Measures of trainee performance in advanced endoscopy: A systematic review

Area of Science:

• Medical Education
• Gastroenterology
• Surgical Skills Assessment

Background:

• Advanced endoscopy training presents challenges due to technical complexity and inherent risks.
• The shift towards competency-based training necessitates validated performance measures for trainees.
• Individual learning curves in endoscopy vary, highlighting the need for standardized assessment tools.

Purpose of the Study:

• To systematically review and critically evaluate existing performance measures for advanced endoscopy trainees.
• To identify validated tools for assessing skills in complex endoscopic procedures.
• To inform the development of competency-based training curricula in advanced endoscopy.

Main Methods:

• A comprehensive literature search was conducted across major databases (MEDLINE, EMBASE, CENTRAL, ISI Web of Knowledge) from 1980 to 2016.
• Search strategy employed MeSH terms related to 'advanced endoscopy' and 'performance'.
• Outcomes assessed included face, content, and construct validity, alongside reliability of performance measures.

Main Results:

• 77 studies met inclusion criteria, covering procedures like ERCP, EUS, colonoscopic polypectomy (CP), and balloon-assisted enteroscopy (BAE).
• Validated and reliable performance measures were identified for ERCP, EUS, and CP, applicable to both patient-based and simulator training.
• Specific technical skills demonstrated validity as performance measures, including selective biliary cannulation (ERCP) and T-staging (EUS). Evidence for EMR and luminal stenting was insufficient.

Conclusions:

• Multiple valid and accessible performance measures exist for trainees in ERCP, EUS, CP, BAE, and RFA.
• These validated tools are crucial for advanced endoscopy training programs transitioning to competency-based education.
• Implementation of these measures supports a move from traditional apprenticeship to objective skill assessment.