A prospective comparison of live and video-based assessments of colonoscopy performance

Published:August 28, 2017DOI:

      Background and Aims

      Colonoscopy performance is typically assessed by a supervisor in the clinical setting. There are limitations of this approach, however, because it allows for rater bias and increases supervisor workload demand during the procedure. Video-based assessment of recorded procedures has been proposed as a complementary means by which to assess colonoscopy performance. This study sought to investigate the reliability, validity, and feasibility of video-based assessments of competence in performing colonoscopy compared with live assessment.


      Novice (<50 previous colonoscopies), intermediate (50-500), and experienced (>1000) endoscopists from 5 hospitals participated. Two views of each colonoscopy were videotaped: an endoscopic (intraluminal) view and a recording of the endoscopist’s hand movements. Recorded procedures were independently assessed by 2 blinded experts using the Gastrointestinal Endoscopy Competency Assessment Tool (GiECAT), a validated procedure-specific assessment tool comprising a global rating scale (GRS) and checklist (CL). Live ratings were conducted by a non-blinded expert endoscopist. Outcomes included agreement between live and blinded video-based ratings of clinical colonoscopies, intra-rater reliability, inter-rater reliability and discriminative validity of video-based assessments, and perceived ease of assessment.


      Forty endoscopists participated (20 novices, 10 intermediates, and 10 experienced). There was good agreement between the live and video-based ratings (total, intra-class correlation [ICC] = 0.847; GRS, ICC = 0.868; CL, ICC = 0.749). Intra-rater reliability was excellent (total, ICC = 0.99; GRS, ICC = 0.99; CL, ICC = 0.98). Inter-rater reliability between the 2 blinded video-based raters was high (total, ICC = 0.91; GRS, ICC = 0.918; CL, ICC = 0.862). GiECAT total, GRS, and CL scores differed significantly among novice, intermediate, and experienced endoscopists (P < .001). Video-based assessments were perceived as “fairly easy,” although live assessments were rated as significantly easier (P < .001).


      Video-based assessments of colonoscopy procedures using the GiECAT have strong evidence of reliability and validity. In addition, assessments using videos were feasible, although live assessments were easier.


      CI (confidence interval), CL (checklist), GiECAT (Gastrointestinal Endoscopy Competency Assessment Tool), GRS (global rating scale), ICC (intra-class correlation coefficient), SD (standard deviation)
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      Linked Article

      • Video-based performance assessment in endoscopy: Moving beyond “see one, do one, teach one”?
        Gastrointestinal EndoscopyVol. 87Issue 3
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          We are living in an era of incredible and rapid change in healthcare delivery, with economic forces, technological innovations, and even social media1 rapidly changing the practice of gastroenterology. Over the past 30 years, GI endoscopy has been shaped by improvements in video quality and processing, with each new generation of endoscopes offering greater diagnostic and therapeutic potential, and in the process increasing the breadth of diseases that are amenable to endoscopic management. However, despite the rapid advancements in endoscope technology, the traditional method of teaching endoscopy and assessing competency has hardly changed; namely, bedside proctoring with real-time feedback and hands-on instruction.
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