Train-the-trainer education and colonoscopy quality indicators: where to now?

To the Editor In their recent national randomised trial published in Gut, Kaminski et al1 reported that a quality improvement intervention involving dedicated training of endoscopy centre leaders in colonoscopy provided superior improvement in adenoma detection rates (ADRs) in screening colonoscopy compared with those randomised to receive simple audit and feedback. While study results are subject to a possible Hawthorne effect given ADRs were higher during the period when study participants were aware of being monitored, the findings otherwise appeared robust with ADR improvement observed across all endoscopist specialties, colonoscopy experience and types of screening facilities. These are important findings given that ADR is a key quality indicator of colonoscopy because of its role as an independent predictor of the development interval colorectal cancer (CRC) after colonoscopy and association with CRC death.2–4

However, ADR is only one of many colonoscopy quality...

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