title: Combining different methods improves assessment of competence in colonoscopy.
abstract: OBJECTIVE
  To develop a reliable method of assessing competence in colonoscopy based on multiple sources.
  
  
  METHODS
  Physicians with varying degrees of experience in colonoscopy performed two colonoscopies each in a standardized simulated environment. Their performances were assessed under direct observation by an expert rater and by automatic computerized analysis of operator movements and scope movements, respectively. Reliability (Cronbach's alpha) for subjective assessment, time to cecum, analysis of operator movement and analysis of scope movements were calculated. Composite score calculations were used to explore different combinations of the measures.
  
  
  RESULTS
  Twenty physicians were included in the study. The reliability (Cronbach's alpha) were 0.92, 0.57, 0.87 and 0.55 for the subjective score assessed under direct observation, time to cecum, distance between operator's hands and colonoscopy progression score, respectively. Equal weight (=25%) to all four methods resulted in a reliability of 0.91 and optimal weighting of the methods (55%, 10%, 25% and 10%, respectively) resulted in a maximum reliability of 0.95.
  
  
  CONCLUSIONS
  Combining subjective expert ratings with automated objective assessments results in a less biased and more reliable assessment of competence in colonoscopy.
authors.affiliation: a Copenhagen Academy for Medical Education and Simulation (CAMES) , The Capital Region of Denmark , Copenhagen , Denmark.
authors.forename: Lars
authors.initials: L
authors.lastname: Konge
authors.affiliation: b Marine Biological Laboratory, Department of Biology , University of Copenhagen , Helsingør , Denmark.
authors.forename: Morten Bo Søndergaard
authors.initials: MB
authors.lastname: Svendsen
authors.affiliation: c Department of Surgery, C-Tx , Copenhagen University Hospital Rigshospitalet , Copenhagen , Denmark.
authors.forename: Louise
authors.initials: L
authors.lastname: Preisler
authors.affiliation: c Department of Surgery, C-Tx , Copenhagen University Hospital Rigshospitalet , Copenhagen , Denmark.
authors.forename: Lars Bo
authors.initials: LB
authors.lastname: Svendsen
authors.affiliation: d Department of Medical Education , University of Illinois Chicago , Chicago , IL , USA.
authors.forename: Yoon Soo
authors.initials: YS
authors.lastname: Park
mesh_terms: D000328:Adult; D002983:Clinical Competence / Q000592:standards*; D003113:Colonoscopy / Q000193:education*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010820:Physicians; D015203:Reproducibility of Results
keywords: Colonoscopy; assessment; competence; composite scores; multisource assessment