Can Pediatric Endoscopists Accurately Assess Their Clinical Competency? A Comparison Across Skill Levels

Background: Assessment is critical to support pediatric endoscopy training. Although trainee engagement in assessment is encouraged, the use of self-assessment and its accuracy among pediatric endoscopists is not well described. We aimed to determine the self-assessment accuracy of novice, intermediate and experienced pediatric endoscopists. Methods: Novice (performed 1000) pediatric endoscopists from 3 North American academic teaching hospitals each performed a clinical colonoscopy. Endoscopists were assessed in real-time by two experienced endoscopists using the Gastrointestinal Endoscopy Competency Assessment Tool for Pediatric Colonoscopy (GiECATKIDS). In addition, participants self-assessed their performance using the same instrument. Self-assessment accuracy between the externally assessed and self-assessed scores was evaluated using absolute difference scores, intraclass correlation coefficients (ICCs), and Bland-Altman analyses. Results: 47 endoscopists participated (21 novices, 16 intermediates and 10 experienced). There was moderate agreement of externally assessed and self-assessed GiECATKIDS total scores with an ICC of 0.72 (95% confidence interval [CI], 0.55–0.83). The absolute difference scores among the three groups were significantly different (P = 0.005), with experienced endoscopists demonstrating a more accurate self-assessment compared to novices (P = 0.003). Bland-Altman plots revealed that novice endoscopists' self-assessed scores tended to be higher than their externally-assessed scores, indicating they overestimated their performance. Conclusions: We found that endoscopic experience was positively associated with self-assessment accuracy among pediatric endoscopists. Novices were inaccurate in assessing their endoscopic competence and were prone to overestimation of their performances. Our findings suggest novices may benefit from targeted interventions aimed at improving their insight and self-awareness. Address correspondence and reprint requests to Catharine M. Walsh, MD, MEd, PhD, FAAP, FRCPC, Division of Gastroenterology, Hepatology and Nutrition, the Learning and Research Institutes, Hospital for Sick Children, Department of Paediatrics and the Wilson Centre, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Hospital for Sick Children, Division of Gastroenterology, Hepatology and Nutrition, 555 University Ave, Room 8256, Black Wing, Toronto, ON, Canada M5G 1X8 (E-mail: catharine.walsh@mail.utoronto.ca). Received 1 May, 2018 Accepted 6 October, 2018 Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (www.jpgn.org). Financial Disclosure: The authors have no financial relationships relevant to this article to disclose. Sources of Funding: This project was supported by an American Society of Gastrointestinal Endoscopy Quality in Endoscopic Research Award. CMW hold a Career Development Award from the Canadian Child Health Clinician Scientist Program. Disclosures: None. Funding /Support: This project was supported by an American Society of Gastrointestinal Endoscopy Quality in Endoscopic Research Award. CMW holds a Career Development Award from the Canadian Child Health Clinician Scientist Program. Role of the sponsor: No funding organization had any role in the design and conduct of the study, collection, management, analysis and interpretation of the data; and preparation, review, or approval of the manuscript. Previous presentations: The abstract of an earlier version of this article was presented as an oral presentation at the 2015 NASPGHAN Annual Meeting, where it was awarded the "NASPGHAN Endoscopy Prize". Conflicts of Interest: No authors have any conflicts of interest to report. © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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