Procedural performance in gastrointestinal endoscopy: an assessment and self-appraisal tool

Am J Surg. 2008 Sep;196(3):450-5. doi: 10.1016/j.amjsurg.2007.10.024. Epub 2008 Jun 30.


Aims: Assessing endoscopic technical skills competency in a structured manner is a topical issue, in light of several workforce factors that may affect the training of future endoscopists. To date there has been little attempt to comprehensively assess both generic and specific technical skills in lower gastrointestinal endoscopies; the current study aimed to develop and validate a tool that can assess these varied skills.

Methods: Hierarchical task analyses of generic and specific technical skills were constructed on flexible sigmoidoscopy and colonoscopy after expert panel discussions. Generic technical skills are subtasks (eg, movements of the control wheel) that allow the endoscopist to complete a main task (specific technical skills), for example, reaching the cecum. Weighted Likert scales were then constructed individually for generic and specific technical skills for each procedure. Two observers assessed each procedure independently.

Results: A total of 135 endoscopic procedures were performed by 9 consultants and 12 registrars. Mean inter-rater reliability Cronbach alphas were .83 and .80, P < or =.05, for generic and specific skills, respectively, for each procedure. Construct validity results using analysis of variance (ANOVA) for consultants and trainees were significant for each procedure, P = .005, P = .003 for generic, and P = .012, P = .004 for specific technical skills.

Conclusions: This new assessment/self-appraisal tool for lower gastrointestinal endoscopies seems to have face, content, concurrent, and construct validities. The tool has the possibility of being used in training and self-appraisal. We aim to modify and apply this tool to other endoscopic procedures in the future, such as endoscopic retrograde cholangiopancreatography (ERCP), endoluminal and transluminal procedures.

Publication types

  • Validation Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Clinical Competence
  • Colonoscopy*
  • Education, Medical, Graduate
  • Educational Measurement / methods*
  • Endoscopy, Gastrointestinal
  • Female
  • General Surgery / education*
  • Humans
  • Male
  • Middle Aged
  • Reproducibility of Results
  • Sigmoidoscopy