Assessment of esophagogastroduodenoscopy skills on simulators before real-life performance

Anders Bo Nielsen; Finn Møller Pedersen; Christian B Laursen; Lars Konge; Stig Laursen

doi:10.1055/a-1814-9747

Assessment of esophagogastroduodenoscopy skills on simulators before real-life performance

Endosc Int Open. 2022 Jun 10;10(6):E815-E823. doi: 10.1055/a-1814-9747. eCollection 2022 Jun.

Authors

Anders Bo Nielsen^{1

2

3}, Finn Møller Pedersen^{2

3}, Christian B Laursen^{4

5}, Lars Konge⁶, Stig Laursen^{2

3}

Affiliations

¹ Odense University Hospital, SimC - Simulation Center, Odense, Denmark.
² Odense University Hospital, Department of Medical Gastroenterology, Odense, Denmark.
³ University of Southern Denmark, Department of Clinical Research, Odense, Denmark.
⁴ Odense University Hospital, Department of Respiratory Medicine, Odense, Denmark.
⁵ University of Southern Denmark, Respiratory Research Unit, Odense, Denmark.
⁶ Capital Region of Denmark - Copenhagen Academy for Medical Education and Simulation, Copenhagen, Denmark.

Abstract

Background and study aims Operator competency is essential for esophagogastroduodenoscopy (EGD) quality, which makes appropriate training with a final test important. The aims of this study were to develop a test for assessing skills in performing EGD, gather validity evidence for the test, and establish a credible pass/fail score. Methods An expert panel developed a practical test using the Simbionix GI Mentor II simulator (3 D Systems) and an EGD phantom (OGI 4, CLA Medical) with a diagnostic (DP) and a technical skills part (TSP) for a prospective validation study. During the test a supervisor measured: 1) total time; 2) degree of mucosal visualization; and 3) landmarks and pathology identification. The contrasting groups standard setting method was used to establish a pass/fail score. Results We included 15 novices (N), 10 intermediates (I), and 10 experienced endoscopists (E). The internal structure was high with a Cronbach's alpha of 0.76 for TSP time consumption and 0.74 for the identification of landmarks. Mean total times, in minutes, for the DP were N 15.7, I 11.3, and E 7.0, and for TSP., they were N 7.9, I 8.9, and E 2.9. The total numbers of identified landmarks were N 26, I 41, and E 48. Mean visualization percentages were N 80, I 71, and E 71. A pass/fail standard was established requiring identification of all landmarks and performance of the TSP in < 5 minutes. All experienced endoscopists passed, while none of the endoscopists in the other categories did. Conclusions We established a test that can distinguish between participants with different competencies. This enables an objective and evidence-based approach to assessment of competencies in EGD.

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