A framework of credentialing and defining scope of practice in healthcare providers for colonoscopy and its applicability in Hong Kong

Abstract

Introduction: In recent years, the incidence of colorectal cancer in Hong Kong has risen to become the most frequent cancer type whereas its mortality ranks second. As effective screening is demonstrated to improve survival outcomes, the government in response proposed a mass population colorectal cancer screening program for high-risk groups; screening methods include fecal occult blood test, flexible sigmoidoscopy, and colonoscopy. Because colonoscopy is a highly operator-dependent and is therefore very prone to human error, processes to ensure it is performed safely include credentialing and defining scope of practice. As this concept is relatively new in Hong Kong, this study aims to investigate its applicability specific to colonoscopy in the city’s medical profession through determining competency indicators in the procedure. Methods: A systematic review was performed using online databases—PubMed and Google Scholar—to retrieve sources of information. Aside from academic research, guidelines from professional associations from three countries were also incorporated in this paper; they are the Gastroenterological Society of Australia, the Canadian Association of Gastroenterology, and the American Society for Gastrointestinal Endoscopy. Results: Technical aspects for competency include a mean withdrawal time of over 6 minutes;; first time examination adenoma detection rate of ≥ 25% and ≥ 15% in asymptomatic men and women ages > 50, respectively; ≥ 90% cecal intubation rate in all cases; perforation and post-polypectomy bleeding complication rates at < 1/1,000 and < 1/100 cases respectively;; and annual volume rates between 100 to 150 procedures. Experience is a significant factor in improving technical competency. Cognitive competency include correctly identifying and managing abnormalities, and knowledge of appropriate patient indications and contraindications for screening colonoscopy, risk management, and intervals for the procedure. . Conclusion: Guidelines recommend annual volume rates to be used as the primary indicator of technical competency, whereas the minimum medical academic qualification is recommended to have residency in endoscopic surgery. As colonoscopy is provided in both the public and private healthcare sector, the credentialing committee should have authority to influence colonoscopy providers in both sectors. A suitable agency is the Hong Kong Academy of Medicine, as they accredit specialists, and colonoscopy overseas is typically performed by endoscopists having received specialty training.