The intended and unintended consequences of performance monitoring in colonoscopy

Self-assessment of Competence in Endoscopy: Challenges and Insights

BACKGROUND

Endoscopists use self-assessment to monitor the development and maintenance of their skills. The accuracy of these self-assessments, which reflects how closely one's own rating corresponds to an external rating, is unclear.

METHODS

In this narrative review, we critically examine the current literature on self-assessment in gastrointestinal endoscopy with the aim of informing training and practice and identifying opportunities to improve the methodological rigor of future studies.

RESULTS

In the seven included studies, the evidence regarding self-assessment accuracy was mixed. When stratified by experience level, however, novice endoscopists were least accurate in their self-assessments and tended to overestimate their performance. Studies examining the utility of video-based interventions using observation of expert benchmark performances show promise as a mechanism to improve self-assessment accuracy among novices.

CONCLUSIONS

Based on the results of this review, we highlight problematic areas, identify opportunities to improve the methodological rigor of future studies on endoscopic self-assessment and outline potential avenues for further exploration.

Progressive learning in endoscopy simulation training improves clinical performance: a blinded randomized trial

BACKGROUND AND AIMS

A structured comprehensive curriculum (SCC) that uses simulation-based training (SBT) can improve clinical colonoscopy performance. This curriculum may be enhanced through the application of progressive learning, a training strategy centered on incrementally challenging learners. We aimed to determine whether a progressive learning-based curriculum (PLC) would lead to superior clinical performance compared with an SCC.

METHODS

This was a single-blinded randomized controlled trial conducted at a single academic center. Thirty-seven novice endoscopists were recruited and randomized to either a PLC (n = 18) or to an SCC (n = 19). The PLC comprised 6 hours of SBT, which progressed in complexity and difficulty. The SCC included 6 hours of SBT, with cases of random order of difficulty. Both groups received expert feedback and 4 hours of didactic teaching. Participants were assessed at baseline, immediately after training, and 4 to 6 weeks after training. The primary outcome was participants' performance during their first 2 clinical colonoscopies, as assessed by using the Joint Advisory Group Direct Observation of Procedural Skills assessment tool (JAG DOPS). Secondary outcomes were differences in endoscopic knowledge, technical and communication skills, and global performance in the simulated setting.

RESULTS

The PLC group outperformed the SCC group during first and second clinical colonoscopies, measured by JAG DOPS (P < .001). Additionally, the PLC group had superior technical and communication skills and global performance in the simulated setting (P < .05). There were no differences between groups in endoscopic knowledge (P > .05).

CONCLUSIONS

Our findings demonstrate the superiority of a PLC for endoscopic simulation, compared with an SCC. Challenging trainees progressively is a simple, theory-based approach to simulation whereby the performance of clinical colonoscopies can be improved. (Clinical trial registration number: NCT02000180.).