Development and validation of a novel method for assessing competency in polypectomy: direct observation of polypectomy skills

Background: Despite its ubiquitous use over the past 4 decades, there is no structured, formal method with which to assess polypectomy. Objective: To develop and validate a new method with which to assess competency in polypectomy. Design: Polypectomy underwent task deconstruction, and a structured checklist and global assessment scale were developed (direct observation of polypectomy skills [DOPyS]). Sixty bowel cancer screening polypectomy videos were randomly chosen for analysis and were scored independently by 7 expert assessors by using DOPyS. Each parameter and the global rating were scored from 1 to 4 (scores >= 3 = competency). The scores were analyzed by using generalizability theory (G theory). Setting: multicenter. Results: Fifty-nine of the 60 videos were assessable and scored. The majority of the assessors agreed across the pass/fail divide for the global assessment scale in 58 of 59 (98%) polyps. For G-theory analysis, 47 of the 60 videos were analyzed. G-theory analysis suggested that DOPyS is a reliable assessment tool, provided that it is used by 2 assessors to score 5 polypectomy videos all performed by 1 endoscopist. DOPyS scores obtained in this format would reflect the endoscopist's competence. Limitations: Small sample and polyp size. Conclusions: This study is the first attempt to develop and validate a tool designed specifically for the assessment of technical skills in performing polypectomy. G-theory analysis suggests that DOPyS could reliably reflect an endoscopist's competence in performing polypectomy provided a requisite number of assessors and cases were used. (Gastrointest Endosc 2011;73:1232-39.)