title: Assessment of colorectal polyp recognition skill: development and validation of an objective test.
abstract: The quality of colonoscopy is known to vary. The extent to which colonoscopists can recognize the presence of subtle colorectal lesions by visually distinguishing them from the surrounding mucosa (i.e., polyp recognition skill) may be one of several attributes that influence polyp detection rates. The aim of the present study was to develop and validate the first objective test of polyp recognition skill.
  
  
  
  Validation study. Twenty-eight experienced colonoscopists and eighty novices took a preliminary 280-item computer-based polyp recognition test. Items were genuine endoscopic images which participants assessed for the presence of "likely polyps." Half included clinically identified polyps. Participants clicked on a suspected lesion or a button marked "no likely polyp", and the main outcome measures were accuracy and response latency. The best items were selected for the final 50-item test.
  
  
  
  In the preliminary test, experienced colonoscopists correctly identified more polyps than novices (P < .0001) and better discriminated between clinically identified polyps and non-polyp features (as measured by d', P < .0001). For polyp items, the experienced group also responded faster (P < .01). Effect sizes were large for accuracy (Cohen's d = 3.22) and d' (Cohen's d = 3.22). The 50 final test items produced comparable results for accuracy, d', and response latency. For both versions of the test, score scale reliability was high for both polyp and non-polyp items (α = .82 to .97).
  
  
  
  The observed experienced-novice differences support the construct validity of the performance measures derived from the tests, indicating that polyp recognition skill can be quantified objectively. The final test may potentially be used to assess trainees, but test sensitivity may be insufficient to make fine-grained distinctions between different skill levels among experienced colonoscopists. More sensitive future tests may provide a valuable supplement to clinical detection rates, allowing objective comparisons between skilled colonoscopists.
authors.affiliation: Clinical Skills Development Service, Metro North Hospital and Health Service, Brisbane, Australia. Andrew.Hill@health.qld.gov.au.|School of Psychology, The University of Queensland, Brisbane, Australia. Andrew.Hill@health.qld.gov.au.
authors.forename: Andrew
authors.initials: A
authors.lastname: Hill
authors.affiliation: School of Psychology, The University of Queensland, Brisbane, Australia.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Horswill
authors.affiliation: School of Human Movement Studies, The University of Queensland, Brisbane, Australia.
authors.forename: Annaliese M
authors.initials: AM
authors.lastname: Plooy
authors.affiliation: Clinical Skills Development Service, Metro North Hospital and Health Service, Brisbane, Australia.|School of Psychology, The University of Queensland, Brisbane, Australia.|School of Medicine, The University of Queensland, Brisbane, Australia.
authors.forename: Marcus O
authors.initials: MO
authors.lastname: Watson
authors.affiliation: School of Medicine, The University of Queensland, Brisbane, Australia.
authors.forename: Lachlan N
authors.initials: LN
authors.lastname: Rowlands
authors.affiliation: School of Human Movement Studies, The University of Queensland, Brisbane, Australia.
authors.forename: Guy M
authors.initials: GM
authors.lastname: Wallis
authors.affiliation: School of Human Movement Studies, The University of Queensland, Brisbane, Australia.
authors.forename: Stephan
authors.initials: S
authors.lastname: Riek
authors.affiliation: School of Human Movement Studies, The University of Queensland, Brisbane, Australia.
authors.forename: Robin
authors.initials: R
authors.lastname: Burgess-Limerick
authors.affiliation: Clinical Skills Development Service, Metro North Hospital and Health Service, Brisbane, Australia.|School of Medicine, The University of Queensland, Brisbane, Australia.
authors.forename: David G
authors.initials: DG
authors.lastname: Hewett
mesh_terms: D002983:Clinical Competence; D003106:Colon / Q000000981:diagnostic imaging*; D003111:Colonic Polyps / Q000000981:diagnostic imaging; D003113:Colonoscopy; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000000981:diagnostic imaging*; D007417:Intestinal Polyps / Q000000981:diagnostic imaging*; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D012007:Rectum / Q000000981:diagnostic imaging*; D015203:Reproducibility of Results
keywords: Colonoscopy; Polyp detection; Polyp recognition; Skill assessment; Training