Evaluation of colonoscopy technical skill levels by use of an objective kinematic-based system

Background: Colonoscopy requires training and experience to ensure accuracy and safety. Currently, no objective, validated process exists to determine when an endoscopist has attained technical competence. Kinematics data describing movements of laparoscopic instruments have been used in surgical skill assessment to define expert surgical technique. We have developed a novel system to record kinematics data during colonoscopy and quantitatively assess colonoscopist performance.

Objective: To use kinematic analysis of colonoscopy to quantitatively assess endoscopic technical performance.

Design: Prospective cohort study.

Setting: Tertiary-care academic medical center.

Population: This study involved physicians who perform colonoscopy.

Intervention: Application of a kinematics data collection system to colonoscopy evaluation.

Main outcome measurements: Kinematics data, validated task load assessment instrument, and technical difficulty visual analog scale.

Results: All 13 participants completed the colonoscopy to the terminal ileum on the standard colon model. Attending physicians reached the terminal ileum quicker than fellows (median time, 150.19 seconds vs 299.86 seconds; p<.01) with reduced path lengths for all 4 sensors, decreased flex (1.75 m vs 3.14 m; P=.03), smaller tip angulation, reduced absolute roll, and lower curvature of the endoscope. With performance of attending physicians serving as the expert reference standard, the mean kinematic score increased by 19.89 for each decrease in postgraduate year (P<.01). Overall, fellows experienced greater mental, physical, and temporal demand than did attending physicians.

Limitation: Small cohort size.

Conclusion: Kinematic data and score calculation appear useful in the evaluation of colonoscopy technical skill levels. The kinematic score appears to consistently vary by year of training. Because this assessment is nonsubjective, it may be an improvement over current methods for determination of competence. Ongoing studies are establishing benchmarks and characteristic profiles of skill groups based on kinematics data.