title: Gastrointestinal Endoscopy Competency Assessment Tool: reliability and validity evidence.
abstract: BACKGROUND
  Rigorously developed and validated direct observational assessment tools are required to support competency-based colonoscopy training to facilitate skill acquisition, optimize learning, and ensure readiness for unsupervised practice.
  
  
  OBJECTIVE
  To examine reliability and validity evidence of the Gastrointestinal Endoscopy Competency Assessment Tool (GiECAT) for colonoscopy for use within the clinical setting.
  
  
  METHODS
  Prospective, observational, multicenter validation study. Sixty-one endoscopists performing 116 colonoscopies were assessed using the GiECAT, which consists of a 7-item global rating scale (GRS) and 19-item checklist (CL). A second rater assessed procedures to determine interrater reliability by using intraclass correlation coefficients (ICCs). Endoscopists' first and second procedure scores were compared to determine test-retest reliability by using ICCs. Discriminative validity was examined by comparing novice, intermediate, and experienced endoscopists' scores. Concurrent validity was measured by correlating scores with colonoscopy experience, cecal and terminal ileal intubation rates, and physician global assessment.
  
  
  METHODS
  A total of 116 colonoscopies performed by 33 novice (<50 previous procedures), 18 intermediate (50-500 previous procedures), and 10 experienced (>1000 previous procedures) endoscopists from 6 Canadian hospitals.
  
  
  METHODS
  Interrater and test-retest reliability, discriminative, and concurrent validity.
  
  
  RESULTS
  Interrater reliability was high (total: ICC=0.85; GRS: ICC=0.85; CL: ICC=0.81). Test-retest reliability was excellent (total: ICC=0.91; GRS: ICC=0.93; CL: ICC=0.80). Significant differences in GiECAT scores among novice, intermediate, and experienced endoscopists were noted (P<.001). There was a significant positive correlation (P<.001) between scores and number of previous colonoscopies (total: ρ=0.78, GRS: ρ=0.80, CL: Spearman's ρ=0.71); cecal intubation rate (total: ρ=0.81, GRS: Spearman's ρ=0.82, CL: Spearman's ρ=0.75); ileal intubation rate (total: Spearman's ρ=0.82, GRS: Spearman's ρ=0.82, CL: Spearman's ρ=0.77); and physician global assessment (total: Spearman's ρ=0.90, GRS: Spearman's ρ=0.94, CL: Spearman's ρ=0.77).
  
  
  CONCLUSIONS
  Nonblinded assessments.
  
  
  CONCLUSIONS
  This study provides evidence supporting the reliability and validity of the GiECAT for use in assessing the performance of live colonoscopies in the clinical setting.
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Toronto, Ontario, Canada; Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada; Wilson Centre, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Catharine M
authors.initials: CM
authors.lastname: Walsh
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Toronto, Ontario, Canada; Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Simon C
authors.initials: SC
authors.lastname: Ling
authors.affiliation: Division of Gastroenterology, St. Joseph's Health Centre, University of Western Ontario, London, Ontario, Canada.
authors.forename: Nitin
authors.initials: N
authors.lastname: Khanna
authors.affiliation: Division of Gastroenterology, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Samir C
authors.initials: SC
authors.lastname: Grover
authors.affiliation: Wilson Centre, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Yu
authors.affiliation: Division of Gastroenterology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Mary Anne
authors.initials: MA
authors.lastname: Cooper
authors.affiliation: Division of Gastroenterology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Elaine
authors.initials: E
authors.lastname: Yong
authors.affiliation: Division of Gastroenterology, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Geoffrey C
authors.initials: GC
authors.lastname: Nguyen
authors.affiliation: Division of Gastroenterology, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Gary
authors.initials: G
authors.lastname: May
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Toronto, Ontario, Canada; Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Walters
authors.affiliation: Faculty of Health Sciences, Queen's University Kingston, Ontario, Canada.
authors.forename: Richard
authors.initials: R
authors.lastname: Reznick
authors.affiliation: Division of Gastroenterology, Mount Sinai Hospital, Toronto, Ontario, Canada; Cancer Care Ontario, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Linda
authors.initials: L
authors.lastname: Rabeneck
authors.affiliation: School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John's, Newfoundland, Canada.
authors.forename: Heather
authors.initials: H
authors.lastname: Carnahan
mesh_terms: D000368:Aged; D057189:Checklist / Q000379:methods*; D002983:Clinical Competence; D003113:Colonoscopy / Q000193:education / Q000706:statistics & numerical data; D005260:Female; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D064887:Observational Studies as Topic; D010808:Physical Examination; D011446:Prospective Studies; D011787:Quality of Health Care; D015203:Reproducibility of Results