TABLE 1.

Colonoscopy training, method of post-training assessment and results

Study	Method of training	Method of post-training assessment	Results
Pierzchajlo et al (11) (1997)	Medical school and family practice residency (no formal training in gastrointestinal endoscopy). Attended a didactic, model-based colonoscopy course. Preceptored for 80 colonoscopies by general surgeons and family physicians for a two-year period.	Cecal intubation was the sole criterion for assessment.	Cecal intubation rate: 91.5%*
Design: Retrospective chart review
Unit of analysis: 751 colonoscopies
Setting: Two hospitals
One physician performed procedures
Wexner et al (12) (1998)	No discussion of colonoscopy-specific training was given.	Assessment was made by measuring: cecal intubation rate; average procedure time; serious complication rates (bleeding, perforations)	Cecal intubation rate†: 96.5%; average procedure time: <30 min; serious complication rates: 0.24%; bleeding: 0.10% (n=2); perforations: 0.14% (n=3)
Design: Retrospective chart review
Unit of analysis: 2069 procedures
Setting: Two hospitals
Four surgeons performed procedures
Wexner et al (13) (2001)	No discussion of colonoscopy-specific training was given.	Assessment was made by measuring: cecal intubation rate; time to completion; intraprocedural complication rates; (arrhythmia, bradycardia, hypotension, hypoxia); postprocedural complication rates for diagnostic colonoscopy (bleeding, perforations)	Cecal intubation rate: 92%; average time to completion: 22.7 min (range 1 min to 170 min); complication rates: 0.2%‡; bleeding: 0%; perforations: 0.02%
Design: Prospective case series
Unit of analysis: 13,580 colonoscopies
Setting: Not specified
207 surgeons performed procedures
Kirby (14) (2004)	Training of general practitioner consisted of 30 supervised colonoscopies over 2.5 years during general surgery training.	Assessment was made by measuring: cecal intubation rate. Complications examined: bleeding, perforation, hypotension	Cecal intubation rate: 60% to 70% (90% in last three years of study)§. Complications: 0%
Design: Retrospective chart review
Unit of analysis: 616 procedures
Setting: Single hospital
One physician performed procedures
Edwards and Norris (15) (2004)	No discussion of colonoscopy-specific training was given.	Assessment was made by measuring: cecal intubation rate; time to reach cecum; procedure time; complications examined¶	Cecal intubation rate: 96.5%: (range 91% to 100%); average time to reach cecum: 15.9 min (range 6.5 min to 23.8 min); average procedure time: 34.4 min; complications: 2% (no bleeding or perforations)
Design: Prospective case series
Unit of analysis: 200 colonoscopies
Setting: Single hospital
Four family physicians performed procedures

^*The authors conclude that family physicians can acquire colonoscopic skills, including polypectomy, after completing family practice residency training. No training effect was observed over the 751 procedures; however, complication rates were higher in the first 120 procedures. The authors suggest that for physicians competent in flexible sigmoidoscopy, 50 supervised colonoscopies is a reasonable number to assure competency and safety;

^†The authors suggest that it is not the specialty of the surgeon or physician that predicts the safety, efficacy and outcome of colonoscopy but the amount of training and experience;

^‡Surgeons can safely and effectively perform colonoscopy. The authors suggest that these data imply a threshold level to ensure safe colonoscopy does not exist;

^§The authors suggest that a partially trained individual working alone takes longer to develop competence (eg, to achieve 80% to 90% cecal intubation rates, 300 colonoscopies were required);

^¶Use of reversal agents with sedation, cardiorespiratory problems with sedation, bowel perforation, hospital admission, emergency department visits and bleeding requiring transfusion