Polyp Detection in Colonoscopy Training: A Qualitative Analysis of Resident Challenges and Expert Strategies

Colorectal cancer (CRC) is a leading cause of mortality, and early detection through colonoscopy is critical for reducing death rates. However, up to 26% of precancerous polyps are missed, often due to variability in physician skill. Simulation-based training (SBT), like physical simulators (PS), have the potential to improve patient outcomes in colonoscopy by reducing cecal intubation time (CIT). PS offer more realistic experiences than virtual simulators, but lack integrated feedback, limiting its effectiveness in polyp detection (PD) training. Results found that experts achieved lower CIT compared to novice residents, identified key challenges residents face in navigation, scope manipulation, and fold inspection, and found that experts employ techniques such as lumen centering, re-advancement, and fold inspection to enhance PD. These findings emphasize the need for targeted feedback within PS training to improve colonoscopy performance. Feedback-driven training strategies using expert strategies may potentially reduce polyp miss rates and improve CRC screening outcomes.