Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Toronto, Ontario, Canada; Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada; Wilson Centre, University of Toronto, Toronto, Ontario, Canada.
Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Toronto, Ontario, Canada; Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada.
Gastrointest Endosc. 2015;81(6):1417-1424.e2. doi: 10.1016/j.gie.2014.11.030. Epub 2015 Mar 7.
Rigorously developed and validated direct observational assessment tools are required to support competency-based colonoscopy training to facilitate skill acquisition, optimize learning, and ensure readiness for unsupervised practice.
To examine reliability and validity evidence of the Gastrointestinal Endoscopy Competency Assessment Tool (GiECAT) for colonoscopy for use within the clinical setting.
Prospective, observational, multicenter validation study. Sixty-one endoscopists performing 116 colonoscopies were assessed using the GiECAT, which consists of a 7-item global rating scale (GRS) and 19-item checklist (CL). A second rater assessed procedures to determine interrater reliability by using intraclass correlation coefficients (ICCs). Endoscopists' first and second procedure scores were compared to determine test-retest reliability by using ICCs. Discriminative validity was examined by comparing novice, intermediate, and experienced endoscopists' scores. Concurrent validity was measured by correlating scores with colonoscopy experience, cecal and terminal ileal intubation rates, and physician global assessment.
A total of 116 colonoscopies performed by 33 novice (<50 previous procedures), 18 intermediate (50-500 previous procedures), and 10 experienced (>1000 previous procedures) endoscopists from 6 Canadian hospitals.
Interrater and test-retest reliability, discriminative, and concurrent validity.
Interrater reliability was high (total: ICC=0.85; GRS: ICC=0.85; CL: ICC=0.81). Test-retest reliability was excellent (total: ICC=0.91; GRS: ICC=0.93; CL: ICC=0.80). Significant differences in GiECAT scores among novice, intermediate, and experienced endoscopists were noted (P<.001). There was a significant positive correlation (P<.001) between scores and number of previous colonoscopies (total: ρ=0.78, GRS: ρ=0.80, CL: Spearman's ρ=0.71); cecal intubation rate (total: ρ=0.81, GRS: Spearman's ρ=0.82, CL: Spearman's ρ=0.75); ileal intubation rate (total: Spearman's ρ=0.82, GRS: Spearman's ρ=0.82, CL: Spearman's ρ=0.77); and physician global assessment (total: Spearman's ρ=0.90, GRS: Spearman's ρ=0.94, CL: Spearman's ρ=0.77).
Nonblinded assessments.
This study provides evidence supporting the reliability and validity of the GiECAT for use in assessing the performance of live colonoscopies in the clinical setting.
为了支持基于能力的结肠镜检查培训，需要严格开发和验证直接观察评估工具，以促进技能的获取、优化学习并确保能够独立进行实践。
在临床环境中检查胃肠内镜能力评估工具（GiECAT）在结肠镜检查中的可靠性和有效性证据。
前瞻性、观察性、多中心验证研究。61 名内镜医师进行了 116 例结肠镜检查，使用包括 7 项总体评分量表（GRS）和 19 项检查表（CL）的 GiECAT 进行评估。第二位评估者使用组内相关系数（ICC）评估程序以确定观察者间的可靠性。使用 ICC 比较内镜医师的第一次和第二次手术评分以确定测试-重测可靠性。通过比较新手、中级和经验丰富的内镜医师的评分来检查区分效度。通过与结肠镜检查经验、盲肠和末端回肠插管率以及医师总体评估相关联来测量同时效度。
来自加拿大 6 家医院的 33 名新手（<50 例之前的手术）、18 名中级（50-500 例之前的手术）和 10 名经验丰富的（>1000 例之前的手术）内镜医师共进行了 116 例结肠镜检查。
观察者间和测试-重测可靠性、区分度和同时效度。
观察者间的可靠性很高（总评分：ICC=0.85；GRS：ICC=0.85；CL：ICC=0.81）。测试-重测可靠性很好（总评分：ICC=0.91；GRS：ICC=0.93；CL：ICC=0.80）。在新手、中级和经验丰富的内镜医师中，GiECAT 评分存在显著差异（P<.001）。评分与之前结肠镜检查次数（总评分：ρ=0.78，GRS：ρ=0.80，CL：Spearman's ρ=0.71）；盲肠插管率（总评分：ρ=0.81，GRS：Spearman's ρ=0.82，CL：Spearman's ρ=0.75）；回肠插管率（总评分：Spearman's ρ=0.82，GRS：Spearman's ρ=0.82，CL：Spearman's ρ=0.77）；以及医师总体评估（总评分：Spearman's ρ=0.90，GRS：Spearman's ρ=0.94，CL：Spearman's ρ=0.77）之间存在显著正相关（P<.001）。
非盲评估。
本研究提供了支持在临床环境中使用 GiECAT 评估结肠镜检查性能的可靠性和有效性的证据。
