INDEX SCREENING COLONOSCOPY QUALITY METRICS FOR TRAINEES HAVE IMPROVED DURING THE COVID-19 PANDEMIC

ABSTRACT

Introduction: The coronavirus-2019 (COVID-19) pandemic has led to the suspension of elective outpatient procedures. Clinical educators have raised concerns that gastroenterology fellows have gotten reduced endoscopy exposure with possible decrease in quality metrics. We investigated whether quality parameters such as adenoma detection rate (ADR) and withdrawal times in index screening colonoscopies where fellows were involved have been affected now that elective procedures have resumed in greater numbers. Methods: This is a single-center observational study comparing patients who underwent index screening colonoscopies since our outpatient facilities reopened (7/1/2021 through 9/30/2021) with a pre-pandemic cohort (7/1/2018 through 9/30/2018). We collected demographic information and we tabulated the number of polyps detected, the number of tubular adenomas, and the withdrawal times. We used Chi-square testing to determine significance among our categorical variables and used t-tests to compare means for our numerical variables, particularly between procedures with and without fellow involvement, and between cohorts. All statistical analysis was done in R (R Core Team, 2020). Results: We identified 121 patients in the 2018 cohort without trainee involvement and 38 patients in the same cohort wherein fellows did the procedure. We also identified 186 patients in the 2021 cohort without fellow involvement and 58 patients in the same cohort wherein a trainee did the procedure (Table 1). The 2018 group had an overall ADR of 32.2% (25.0% for women, 39.3% for men) without fellows, and an overall ADR of 21.1% (5.6% for women, 35.0% for men) with trainees. The ADR for women was significantly lower for trainees (p=0.01), but otherwise ADR and withdrawal times were not significantly different. The 2021 cohort, however, showed improvement in all ADRs for fellows compared to 2018, and the ADR for women was equivalent to that of the attendings. Moreover, the withdrawal times were significantly longer for trainees in 2021 (18.9 vs. 15.3 minutes;p=0.01). When comparing fellows' metrics from 2018 and 2021, there was no statistically significant difference in overall ADR, ADR for men, or withdrawal times, though ADR for women had improved (p=0.02). Conclusion: When compared to a similar pre-pandemic cohort, the quality metrics for index colonoscopies have improved for our fellows, particularly with regard to female patients. We are undertaking further data collection to ensure that our findings are stable over a longer time period.(Table Presented) (Table Presented)