title: Simulated Colonoscopy Objective Performance Evaluation (SCOPE): a non-computer-based tool for assessment of endoscopic skills.
abstract: BACKGROUND
  The Simulated Colonoscopy Objective Performance Evaluation (SCOPE) was developed to fill the need for a lower-cost, non-virtual-reality (VR)-based assessment tool. This study aimed to evaluate the ability of SCOPE to assess endoscopic skills objectively.
  
  
  METHODS
  Four tasks were created using the Kyoto Kagaku colonoscopy model (Kyoto Kagaku Co., Ltd., Kyoto, Japan). The SCOPE tasks included Scope Manipulation (SM) requiring torque and tip deflection to align a shape in the colon with a matching shape on the monitor; Tool Targeting (TT) requiring coordination with biopsy forceps to contact a metal target; Loop Management (LM) requiring prevention, recognition, and reduction of a redundant sigmoid colon with navigation to the cecum; and Mucosal Inspection (MI) requiring identification of simulated polyps during withdrawal and retroflexion. Key performance metrics were identified, and a normalized scoring system was developed. For the study, 35 subjects were stratified into three cohorts based on colonoscopy experience: novice (0-50 colonoscopies; n = 11), intermediate (51-139 colonoscopies; n = 13), and experienced (>140 colonoscopies; n = 11). The subjects performed two trials of all four tasks.
  
  
  RESULTS
  Across all four tasks, the experienced endoscopists (E) consistently outperformed the intermediates (I), who in turn outperformed the novices (N). The mean normalized scores with 95 % confidence intervals (CI) are as follows: SM: N (54; range, 26-82), I (92; range, 79-106), E (106; range, 93-118) (p = 0.0006). TT: N (40; range, 24-55), I (77; range, 63-91), E (88; range, 72-105) (p < 0.0001). LM: N (51; range, 24-79), I (80; range, 59-101), E (101; range, 98-105) (p = 0.003). MI: N (73; range, 53-92), I (85; range, 76-95), E (100; range, 91-108) (p = 0.013). Total score: N (218; range, 155-280), I (335; range, 299-371), E (395; range, 371-419) (p < 0.0001). The test-retest reliability (0.6) for the expert total score was respectable.
  
  
  CONCLUSIONS
  The validity evidence from this study shows that scores on SCOPE tasks can differentiate between groups expected to have different levels of technical skill. This model shows promise as a low-technology tool for objective assessment or training of endoscopic skills.
authors.affiliation: Norman M. Rich Department of Surgery, Uniformed Services University/Walter Reed National Military Medical Center, 4301 Jones Bridge Road A-3010, Bethesda, MD, 20814, USA, eritter@usuhs.edu.
authors.forename: E M
authors.initials: EM
authors.lastname: Ritter
authors.forename: T C
authors.initials: TC
authors.lastname: Cox
authors.forename: K D
authors.initials: KD
authors.lastname: Trinca
authors.forename: J P
authors.initials: JP
authors.lastname: Pearl
mesh_terms: D002983:Clinical Competence; D003113:Colonoscopy / Q000193:education*; D003363:Cost Control; D004521:Educational Measurement / Q000191:economics* / Q000379:methods*; D005260:Female; D006801:Humans; D007564:Japan; D017145:Models, Educational; D015203:Reproducibility of Results; D013647:Task Performance and Analysis