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Global Assessment of Gastrointestinal Endoscopic Skills (GAGES): a valid measurement tool for technical skills in flexible endoscopy

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Abstract

Background

Simulators may improve the efficiency, safety, and quality of endoscopic training. However, no objective, reliable, and valid tool exists to assess clinical endoscopic skills. Such a tool to measure the outcomes of educational strategies is a necessity. This multicenter, multidisciplinary trial aimed to develop instruments for evaluating basic flexible endoscopic skills and to demonstrate their reliability and validity.

Methods

The Global Assessment of Gastrointestinal Endoscopic Skills (GAGES) Upper Endoscopy (GAGES-UE) and Colonoscopy (GAGES-C) are rating scales developed by expert endoscopists. The GAGES scale was completed by the attending endoscopist (A) and an observer (O) in self-assessment (S) during procedures to establish interrater reliability (IRR, using the intraclass correlation coefficient [ICC]) and internal consistency (IC, using Cronbach’s alpha). Instrumentation was evaluated when possible and correlated with total scores. Construct and external validity were examined by comparing novice (NOV) and experienced (EXP) endoscopists (Student’s t-test). Correlations were calculated for GAGES-UE and GAGES-C with participants who had performed both.

Results

For the 139 completed evaluations (60 NOV, 79 EXP), IRR (A vs. O) was 0.96 for GAGES-UE and 0.97 for GAGES-C. The IRR between S and A was 0.78 for GAGES-UE and 0.89 for GAGES-C. The IC was 0.89 for GAGES-UE, and 0.95 for GAGES-C. There were mean differences between the NOV and the EXP endoscopists for GAGE-UE (14.4 ± 3.7 vs. 18.5 ± 1.6; p < 0.001) and GAGE-C (11.8 ± 3.8 vs. 18.8 ± 1.3; p < 0.001). Good correlation was found between the scores for the GAGE-UE and the GAGE-C (r = 0.75; n = 37). Instrumentation, when performed, demonstrated correlations with total scores of 0.84 (GAGE-UE; n = 73) and 0.86 (GAGE-C; n = 45).

Conclusions

The GAGES-UE and GAGES-C are easy to administer and consistent and meet high standards of reliability and validity. They can be used to measure the effectiveness of simulator training and to provide specific feedback. The GAGES results can be generalized to North American and European endoscopists and may contribute to the definition of technical proficiency in endoscopy.

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Acknowledgments

We acknowledge all the members of the FES taskforce for their participation in this research. We also thank Lisa Jukelevics, Carla Bryant, and Sarah Colon for their help and support in bringing this project forward. Given the limited number of authors that could be included, we also acknowledge all the contributors from the different institutions that made this study possible. This project was supported in part by SAGES and the Fundamentals of Endoscopic Surgery Task Force.

Disclosures

Melina C. Vassiliou, Pepa A. Kaneva, Benjamin K. Poulose, Brian J. Dunkin, Jeffrey M. Marks, Riadh Sadik, Gideon Sroka, Mehran Anvari, Klaus Thaler, Gina L. Adrales, Jeffrey W. Hazey, Jenifer R. Lightdale, Vic Velanovich, Lee L. Swanstrom, John D. Mellinger, and Gerald M. Fried have no conflicts of interest or financial ties relevant to this report to disclose.

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Authors and Affiliations

  1. McGill University Health Centre, Montreal, QC, Canada

    Melina C. Vassiliou, Pepa A. Kaneva, Gideon Sroka & Gerald M. Fried

  2. Vanderbilt University, Nashville, TN, USA

    Benjamin K. Poulose

  3. Methodist Hospital, Houston, TX, USA

    Brian J. Dunkin

  4. Case Medical Center, Cleveland, OH, USA

    Jeffrey M. Marks

  5. Sahlgrenska Hospital, Gothenburg, Sweden

    Riadh Sadik

  6. McMaster University, Hamilton, ON, Canada

    Mehran Anvari

  7. University of Missouri, Columbus, MO, USA

    Klaus Thaler

  8. Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA

    Gina L. Adrales

  9. Ohio State University, Columbus, OH, USA

    Jeffrey W. Hazey

  10. Children’s Hospital Boston, Boston, MA, USA

    Jenifer R. Lightdale

  11. Henry Ford Hospital, Detroit, MI, USA

    Vic Velanovich

  12. Legacy Health, Portland, OR, USA

    Lee L. Swanstrom

  13. Medical College of Georgia, Augusta, GA, USA

    John D. Mellinger

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  1. Melina C. Vassiliou
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Correspondence to Melina C. Vassiliou.

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Vassiliou, M.C., Kaneva, P.A., Poulose, B.K. et al. Global Assessment of Gastrointestinal Endoscopic Skills (GAGES): a valid measurement tool for technical skills in flexible endoscopy. Surg Endosc 24, 1834–1841 (2010). https://doi.org/10.1007/s00464-010-0882-8

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  • DOI: https://doi.org/10.1007/s00464-010-0882-8

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