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Title: Learning curve analysis for competence in colonoscopic polypectomy
Author: Rajendran, Arun
ISNI:       0000 0004 9357 6438
Awarding Body: King's College London
Current Institution: King's College London (University of London)
Date of Award: 2020
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Polypectomy is one of the most common therapeutic procedures performed in lower gastrointestinal endoscopy and interrupts the natural progression of sporadic polyps to colorectal cancer. There is an increasing demand and need for endoscopists worldwide to be trained in performing safe and competent polypectomies to reduce adverse events and to prevent post-colonoscopy colorectal cancer. There is significant variability in training and paucity of data on how trainees acquire competency in polypectomy. Understanding the learning curve of polypectomy and formalised polypectomy training/assessment is proposed as a mechanism to improve polypectomy training and hence patient outcomes. The overarching goal of the thesis was to investigate the learning curve for competence in colonoscopic polypectomy and to explore the implementation issues of a polypectomy assessment tool DOPyS (Directly Observed Polypectomy skills). Chapter 1 introduces the key concepts about polyps and polypectomy, including training and assessment. A narrative review of the recent literature on learning curves of lower gastrointestinal therapeutic procedures is explored in Chapter 2, finding little evidence on how trainees acquire competency. The review ascertained a need to identify competency markers for colonoscopic polypectomy. In Chapter 3, retrospective study of DOPyS assessments in the UK identified technical and non-technical skills where trainees consistently underperformed. The study revealed a need to start polypectomy training earlier and develop targeted interventions to improve training. In Chapter 4, the polypectomy e-module was developed as an interactive intervention for learning basic skills in polypectomy and for exposure to DOPyS in a systematic approach. The prospective multicentre I-DOPyS study identified a potential number of polypectomies required by the trainee to gain competence and exposed the limitations of large scale implementation of DOPyS as an assessment tool (Chapter 5). The implementation issues of DOPyS identified in the prospective study is further explored in Chapter 6. The DOPyS implementation survey suggested that although DOPyS scored high in implementation outcome variables, there were sustainability issues that need addressing. Finally, Chapter 7 summarises the findings and highlights opportunities to understand the learning curve of polypectomy and to improve the sustainability of DOPyS. These can be used to identify gaps in polypectomy training and to develop guidelines/interventions to improve training. To the best of my knowledge, this thesis represents the first specific compilation of research on learning curves in polypectomy and implementation research on DOPyS. It outlines a better understanding of the learning curve for colonoscopic polypectomy and the issues around global implementation and uptake of DOPyS.
Supervisor: Sevdalis, Nick Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available