Assessment of Endoscopic Skills of Gastroenterology Trainees by Self-Evaluation, Endoscopy Nurses and Attendings: Correlation Between Three Sides of the Story

Abstract

Background: Assessment of competence in endoscopic procedures is poorly studied and lacks clear definitions. Traditionally, endoscopic skills are evaluated by attendings but this may be prone to subjective bias due to each attendings preference for individual technique. Endoscopy nurses observe all endoscopists including trainees, hence they may have a different perspective when evaluating skills. Thus, endoscopy nurses may play an important role in the assessment of trainees skills. Since there are no definite objective methods of scoring endoscopic skills, trainees may have a different perception of their own skills compared to that of attendings and nurses. Aims: To determine the correlation between trainees self-evaluation (TSE) and nurses evaluation with that of the attendings in the assessment of trainees endoscopic skills. Methods: This study was done in Gastroenterology division at MetroHealth Medical Center where there are 8 trainees, 8 attendings and 10 endoscopy nurses. Evaluation sheets to grade trainees on a scale of 1-6 (1 = poor, 2 = fair, 3 = good, 4 = very good, 5 = excellent and 6 = outstanding) in four parameters i.e., interpersonal skills, endoscopic knowledge, technical skills in upper endoscopy and colonoscopy were distributed. Overall evaluation was calculated from the above scores. Evaluators were blinded to each other and confidentiality was maintained. Combined nurses evaluation (CNE) and combined attending evaluation (CAE) was derived from Mean of all scores of individual evaluators. Results: There was a good correlation between CNE and CAE in all parameters including overall evaluation (r = 0.571- 0.786, p < 0.05) except in colonoscopy skills (r = 0.138, p > 0.05). The CNE uniformly over-graded trainees by 0.28 to 0.51 points compared to CAE. There was no correlation between TSE and CAE (r = 0.000-0.634, p > 0.05). There were variations in the evaluation of trainees among individual attendings and nurses. Conclusions: In the assessment of endoscopic skills of trainees, CNE correlates well with CAE. Self-perception of endoscopic skills by trainees does not correlate with CAE. Global evaluation by all attendings and nurses should be considered to grade trainees endoscopic skills, since individual evaluations may be prone to subjective bias. This issue should be given greater attention in the assessment of endoscopic skills in future.