Analysis of lesion localisation at colonoscopy: outcomes from a multi-centre U.K. study.

BACKGROUND: Colonoscopy is currently the gold standard for detection of colorectal lesions, but may be limited in anatomically localising lesions. This audit aimed to determine the accuracy of colonoscopy lesion localisation, any subsequent changes in surgical management and any potentially influencing factors. METHODS: Patients undergoing colonoscopy prior to elective curative surgery for colorectal lesion/s were included from 8 registered U.K. sites (2012-2014). Three sets of data were recorded: patient factors (age, sex, BMI, screener vs. symptomatic, previous abdominal surgery); colonoscopy factors (caecal intubation, scope guide used, colonoscopist accreditation) and imaging modality. Lesion localisation was standardised with intra-operative location taken as the gold standard. Changes to surgical management were recorded. RESULTS: 364 cases were included; majority of lesions were colonic, solitary, malignant and in symptomatic referrals. 82% patients had their lesion/s correctly located at colonoscopy. Pre-operative CT visualised lesion/s in only 73% of cases with a reduction in screening patients (64 vs. 77%; p = 0.008). 5.2% incorrectly located cases at colonoscopy underwent altered surgical management, including conversion to open. Univariate analysis found colonoscopy accreditation, scope guide use, incomplete colonoscopy and previous abdominal surgery significantly influenced lesion localisation. On multi-variate analysis, caecal intubation and scope guide use remained significant (HR 0.35, 0.20-0.60 95% CI and 0.47; 0.25-0.88, respectively). CONCLUSION: Lesion localisation at colonoscopy is incorrect in 18% of cases leading to potentially significant surgical management alterations. As part of accreditation, colonoscopists need lesion localisation training and awareness of when inaccuracies can occur.

From cadavers to clinical practice: the anatomy of lifelong learning.

BACKGROUND: Much has been postulated about the perceived deterioration of anatomy knowledge amongst graduates. Little is known about levels of confidence in, and educational needs concerning, clinical anatomy knowledge amongst foundation year doctors. AIMS: To establish foundation year doctors' perceptions of anatomy related to: importance to career, confidence in anatomy knowledge and its application, preferred methods of teaching. Secondarily, to determine impact of an integrated clinical approach to anatomy teaching on foundation year doctors' level of knowledge and confidence in its clinical application of anatomy. METHODS: A course teaching anatomy through common surgeries and related radiology was delivered to foundation year doctors. A pre- and post-course assessment based on anatomy competence score assessed holistic knowledge acquisition. Foundation year doctors' perceptions of anatomy and course satisfaction were measured through questionnaire. RESULTS: Confidence in applying anatomy knowledge was low. The average pre- and post-course assessment score increased from 55% to 81%; 92.86% felt an integrated clinical approach to anatomy teaching improved their confidence on the subject and 58.62% felt it improved their clinical skills. CONCLUSION: This study identified a need for ongoing educational support for foundation year doctors regarding anatomy teaching. An integrated clinical approach to teaching anatomy proved both highly relevant and popular, as well as an effective teaching approach.