The Gastrointestinal Endoscopy Competency Assessment Tool for Pediatric Colonoscopy

Objectives: Validated assessment tools are required to support competency-based education. We aimed to assess the reliability and validity of the Gastrointestinal Endoscopy Competency Assessment Tool for Pediatric Colonoscopy (GiECAT(KIDS)), an instrument developed by 41 North American experts using Delphi methodology. Methods: GiECAT(KIDS) consists of a 7-item global rating scale (GRS) and an 18-item checklist (CL). An attending physician assessed 104 colonoscopies performed at 3 North American hospitals by 56 endoscopists, including 25 novices (<50 previous procedures), 21 intermediates (50-250), and 10 advanced endoscopists (>500). Another observer rated procedures to assess interrater reliability using intraclass correlation coefficient (ICC). Test-retest reliability was measured with ICC comparing endoscopists' first and second procedure scores. Discriminative validity was examined by comparing experience level with scores. Concurrent validity was assessed by correlating scores with colonoscopy experience, cecal and terminal ileal intubation rates, and physician global assessment. Results: Interrater reliability of the GiECAT(KIDS) was high (total: ICC = 0.88; GRS: ICC = 0.79; CL: ICC = 0.89). Test-retest reliability was excellent (total: ICC = 0.94; GRS: ICC = 0.94; CL: ICC = 0.84). GiECAT(KIDS) total, GRS, and CL scores differed significantly among novice, intermediate, and advanced endoscopists (P < 0.001). There was a significant positive correlation (P < 0.001) between scores and number of previous colonoscopies (total: rho = 0.91, GRS: rho = 0.92, CL: rho = 0.84), cecal intubation rate (total: rho = 0.82, GRS: rho = 0.85, CL: rho = 0.77), ileal intubation rate (total: rho = 0.82, GRS: rho = 0.82, CL: rho = 0.80), and physician global assessment (total: rho = 0.95, GRS: rho = 0.94, CL: rho = 0.89). Conclusions: The GiECAT(KIDS) demonstrates strong reliability and validity as a measure of performance of pediatric colonoscopy that can be used to support training and assessment.