The current state of colonoscopy training in family medicine residency programs.

Colorectal cancer is the second leading cause of cancer death in men and women in the United States. It is estimated that colorectal cancer will cause approximately 56,730 deaths in 2004, accounting for 10% of cancer deaths. The US Preventive Services Task Force strongly urges that all adults ages 50 and over be screened for colorectal cancer. In 1997, the Agency for Health Care Policy and Research (AHCPR) recommended that beginning at the age of 50, people should undergo one of the following screening regimens: fecal occult blood testing (FOBT) annually, flexible sigmoidoscopy every 5 years, FOBT and sigmoidoscopy every 5 years, double contrast barium enema every 5 to 10 years, or colonoscopy every 10 years. Among the available screening options, FOBT and sigmoidoscopy have been the most well-studied methods for colorectal cancer screening, but only one third of Americans are screened by FOBT or sigmoidoscopy. Recent evidence suggests that colonoscopy may be a useful screening procedure for colorectal cancer. There are many barriers that preclude individuals from receiving colorectal cancer screening, including patient, physician, and health system factors. One health system barrier is the lack of capacity to perform screening tests, including colonoscopy, on all eligible patients. While the majority of family medicine residencies provide training in flexible sigmoidoscopy, a prior study reported that only one in four family medicine residencies provide training in colonoscopy. Training requirements vary widely by professional organization and subspecialty. The American College of Physicians recommends 50 colonoscopies for acquisition of clinical competence, while the American College of Gastroenterology (ACG), the American Gastroenterological Association (AGA), and the American Society for Gastrointestinal Endoscopy (ASGE) have recommended performing as many as 140 supervised colonoscopies and 30 polypectomies as a minimum training requirement for hospital privileges. Although family phyResidency Education