3363 Video evaluation of endoscopic competency.

Abstract

Background: Previous attempts at measuring competency in colonoscopy have scored depth of endoscope insertion, procedure time, identification of anatomical landmarks & frequency of ancillary manoeuvres used. Instrument manipulation/dexterity & hand-eye co-ordination are key skills necessary for achieving proficiency, but have never been objectively evaluated. Aims: To develop a qualitative & quantitative score for measuring technical competency in colonoscopy using videotape evaluation. Methods: Eight endoscopists at varying levels of experience were prospectively videotaped performing colonoscopic insertion & withdrawal, using a purpose designed video tri-split mixing unit. Three images were generated, 1). a CCTV view showing instrument handling, 2). the endoscopic mucosal view, and 3). a continuous display of anatomical depth of insertion using magnetic endoscope imaging (MEI). The video tapes were reviewed blindly and in random order by 2 experts who independently scored 4 aspects of the examination: 1. Manipulation of instrument controls [instrument grip (0-4), tip/steering control (0-3) & appropriate aspiration/insufflation (0-2)] 2. Manipulation of instrument shaft [Grip (0-2), rotation/torqueing (0-6), attempts to straighten scope (0-6)] 3. Mucosal visualisation (0-6) 4. Anatomical depth of insertion, within first 5 mins of the examination (0-4)(Maximum total score summed=33). Results: Comparing the ratings/scores as assessed by the 2 blinded experts, for each individual endoscopist, there was good repeatability/agreement for the total score summed for each of the 4 criteria (mean difference 1 (SD 3.2); 95% limits of agreement [-5.4 to 7.4]) (See Table). Conclusions: Video-evaluation provides both a reliable & objective measurement of endoscopic competence, and provides specific feedback to trainees. Further work is necessary to evaluate its usefulness in monitoring training/performance & developing standards of practice.