Assessment of colorectal polyp recognition skill: development and validation of an objective test

Hill, Andrew, Horswill, Mark S., Plooy, Annaliese M., Watson, Marcus O., Rowlands, Lachlan N., Wallis, Guy M., Riek, Stephan, Burgess-Limerick, Robin and Hewett, David G. (2016) Assessment of colorectal polyp recognition skill: development and validation of an objective test. Surgical Endoscopy, 31 6: 1-11. doi:10.1007/s00464-016-5243-9


Author Hill, Andrew
Horswill, Mark S.
Plooy, Annaliese M.
Watson, Marcus O.
Rowlands, Lachlan N.
Wallis, Guy M.
Riek, Stephan
Burgess-Limerick, Robin
Hewett, David G.
Title Assessment of colorectal polyp recognition skill: development and validation of an objective test
Journal name Surgical Endoscopy   Check publisher's open access policy
ISSN 0930-2794
1432-2218
Publication date 2016-09-20
Year available 2017
Sub-type Article (original research)
DOI 10.1007/s00464-016-5243-9
Open Access Status Not yet assessed
Volume 31
Issue 6
Start page 1
End page 11
Total pages 11
Place of publication New York, NY, United States
Publisher Springer New York LLC
Language eng
Abstract The quality of colonoscopy is known to vary. The extent to which colonoscopists can recognize the presence of subtle colorectal lesions by visually distinguishing them from the surrounding mucosa (i.e., polyp recognition skill) may be one of several attributes that influence polyp detection rates. The aim of the present study was to develop and validate the first objective test of polyp recognition skill.
Formatted abstract
Background: The quality of colonoscopy is known to vary. The extent to which colonoscopists can recognize the presence of subtle colorectal lesions by visually distinguishing them from the surrounding mucosa (i.e., polyp recognition skill) may be one of several attributes that influence polyp detection rates. The aim of the present study was to develop and validate the first objective test of polyp recognition skill.

Methods: Validation study. Twenty-eight experienced colonoscopists and eighty novices took a preliminary 280-item computer-based polyp recognition test. Items were genuine endoscopic images which participants assessed for the presence of “likely polyps.” Half included clinically identified polyps. Participants clicked on a suspected lesion or a button marked “no likely polyp”, and the main outcome measures were accuracy and response latency. The best items were selected for the final 50-item test.

Results: In the preliminary test, experienced colonoscopists correctly identified more polyps than novices (P < .0001) and better discriminated between clinically identified polyps and non-polyp features (as measured by d′, P < .0001). For polyp items, the experienced group also responded faster (P < .01). Effect sizes were large for accuracy (Cohen’s d = 3.22) and d′ (Cohen’s d = 3.22). The 50 final test items produced comparable results for accuracy, d′, and response latency. For both versions of the test, score scale reliability was high for both polyp and non-polyp items (α = .82 to .97).

Conclusions: The observed experienced–novice differences support the construct validity of the performance measures derived from the tests, indicating that polyp recognition skill can be quantified objectively. The final test may potentially be used to assess trainees, but test sensitivity may be insufficient to make fine-grained distinctions between different skill levels among experienced colonoscopists. More sensitive future tests may provide a valuable supplement to clinical detection rates, allowing objective comparisons between skilled colonoscopists.
Keyword Colonoscopy
Training
Skill assessment
Polyp recognition
Polyp detection
Q-Index Code C1
Q-Index Status Provisional Code
Grant ID FT100100020
Institutional Status UQ

 
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Created: Wed, 05 Oct 2016, 21:48:40 EST by Sandrine Ducrot on behalf of School of Human Movement and Nutrition Sciences