Vassiliou Melina C, Dunkin Brian J, Fried Gerald M, Mellinger John D, Trus Thadeus, Kaneva Pepa, Lyons Calvin, Korndorffer James R, Ujiki Michael, Velanovich Vic, Kochman Michael L, Tsuda Shawn, Martinez Jose, Scott Daniel J, Korus Gary, Park Adrian, Marks Jeffrey M
McGill University Health Centre, Montreal General Hospital, 1650 Cedar Avenue, L9-313, Montreal, QC, H3G 1A4, Canada,
Surg Endosc. 2014 Mar;28(3):704-11. doi: 10.1007/s00464-013-3298-4. Epub 2013 Nov 20.
The Fundamentals of Endoscopic Surgery™ (FES) program consists of online materials and didactic and skills-based tests. All components were designed to measure the skills and knowledge required to perform safe flexible endoscopy. The purpose of this multicenter study was to evaluate the reliability and validity of the hands-on component of the FES examination, and to establish the pass score.
Expert endoscopists identified the critical skill set required for flexible endoscopy. They were then modeled in a virtual reality simulator (GI Mentor™ II, Simbionix™ Ltd., Airport City, Israel) to create five tasks and metrics. Scores were designed to measure both speed and precision. Validity evidence was assessed by correlating performance with self-reported endoscopic experience (surgeons and gastroenterologists [GIs]). Internal consistency of each test task was assessed using Cronbach's alpha. Test-retest reliability was determined by having the same participant perform the test a second time and comparing their scores. Passing scores were determined by a contrasting groups methodology and use of receiver operating characteristic curves.
A total of 160 participants (17 % GIs) performed the simulator test. Scores on the five tasks showed good internal consistency reliability and all had significant correlations with endoscopic experience. Total FES scores correlated 0.73, with participants' level of endoscopic experience providing evidence of their validity, and their internal consistency reliability (Cronbach's alpha) was 0.82. Test-retest reliability was assessed in 11 participants, and the intraclass correlation was 0.85. The passing score was determined and is estimated to have a sensitivity (true positive rate) of 0.81 and a 1-specificity (false positive rate) of 0.21.
The FES hands-on skills test examines the basic procedural components required to perform safe flexible endoscopy. It meets rigorous standards of reliability and validity required for high-stakes examinations, and, together with the knowledge component, may help contribute to the definition and determination of competence in endoscopy.
《内镜手术基础》（FES）项目包括在线资料以及基于理论和技能的测试。所有组件旨在衡量进行安全的软性内镜检查所需的技能和知识。这项多中心研究的目的是评估FES考试实践部分的可靠性和有效性，并确定及格分数。
内镜专家确定了软性内镜检查所需的关键技能集。然后在虚拟现实模拟器（GI Mentor™ II，Simbionix™ Ltd.，以色列航空城）中对其进行建模，以创建五项任务和指标。分数旨在衡量速度和精度。通过将表现与自我报告的内镜检查经验（外科医生和胃肠病学家[GI]）进行关联来评估效度证据。使用克朗巴赫α系数评估每个测试任务的内部一致性。通过让同一参与者再次进行测试并比较他们的分数来确定重测信度。通过对比组方法和使用受试者工作特征曲线来确定及格分数。
共有160名参与者（17%为胃肠病学家）进行了模拟器测试。五项任务的分数显示出良好的内部一致性信度，并且所有分数与内镜检查经验均具有显著相关性。FES总分与参与者的内镜检查经验水平的相关性为0.73，证明了其效度，其内部一致性信度（克朗巴赫α系数）为0.82。对11名参与者进行了重测信度评估，组内相关系数为0.85。确定了及格分数，估计其灵敏度（真阳性率）为0.81，1-特异度（假阳性率）为0.21。
FES实践技能测试考察了进行安全的软性内镜检查所需的基本程序组件。它符合高风险考试所需的严格可靠性和效度标准，并且与知识部分一起，可能有助于内镜检查能力的定义和确定。
