Fellow Involvement May Increase Adenoma Detection Rates During Colonoscopy

Rogart, Jason N.; Siddiqui, Uzma D.; Jamidar, Priya A.; Aslanian, Harry R.

doi:10.1111/j.1572-0241.2008.02085.x

Cited by 82 publications

(68 citation statements)

References 32 publications

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“…The air group overall ADR of 30% (Table 3) is comparable to those in studies employing standard equipment and techniques in sedated patients [15][16][17][18][19][20][21][22][23][24] (Table 5). The water group overall ADR of 38% (Table 3) could possibly exceed those in studies employing chromoendoscopy and standard colonoscope in sedated patients 25,26 ( Table 5).…”

Section: Discussionsupporting

confidence: 62%

The water method significantly enhances proximal diminutive adenoma detection rate in unsedated patients

Leung

Leung²,

Siao-Salera³

et al. 2011

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Section: Discussionsupporting

confidence: 62%

The water method significantly enhances proximal diminutive adenoma detection rate in unsedated patients

Leung

Leung²,

Siao-Salera³

et al. 2011

jig

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“…There is little data on whether involvement of a gastroenterology fellow enhances polyp or adenoma detection. In two previous studies, PDR and ADR were increased with fellow involvement [3,4]. In our retrospective study, the ADR during procedures performed by a GI fellow under attending supervision was comparable to those performed by an attending alone.…”

mentioning

confidence: 52%

Fellow Involvement During Colonoscopy Does Not Reduce Adenoma Detection Rate

2010

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Colonoscopy is effective in reducing the morbidity and mortality of colorectal cancer (CRC). However, colonoscopy is a technical procedure that requires expertise to maximize accuracy, and an adequate procedure volume is necessary to achieve competence [1]. Few studies have examined if gastroenterology (GI) fellows, who have less endoscopy experience than their attending physicians, are less likely to identify adenomas and cancers.We performed a retrospective review of 1,190 patients who underwent age-appropriate, average-risk screening colonoscopy to assess whether performance by a GI fellow affects adenoma detection rate (ADR). Nine hundred seventy-one colonoscopies were performed by one of five GI and three colorectal surgery attendings alone. Two hundred nineteen were performed by a GI fellow under the supervision of one of the same five GI attendings. There was no significant difference in patient age, gender, or colonoscopy prep quality between the patients in the attending group and the trainee group. The polyp detection rate (PDR) in the attending group was 43.3% versus 48.8% in the fellow group. The adenoma detection rate (ADR) was 25.6% in the attending group versus 27.9% in the fellow group. Advanced adenoma detection was 6.5% in the attending group versus 5.9% in the fellow group.ADR is increasingly used as a quality measure to assess colonoscopic competency. Factors reported to affect PDR and ADR include withdrawal time, cecal intubation rates, adequacy of bowel preparation, and time spent cleaning the colonic mucosa of excess fluid [2]. There is little data on whether involvement of a gastroenterology fellow enhances polyp or adenoma detection. In two previous studies, PDR and ADR were increased with fellow involvement [3,4]. In our retrospective study, the ADR during procedures performed by a GI fellow under attending supervision was comparable to those performed by an attending alone. This finding has clinical significance, because although GI fellows have less endoscopic experience than GI attendings, they are able to identify clinically relevant polyps while performing supervised colonoscopies. This can possibly be explained by an increased recognition of small polyps by a second set of eyes or by longer procedure times [4]. Future prospective studies are needed to determine if fellow involvement during colonoscopy impacts ADR.

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“…The Bfellow effect^is not well documented in medical oncology literature, but there are a few examples from other disciplines, in which involvement of fellows can improve quality of care. For example, in the field of gastroenterology, the involvement of fellows in colonoscopies increased the detection of subtle adenomas [4,5].…”

Section: Discussionmentioning

confidence: 99%

Comparison of Quality Oncology Practice Initiative (QOPI) Measure Adherence Between Oncology Fellows, Advanced Practice Providers, and Attending Physicians

et al. 2015

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Quality improvement measures are uniformly applied to all oncology providers, regardless of their roles. Little is known about differences in adherence to these measures between oncology fellows, advance practice providers (APP), and attending physicians. We investigated conformance across Quality Oncology Practice Initiative (QOPI) measures for oncology fellows, advance practice providers, and attending physicians at the Durham Veterans Affairs Medical Center (DVAMC). Using data collected from the Spring 2012 and 2013 QOPI cycles, we abstracted charts of patients and separated them based on their primary provider. Descriptive statistics and the chi-square test were calculated for each QOPI measure between fellows, advanced practice providers (APPs), and attending physicians. A total of 169 patients were reviewed. Of these, 31 patients had a fellow, 39 had an APP, and 99 had an attending as their primary oncology provider. Fellows and attending physicians performed similarly on 90 of 94 QOPI metrics. High-performing metrics included several core QOPI measures including documenting consent for chemotherapy, recommending adjuvant chemotherapy when appropriate, and prescribing serotonin antagonists when prescribing emetogenic chemotherapies. Low-performing metrics included documentation of treatment summary and taking action to address problems with emotional well-being by the second office visit. Attendings documented the plan for oral chemotherapy more often (92 vs. 63%, P=0.049). However, after the chart audit, we found that fellows actually documented the plan for oral chemotherapy 88% of the time (p=0.73). APPs and attendings performed similarly on 88 of 90 QOPI measures. The quality of oncology care tends to be similar between attendings and fellows overall; some of the significant differences do not remain significant after a second manual chart review, highlighting that the use of manual data collection for QOPI analysis is an imperfect system, and there may be significant inter-observer variability.

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Fellow Involvement May Increase Adenoma Detection Rates During Colonoscopy

Cited by 82 publications

References 32 publications

The water method significantly enhances proximal diminutive adenoma detection rate in unsedated patients

The water method significantly enhances proximal diminutive adenoma detection rate in unsedated patients

Fellow Involvement During Colonoscopy Does Not Reduce Adenoma Detection Rate

Comparison of Quality Oncology Practice Initiative (QOPI) Measure Adherence Between Oncology Fellows, Advanced Practice Providers, and Attending Physicians

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