GAPS-EUS: a new and reliable tool for the assessment of basic skills and performance in EUS among endosonography trainees

Abstract

Objective: Endosonography (EUS) is a useful but complex diagnostic modality which requires advanced endoscopy training and guidance by a supervisor. Since learning curves vary among individuals, assessment of the actual competence among EUS trainees is important.

Design/methods: We designed a novel assessment tool entitled Global Assessment of Performance and Skills in EUS (GAPS-EUS) for assessing skills among EUS trainees. Five quality indicators were marked on a five-grade scale by the supervisor (Observer Score) and by the trainee (Trainee Score). Trainees were included in two high-volume centres (Gothenburg, Sweden, and Bologna, Italy). Outcomes were feasibility, patient safety, reliability, and validity of GAPS-EUS in trainee-performed EUS procedures.

Results: Twenty-two EUS-trainees were assessed in a total of 157 EUS procedures with a completion rate of 157/157 (100 %) and a patient adverse event rate of 2/157 (1.3 %; gastroenteritis n=1, fever n=1). GAPS-EUS showed a high measurement reliability (Cronbach's alpha coefficient=0.87) and a high inter-rater reliability comparing the supervisor and the trainee (r=0.83, r2=0.69, p<0.001). The construct of GAPS-EUS was verified by comparing low-level and high-level performance procedures and the content validity by recording that the EUS-FNA manoeuvre resulted in a lower score than other aspects of EUS 3.07 (95% CI 2.91 to 3.23) vs 3.51 (95% CI 3.37 to 3.65) (p<0.001). External validity was confirmed via similar findings in both centres.

Conclusion: GAPS-EUS is an easy-to-use and reliable tool with a recorded high validity for the assessment of competence among trainees in EUS. It can be recommended to centres involved in the education of future endosonographers.

Trial registration number: NCT02455570.

Keywords: endoscopic procedures; endoscopic ultrasonography; gastrointestinal neoplasia; surgical training.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1

Flowchart of the study enrolment process. EUS, endosonography.

Figure 2

(A) The Observer Score of the first GAPS-EUS assessment in the 3 FTs and in the 19 visiting trainees in relation to the EUS experience among these 22 trainees as measured as the total number of EUS examinations previously performed (under supervision or independently). (B) A bar chart showing the Observer Score of the 92 GAPS-EUS assessments in FT1 in consecutive order and in groups of 10. The error bars symbolise the 95% CIs. (C–E) Three line diagrams showing Observer Score A (C, blue line), Observer Score B (D, red line), and Observer Score C (E, green line) in the 92 consecutive GAPS-EUS assessments of FT1. EUS, endosonography; FT, fellowship trainee; GAPS-EUS, Global Assessment of Performance and Skills in EUS.

Figure 3

Bland-Altman plot showing the difference of Trainee Score–Observer Score on the Y-axis, including the mean value of all scores as a red line, and the Compound Score (mean of Trainee Score and Observer Score) on the X-axis. The upper and the lower black lines depict the +2 SD and the −2 SD.