An innovative method for the assessment of skills in lower gastrointestinal endoscopy

Surg Endosc. 2004 Nov;18(11):1613-9. doi: 10.1007/s00464-004-9002-y. Epub 2004 Oct 11.


Background: Although virtual reality (VR) simulators can be used ability to objectively assess skills in endoscopy, the evaluation is solely quantitative. We have developed a novel method for the objective assessment of technical skills in lower gastrointestinal (GI) endoscopy that incorporates qualitative as well as quantitative measures.

Methods: We developed a virtual endoscopy suite by deconstructing the VR simulator to enable a more realistic and ergonomic placement of the monitor. Trainee endoscopists with varying levels of experience performed the case 4 task of the simulator. Ten essential components of endoscopic performance were rated on a five-point Likert scale (global score) by three independent observers. These observers viewed two videos (one showing scope handling and the other showing the monitor image), which were synchronized and played simultaneously.

Results: The study population comprised six experts (group 1, > 200 procedures), seven subjects with intermediate experience (group 2, 20-80 procedures), and seven novices (group 3, 1-10 procedures). The global score was found to discriminate the level of skills across all three groups (p < 0.001). There were significant differences between groups 1 and 2 (p = 0.003) and groups 2 and 3 (p = 0.004). There was a significant correlation between the global score and the percentage of red-out (without vision) as recorded by the simulator (correlation coefficients = -0.61, p = 0.004).

Conclusion: This novel method for the assessment of technical skills in lower GI endoscopy has construct validity and high interrater reliability.

MeSH terms

  • Clinical Competence*
  • Computer Simulation*
  • Endoscopy, Gastrointestinal / standards*
  • Reproducibility of Results