Validity evidence for observational ERCP competency assessment tools: a systematic review

Abstract

Background: Assessment of competence in endoscopic retrograde cholangiopancreatography (ERCP) is critical to support learning and document competence. Validity evidence supporting ERCP observational assessment tools has not been systematically evaluated. Methods: We conducted a systematic search using electronic databases and hand-searching from inception until August 2021 for studies evaluating observational assessment tools of ERCP performance. We used a unified validity framework to characterize validity evidence from five sources: content, response process, internal structure, relations to other variables, and consequences. Each domain was assigned a score of 0-3 (maximum score 15). We assessed educational utility and methodological quality using the Accreditation Council for Graduate Medical Education framework and the Medical Education Research Quality Instrument, respectively. Results: From 2769 records, we included 17 studies evaluating 7 assessment tools. Five tools were studied for clinical ERCP, one on simulated ERCP, and one on simulated and clinical ERCP. Validity evidence scores ranged from 2-12. The Bethesda ERCP Skills Assessment Tool (BESAT), ERCP Direct Observation of Procedural Skills Tool (ERCP DOPS), and The Endoscopic Ultrasound (EUS) and ERCP Skills Assessment Tool (TEESAT) had the strongest validity evidence with scores of 10, 12, and 11, respectively. Regarding educational utility, most tools were easy to use and interpret, and required minimal additional resources. Overall methodological quality was strong, with scores ranging from 10-12.5 (maximum 13.5). Conclusions: The BESAT, ERCP DOPS, and TEESAT have strong validity evidence compared to other assessments. Integrating tools into training may help drive learners’ development and support competency decision-making.

A Novel Dry Simulator Model for Learning Comprehensive Endoscopic Retrograde Cholangiopancreatography/Endoscopic Sphincterotomy Procedures while Minimizing Adverse Bleeding Events (with Video)

“…These competencies are then integrated into a global assessment tool [ 24 ]. BESAT has strong evidence of validity and the potential to promote learner growth and support decision-making when incorporated into training [ 25 ]. However, providing comprehensive feedback on each aspect of BESAT to trainees during on-the-job training with real patients can be difficult, especially in urgent situations, making simulator-based learning crucial.…”

EUS and ERCP training in Europe: Time for simulation, optimization, and standardization

“…both these assessment tools have shown strong evidence of validity for ERCP. 12 Occurrence of complications should also be assessed to evaluate competence. On average, competence in diagnostic EUS is achieved in 250 cases and for ERCP after 300 cases.…”

“…Observational assessment tools can be used to evaluate trainee's progression and competence, containing a mix of technical, cognitive and integrative skills, but also pre‐ and post‐procedural, and specific procedure‐related outcomes such as cannulation rate, complication rate, and yield of fine needle aspiration/biopsy (FNA/B). The incorporation of formal observational assessment tools such as DOPS or TEESAT in a training program is recommended by the ESGE; both these assessment tools have shown strong evidence of validity for ERCP 12 . Occurrence of complications should also be assessed to evaluate competence.…”