February 25th, 2010
Who Is Better Qualified to Perform Colonoscopy?
Consider this: The American Society for Gastrointestinal Endoscopy requires physicians to perform at least 200 colonoscopies before it will assess their competency (much less grant them privileges), and most fellows complete at least 500 during their 3-year training programs.
However, the American Board of Surgery now “mandates” that surgical residents need to perform only 50 colonoscopies during their 5-year surgical residency programs, and some surgeons continue to perform these procedures after completing their training.
Granted, we do not know the minimum number of colonoscopies that should be performed during training to ensure competency, but when two different specialty groups vary by a factor of 4 to 10 (50 vs. 200 to 500), something is clearly wrong.
Let me put this in another way. Who do you want to do your exam: the physician who did 50 colonoscopies during training and now does 50 a year, or the one who did 500 during training and now does 500 a year?
5 Responses to “Who Is Better Qualified to Perform Colonoscopy?”
M. Brian Fennerty, MD
Editor-in-Chief
NEJM Journal Watch Gastroenterology
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I would prefer the one who did 500 colonoscopies in his trainee years and 500 per year thereafter.
Unfortunately, this is yet another example of comparing apples to oranges.
I have been a practicing radiologist for thirty years, and for the first twenty, we were roped into observing and taking pictures for ERCP’s. For ten of those twenty years, I was also chairman of the PIP committee, so I had “inside information” about complication rates with ERCP’s and Colonoscopy. We had twelve Board Certified Gastroenterologists on staff–almost all very quick to scope, so I professionally got to know these guys intimately.
Not all of those GI doc’s were created equal in their ability to manipulate a scope and gain access to the ampulla. Two of the twelve had a miserable record for complications, and over the years NEITHER OF THEM IMPROVED.
One of them was actively disciplined and monitored by my committee, and eventually gave up all endoscopies. One didn’t give up, he just moved the exams out of the hospital and into an outpatient surgicenter, where we couldn’t monitor his results. I have more details that could be related…
My conclusion is this: If you have good hands, fifty is enough. If you have bad hands, 5000 won’t be enough. If you really can’t recognize pathology and you really truly can’t handle the biopsy paraphernalia, you shouldn’t do the procedure.
The Certification Procedure is only tangentially related to competency.
I couldn’t agree more with Dr. Grimm on this. I am a surgeon (for full disclosure), but I can’t tell you how many times I’ve had a medical gastroenterologist (one of those 500/year people) tell me that the patholgy is “EXACTLY” 120cm from the anal verge. Anyone who has ever done a laparotomy to find a colon tumor knows that after about 40cm, those numbers are just about meaningless. Just my 2 cents.
I am a surgeon and I performed colonosopic polypectomy just for difficult and risky patients. I think technique is more important than case number performed.
Be patient and careful for any case to prevent complications.Attitude decide whether you are qualified endoscopist.
it’s really all just a crapshoot ………….