Achieving competence in colonoscopy: Milestones and the need for a new endoscopic curriculum in gastroenterology training

Table 1 American Society for Gastrointestinal Endoscopy Core Curriculum list of core motor and cognitive skills required to be competent in colonoscopy[7]

Motor	Cognitive
Correctly holding the colonoscope	Anatomy
Use of the colonoscopy controls	Patient selection
Colonoscope insertion	Preparation
Colonoscope advancement	Colonoscope selection
Tip control	Informed consent
Torque	Sedation management
Lumen identification	Assessment of indication and risks
Withdrawal/mucosal inspection	Pathology identification
Loop reduction	Therapeutic device settings
Angulated turns	Integration of findings into management plans
Terminal ileum intubation	Report generation and communication
Biopsy	Complication management
Snare polypectomy	Quality improvement
	Professionalism

Table 2 Median performance scores (25%-75% interquartile range) on live-patient procedures among fellows trained on colonoscopy simulator vs trainees with bedside training alone[34]

Fellow performance parameters	Simulator fellow (n = 462)	Traditional teaching (n = 423)	P value
Time to reach maximum insertion (min)	20.0 (14.0-25.0)	20.0 (15.0-29.8)	0.170
Median depth of unassisted insertion (1 = rectum, 6 = terminal ileum)	5.0 (4.0-6.0)	5.0 (4.0-5.0)	0.002
% of colonoscopies completed independently	64.1% (59.7-68.5)	56.3% (51.6-61.0)	0.018
Identifies landmarks (1 = strongly disagree, 7 = strongly agree)	7.0 (6.0-7.0)	6.0 (6.0-7.0)	0.003
Inserts in a safe manner (1 = strongly disagree, 7 = strongly agree)	7.0 (6.0-7.0)	7.0 (6.0-7.0)	0.020
Adequately visualizes mucosa during withdrawal	7.0 (6.0-7.0)	6.0 (6.0-7.0)	0.009
Responds appropriately to patient discomfort	7.0 (6.0-7.0)	6.0 (6.0-7.0)	0.255
Patient-reported discomfort	1.0 (1.0-4.0)	1.0 (1.0-4.0)	0.090