Assessment of competency in endoscopy: establishing and validating generalizable competency benchmarks for...

Area of Science:

• Medical Education
• Gastroenterology
• Procedural Skills Assessment

Background:

• Previous colonoscopy learning curves were limited to a single institution.
• The Assessment of Competency in Endoscopy (ACE) tool refines the Mayo Colonoscopy Skills Assessment Tool (MCSAT) with enhanced quality metrics.
• The study aimed to validate the ACE tool and establish generalizable colonoscopy competency benchmarks.

Purpose of the Study:

• To validate the updated Assessment of Competency in Endoscopy (ACE) tool.
• To establish generalizable learning curves and competency benchmarks for colonoscopy.
• To examine a national cohort of gastroenterology trainees.

Main Methods:

• Prospective, multicenter trial assessing gastroenterology fellows' colonoscopy skills.
• Skills evaluated using the ACE tool at intervals of every 50 procedures.
• Learning curves and competency benchmarks established using the contrasting groups method.

Main Results:

• Ninety-three fellows at 10 institutions participated, with 1061 colonoscopies assessed.
• Minimal competency thresholds included an average ACE score of 3.5, cecal intubation time <15 minutes, and 90% independent cecal intubation rate.
• Most fellows achieved all skill endpoints by 300 procedures.

Conclusions:

• Nationally generalizable learning curves for colonoscopy skills were established.
• Recommended minimal competency criteria: ACE score of 3.5, 90% cecal intubation rate, and <15 minutes intubation time.
• Average competence achieved by 250 procedures, aligning with recent recommendations but exceeding other specialties' requirements.