Original article
Clinical endoscopy
Gastrointestinal Endoscopy Competency Assessment Tool: development of a procedure-specific assessment tool for colonoscopy

Presented at Canadian Digestive Disease Week, February 24-27, 2012, Montreal, Quebec, Canada (Can J Gastroenterol 2012;26(Suppl A):74A).
https://doi.org/10.1016/j.gie.2013.10.035Get rights and content

Background

Ensuring competence remains a seminal objective of endoscopy training programs, professional organizations, and accreditation bodies; however, no widely accepted measure of endoscopic competence currently exists.

Objective

By using Delphi methodology, we aimed to develop and establish the content validity of the Gastrointestinal Endoscopy Competency Assessment Tool for colonoscopy.

Design

An international panel of endoscopy experts rated potential checklist and global rating items for their importance as indicators of the competence of trainees learning to perform colonoscopy. After each round, responses were analyzed and sent back to the experts for further ratings until consensus was reached.

Main Outcome Measurements

Consensus was defined a priori as ≥80% of experts, in a given round, scoring ≥4 of 5 on all remaining items.

Results

Fifty-five experts agreed to be part of the Delphi panel: 43 gastroenterologists, 10 surgeons, and 2 endoscopy managers. Seventy-three checklist and 34 global rating items were generated through a systematic literature review and survey of committee members. An additional 2 checklist and 4 global rating items were added by Delphi panelists. Five rounds of surveys were completed before consensus was achieved, with response rates ranging from 67% to 100%. Seven global ratings and 19 checklist items reached consensus as good indicators of the competence of clinicians performing colonoscopy.

Limitations

Further validation required.

Conclusion

Delphi methodology allowed for the rigorous development and content validation of a new measure of endoscopic competence, reflective of practice across institutions. Although further evaluation is required, it is a promising step toward the objective assessment of competency for use in colonoscopy training, practice, and research.

Section snippets

Study design

Delphi methodology was used to achieve consensus among a panel of endoscopy experts regarding standardized criteria for the assessment of competence of clinicians performing colonoscopy. The Delphi method is a research technique that draws on the collective intelligence of a panel of experts to achieve consensus on a specific topic through the use of iterative rounds of anonymous questionnaires.29 Content validity is “the degree to which elements of an assessment instrument are relative to and

Panel of participants

Of the 68 endoscopy experts initially contacted, 55 responded. Experts were from 44 centers internationally and had performed an average of 612 (range 0-2600) colonoscopies over the preceding year. The characteristics of the panel of participants are described in Table 1.

Delphi process

Of the 55 panelists, 55 (100%) completed the round-1 survey, 43 (78.18%) round 2, 38 (69.09%) round 3, 36 (65.45%) round 4 and 37 (67.27%) round 5. There were no significant differences in demographic characteristics between

Discussion

Recent changes in the medical training environment, including a greater emphasis on patient safety and efficiency, an increased complexity of cases, and work hour restrictions, have resulted in decreased trainee independence and time for hands-on clinical training.35 These changes, along with the variable learning curve for colonoscopy,10 emphasize the need for assessment tools capable of objectively and reproducibly documenting trainee progress over time. The GiECAT was developed specifically

Acknowledgments

The authors thank the expert panelists who participated in the Delphi process. The authors would like to thank Drs Brian Hodges and Dorcas Beaton for their insightful comments.

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    DISCLOSURE: This study was supported by an American Society for Gastrointestinal Endoscopy Quality in Endoscopic Research Award. C. Walsh is a doctoral fellow of the CIHR Canadian Child Health Clinician Scientist Training Program and is the recipient of a Department of Paediatrics Research Fellowship (Hospital for Sick Children) award and a Postgraduate Medical Education Award, University of Toronto. H. Carnahan is supported by the BMO Chair in Health Professions Education Research. No funding organization had any role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, or approval of the manuscript. All other authors disclosed no financial relationships relevant to this publication.

    If you would like to chat with an author of this article, you may contact Dr Walsh at [email protected].

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