The following is a summary of “Varied Trainee Competence in Cold Snare Polypectomy: Results of the COMPLETE Randomized Controlled Trial,” published in the October 2023 issue of Gastroenterology by Kaltenbach, et al.
Removing small polyps through cold snare polypectomy (CSP) is recommended as the optimal technique. However, significant variability in CSP technique and quality exists. The learning curve and the impact of targeted training on CSP still need to be discovered. Video feedback has shown promise as an effective pedagogical tool to improve the performance of surgical trainees. For a study, researchers sought to compare CSP performance between trainees who received video-based and conventional apprentice-based concurrent feedback. The hypothesis was that video-based feedback would accelerate competence.
A single-blinded, randomized controlled trial assessed competence in CSP for polyps smaller than 1 cm. The study compared video-based feedback with conventional feedback. Deidentified CSP videos were randomly assigned to blinded raters for assessment using the CSP Assessment Tool. Cumulative sum learning curves were shared with each trainee every 25 CSP. Trainees receiving video feedback also had biweekly individualized terminal feedback. Control trainees received conventional feedback during colonoscopy. The primary outcome was CSP competence, and competence across various domains and changes over polypectomy volume were also assessed.
The study enrolled and randomized 22 trainees, 12 in the video-based feedback group and 10 in the conventional feedback group. A total of 2,339 CSPs were evaluated. The learning curve was observed to be long. Ultimately, 16.7% of trainees in the video feedback group achieved competence after a mean of 135 polyps, while no trainee in the control group achieved competence (P = 0.481). Across all CSP steps, a higher percentage of the video feedback group achieved competence, improving competence by 3% every 20 CSP (P = 0.0004).
The findings indicated that video feedback facilitated trainees in achieving competence in CSP. However, the learning curve was observed to be long. The results strongly suggested that more than current training methods may be required to support trainees in reaching competence by the end of their fellowship programs. The impact of new training methods, such as simulation-based mastery learning, should be assessed to determine whether such methods can lead to faster achievement of competence.