title: Fundamentals of endoscopic surgery: creation and validation of the hands-on test.
abstract: BACKGROUND
  The Fundamentals of Endoscopic Surgery™ (FES) program consists of online materials and didactic and skills-based tests. All components were designed to measure the skills and knowledge required to perform safe flexible endoscopy. The purpose of this multicenter study was to evaluate the reliability and validity of the hands-on component of the FES examination, and to establish the pass score.
  
  
  METHODS
  Expert endoscopists identified the critical skill set required for flexible endoscopy. They were then modeled in a virtual reality simulator (GI Mentor™ II, Simbionix™ Ltd., Airport City, Israel) to create five tasks and metrics. Scores were designed to measure both speed and precision. Validity evidence was assessed by correlating performance with self-reported endoscopic experience (surgeons and gastroenterologists [GIs]). Internal consistency of each test task was assessed using Cronbach's alpha. Test-retest reliability was determined by having the same participant perform the test a second time and comparing their scores. Passing scores were determined by a contrasting groups methodology and use of receiver operating characteristic curves.
  
  
  RESULTS
  A total of 160 participants (17 % GIs) performed the simulator test. Scores on the five tasks showed good internal consistency reliability and all had significant correlations with endoscopic experience. Total FES scores correlated 0.73, with participants' level of endoscopic experience providing evidence of their validity, and their internal consistency reliability (Cronbach's alpha) was 0.82. Test-retest reliability was assessed in 11 participants, and the intraclass correlation was 0.85. The passing score was determined and is estimated to have a sensitivity (true positive rate) of 0.81 and a 1-specificity (false positive rate) of 0.21.
  
  
  CONCLUSIONS
  The FES hands-on skills test examines the basic procedural components required to perform safe flexible endoscopy. It meets rigorous standards of reliability and validity required for high-stakes examinations, and, together with the knowledge component, may help contribute to the definition and determination of competence in endoscopy.
authors.affiliation: McGill University Health Centre, Montreal General Hospital, 1650 Cedar Avenue, L9-313, Montreal, QC, H3G 1A4, Canada, melinavassiliou@gmail.com.
authors.forename: Melina C
authors.initials: MC
authors.lastname: Vassiliou
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Dunkin
authors.forename: Gerald M
authors.initials: GM
authors.lastname: Fried
authors.forename: John D
authors.initials: JD
authors.lastname: Mellinger
authors.forename: Thadeus
authors.initials: T
authors.lastname: Trus
authors.forename: Pepa
authors.initials: P
authors.lastname: Kaneva
authors.forename: Calvin
authors.initials: C
authors.lastname: Lyons
authors.forename: James R
authors.initials: JR
authors.lastname: Korndorffer
authors.forename: Michael
authors.initials: M
authors.lastname: Ujiki
authors.forename: Vic
authors.initials: V
authors.lastname: Velanovich
authors.forename: Michael L
authors.initials: ML
authors.lastname: Kochman
authors.forename: Shawn
authors.initials: S
authors.lastname: Tsuda
authors.forename: Jose
authors.initials: J
authors.lastname: Martinez
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Scott
authors.forename: Gary
authors.initials: G
authors.lastname: Korus
authors.forename: Adrian
authors.initials: A
authors.lastname: Park
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Marks
mesh_terms: D000328:Adult; D002983:Clinical Competence; D003198:Computer Simulation; D004502:Education, Medical, Continuing / Q000592:standards*; D004521:Educational Measurement / Q000379:methods*; D004724:Endoscopy / Q000193:education*; D005260:Female; D006801:Humans; D008297:Male; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014481:United States