title: Reliable and valid assessment of competence in endoscopic ultrasonography and fine-needle aspiration for mediastinal staging of non-small cell lung cancer.
abstract: OBJECTIVE
  Fine-needle aspiration (FNA) guided by endoscopic ultrasonography (EUS) is important in mediastinal staging of non-small cell lung cancer (NSCLC). Training standards and implementation strategies of this technique are currently under discussion. The aim of this study was to explore the reliability and validity of a newly developed EUS Assessment Tool (EUSAT) designed to measure competence in EUS - FNA for mediastinal staging of NSCLC.
  
  
  METHODS
  A total of 30 patients with proven or suspected NSCLC underwent EUS - FNA for mediastinal staging by three trainees and three experienced physicians. Their performances were assessed prospectively by three experts in EUS under direct observation and again 2 months later in a blinded fashion using digital video-recordings. Based on the assessments, intra-rater reliability, inter-rater reliability, and construct validity were explored.
  
  
  RESULTS
  The intra-rater reliability was good (Cronbach's α = 0.80), but comparison of results based on direct observations and blinded video-recordings indicated a significant bias favoring consultants (P = 0.022). Inter-rater reliability was very good (Cronbach's α = 0.93). However, one rater assessing five procedures or two raters each assessing four procedures were necessary to secure a generalizability coefficient of 0.80. The assessment tool demonstrated construct validity by discriminating between trainees and experienced physicians (P = 0.034).
  
  
  CONCLUSIONS
  Competency in mediastinal staging of NSCLC using EUS and EUS - FNA can be assessed in a reliable and valid way using the EUSAT assessment tool. Measuring and defining competency and training requirements could improve EUS quality and benefit patient care.
authors: Centre for Clinical Education, University of Copenhagen and Capital Region of Denmark, Copenhagen, Denmark. lkonge@yahoo.dk
authors: L
authors: L
authors: Konge
authors: P
authors: P
authors: Vilmann
authors: P
authors: P
authors: Clementsen
authors: J T
authors: JT
authors: Annema
authors: C
authors: C
authors: Ringsted
mesh_terms: D000704:Analysis of Variance; D001707:Biopsy, Needle; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging / Q000473:pathology*; D002983:Clinical Competence; D019160:Endosonography; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D008297:Male; D008482:Mediastinum / Q000000981:diagnostic imaging / Q000473:pathology*; D009367:Neoplasm Staging; D011446:Prospective Studies; D015203:Reproducibility of Results; D014741:Video Recording