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Lower gastrointestinal polypectomy competencies in the United Kingdom- A retrospective analysis of Directly Observed Polypectomy Skills (DOPyS).

BACKGROUND AND AIMS
Polypectomy is often the most hazardous part of colonoscopy. There is significant variability in polypectomy training and assessment internationally. DOPyS (Directly Observed Polypectomy Skills) is a validated assessment tool and is used to demonstrate polypectomy competency in the United Kingdom (UK). The study aims to describe the learning curve for polypectomy competency in UK trainees. Methods Retrospective DOPyS data (January 2009 to September 2015) were obtained from the UK Joint Advisory Group for Intestinal Endoscopy (JAG) endoscopy training system (JETS) national database. Number of lower gastrointestinal (LGI) procedures, overall caecal intubation rate (CIR), procedure intensity (PI) and time in days to first DOPyS recorded and to JAG certification was calculated.


RESULTS
4965 DOPyS from 336 trainees were analysed. Within the study period, 124 and 53 trainees achieved provisional and full colonoscopy certification, respectively. Trainees started formative assessment of polypectomy after >130 LGI procedures and at CIR of >70%. Within three years from the first DOPyS, 94% of trainees achieved provisional, and 50% achieved full certification. Higher PI at baseline DOPyS was associated with a higher likelihood of obtaining certification sooner. Conclusion There is a significant variation in time to competency, and this potentially reflects time necessary to acquire polypectomy skills. There is a need to start polypectomy training earlier, once sufficient skills such as tip control are achieved to shorten time to competency. Overall CIR could be used as a guide for such technical skills. Increasing exposure to training lists also potentially reduces time to polypectomy competency.