1.13	0.94-1.35	0.18
	Fellow in 3rd year	17.7%		1.23	1.06-1.44	0.01

¹Mantel-Haenszel χ² (non zero correlation);

²From unconditional logistic regression model controlling for age, sex, race, and colon-cleansing preparation quality. ADR: Adenoma detection rate; PDR: Polyp detection rate; AADR: Advanced adenoma detection rate; RT-ADR: Right sided ADR; LT-ADR: Left sided ADR; aOR: Adjusted odds ratio.

Table 3 Advanced adenomas and total adenomas per colon found during screening colonoscopies by gastroenterology attendings alone and fellows in their first 6 mo of training; Grady Memorial Hospital, Atlanta, Georgia, July 1, 2009 – July 1, 2015

	Attending alone n = 2464 n (%)	Fellows 1st 6 mo n = 627 n (%)	P value1
≥ 1 advanced adenoma (AADR)	215 (8.7)	30 (4.8)	0.001
≥ 1 adenoma ≥ 1 cm	194 (7.9)	21 (3.4)	< 0.0001
≥ 1 adenoma with villous histology	83 (3.4)	14 (2.2)	0.15
≥ 1 adenoma with HGD and/or cancer	26 (1.1)	4 (0.6)	0.34
Mean number of APC	0.61	0.64	0.54

¹P value from χ² test for categorical variables, and student t test for continuous variables. AADR: Advanced adenoma detection rate; HGD: High-grade dysplasia. APC: Adenomas per colon.