The data collected from such an ongoing evaluation system allow reporting of a fellow's performance at any given point in their training as well as the comparison of the individual's scores to the average learning curve of his/her peers at the same points in training (Figure 6.35). In the examples shown, progress reports can graphically depict the learning curves of any of the various competency parameters. In this example, the progress of three different first year fellows—A, B, and C (above, at, and below average, respectively)—is shown. This allows program directors to spot early those trainees who are falling off the learning curve and provide intervention earlier in training. Additionally, these metrics and average learning curves are valuable data for establishing criteria to define what performance equates to “competence” in a reliable, reproducible, and generizable manner. The concept of “competence” at present is rather limited in scope. A method that can formally define and assess competence such as ACE Tool or DOPS can be powerful tools. Each teaching institution should be encouraged to adopt some form of continuous assessment process whether using a comprehensive form such as the one described here or an ongoing skills assessment in a more limited form. Eventually, professional organizations and regulating organizations will require some type of direct measures of competence for all training portfolios as the parameters of cognitive and motor competence are increasingly better defined [50, 51].
Table 6.4 Assessment of Competence in Endoscopy (ACE) tool. This survey is completed by staff during each colonoscopy and grades a fellow's various cognitive and motor skills. This form is meant to augment the data already collected by the procedural database (such as medications administered, cecal intubation, and withdrawal times). Such a form allows for continuous assessment of a fellow's individual skills as they progress toward competence. (Copyrighted and used with permission of Mayo Foundation for Medical Education and Research.)
Modified from the Mayo Colonoscopy Skills Assessment Tool (© Mayo Foundation for Medical Education and Research) as reported in Sedlack RE. The Mayo Colonoscopy Skills Assessment Tool: a validation of a unique instrument to assess colonoscopy skills in trainees. Gastrointest Endosc 2010;72:1125–33. Used with permission.
| ASGE Assessment of Competency in Endoscopy (ACE). Colonoscopy Skills Assessment Tool Fellow: Staff: Date of procedure: Time of Intubation: Time of Maximal Insertion Extent: Time of Extubation: |
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Fellow’s knowledge of the indication and pertinent medical issues (INR, Vitals, Allergies, PMH, etc.):
□ N/A. Not Assessed (i.e. Fellow observed procedure only)
□ 1. Novice (Poor knowledge of patient’s issue, or started sedating without knowing the indication)
□ 2. Intermediate (Missed an Important element, i.e. Allergies, GI Surgical History, or INR in pt on Coumadin) □ 3. Advanced (Missed minor elements)
□ 4. Superior (Appropriate knowledge and integration of patient information)
Management of patient discomfort during this procedure (Sedation titration, Insufflation management, Loop reduction):
□ N/A Fellow observed
□ 1. Novice (Does not quickly recognize patient discomfort or requires repeated staff prompting to act)
□ 2. Intermediate (Recognizes pain but does not address cause [loop or sedation problems] in a timely manner)
□ 3. Advanced (Adequate recognition and corrective measures)
□ 4. Superior (Competent continuous assessment and management, i.e. intermittently reassess level of sedation and comfort)
Effective and efficient use of air, water, and suction:
□ N/A. Not Assessed (i.e. Fellow observed procedure only)
□ 1. Novice (Repeated prompting due to too much/little air, inadequate washing, or repeated suctioning of mucosa)
□ 2. Intermediate (Occasional prompting due to too much/little air, inadequate washing or repeated suctioning of mucosa)
□ 3. Advanced (Adequate use of air, water and suctioning, but room to improve on efficiency)
□ 4. Superior (Efficient and effective management of washing, suctioning, and air)
Lumen identification:
□ N/A. Not Assessed (i.e. Fellow observed procedure only)
□ 1. Novice (Generally only able to recognize lumen if in direct view)
□ 2. Intermediate (Can grossly interpret large folds to help locate which direction the lumen is located)
□ 3. Advanced (Can use more subtle clues [Light/shadows, arcs of fine circular muscles in wall] but struggles at times)
□ 4. Superior (Quickly and reliably recognizes where lumen should be based on even subtle clues)
Scope steering technique during advancement:
□ N/A. Not Assessed (i.e. Fellow observed procedure only)
□ 1. Novice (Primarily “Two‐hand knob steering”, unable to perform two steering maneuvers simultaneously)
□ 2. Intermediate (Frequent 2‐hand knob steering, limited use of simultaneous steering maneuvers [i.e. torque, knob, advance])
□ 3. Advanced (Primarily uses torque steering, can perform simultaneous steering techniques)
□ 4. Superior (Effortlessly combines simultaneous steering techniques [torque, knob, advance] to navigate even many difficult turns)
Fine tip control:
□ N/A. Not Assessed (i.e. Fellow observed procedure only)
□ 1. Novice (Primarily gross tip control only, frequently in red out)
□ 2. Intermediate (Limited fine tip control, “frequently over‐steers turns, struggles with biopsy forceps/snare targeting”)
□ 3. Advanced (loses fine control when keeping lumen or targeting tools at difficult turns when torque or knobs are needed)
□ 4. Superior (Excellent fine tip control or tool targeting even in difficult situation.)
Loop reduction techniques (pull‐back, external pressure, patient position change):
□ N/A. Not Assessed (i.e. Fellow observed procedure only)
□ 1. Novice (Unable to reduce/avoid loops without hands‐on assistance)
□ 2. Intermediate (Needs considerable coaching on when or how to perform loop‐reduction maneuvers)
□ 3. Advanced (Able to reduce/avoid loops with limited coaching)
□ 4. Superior (Without coaching, uses appropriate ext. pressure/position changes/loop‐reduction techniques)
What is the farthest landmark the fellow reached without any hands‐on assistance?
□ N/A. Fellow observed only or Procedure terminated before completion.
□ 1.Rectum, □ 2. Sigmoid, □ 3. Splenic flexure, □ 4. hepatic flexure,
□ 5. Cecum No TI attempt (Reached cecum with no attempt at TI intubation)
□ 6. Cecum Failed TI attempt (Reached cecum but Failed attempt at TI intubation)
□ 7. Terminal Ileum (Successful intubation of TI)
□ 8. Other‐Post surgical anatomy encountered, fellow reached maximal intubation
Adequately visualized mucosa during withdrawal
□ N/A. Not Assessed (i.e. Fellow observed procedure only)
□ 1. Novice (Red out much of the time, does not visualize significant portions of the mucosa or requires assistance)
□ 2. Intermediate (Able to visualize much of the mucosa but requires direction to re‐inspect missed areas)
□ 3. Advanced (Able to adequately visualize most of the mucosa without coaching)
□ 4. Superior (Good visualization
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