Post written by Navin L. Kumar, MD and John R. Saltzman, MD, from Brigham and Women’s Hospital, Division of Gastroenterology, Hepatology and Endoscopy, and Harvard Medical School, Boston, Massachusetts, USA.

The focus of our study was to develop and validate a concise assessment tool to evaluate real-time fellow performance in colonoscopy via a web-based application that was optimized for smartphone use.

Attending assessment of fellow performance plays a critical role in the development of fellow endoscopic skills, particularly in learning how to perform colonoscopy. Although a handful of assessment tools have been developed, these tools are largely paper-based and contain multiple questions for an attending to complete. Thus, their usage for real-time, continuous assessment is limited. In fact, a recent nationwide survey study found that only 30% of fellowship programs use any form of validated assessment.

To improve the frequency and quality of attending assessment, we designed a concise 5-point evaluation tool that contained both summative and formative feedback, and then incorporated the tool into a web-based application to allow for continuous, point-of-care assessment of fellow performance in colonoscopy.

We first developed the SAFE-T (Skill Assessment in Fellow Endoscopy Training) tool with a team of endoscopy educators and pilot-tested the tool with both faculty and fellows. The tool is a 5-part questionnaire that assesses objective performance of the fellow, case complexity in terms of both insertion and interventions performed, overall performance of the fellow on a 5-point scale (summative assessment), and a single area for the fellow to improve based on a pre-selected list of 12 major cognitive and motor tasks (formative assessment). The SAFE-T tool was adapted into a web-based application that was accessible on both smartphones and computers. We then aimed to validate the tool in a 6-month prospective study of 15 gastroenterology fellows from a single fellowship program.

Figure 1. SAFE-T overall performance scores by fellow year.

Twenty-six faculty completed 350 SAFE-T evaluations of the 15 fellows in the study. The SAFE-T overall performance score demonstrated discriminative validity with its ability to differentiate fellow performance by year of training, cecal intubation, and case complexity. The tool also showed excellent inter-rater reliability and a high correlation with the previously validated Mayo Colonoscopy Skills Assessment Tool. Participating faculty noted that the tool was easy to use, took less than 2 minutes to complete, and improved the quality of feedback by serving as reminder to debrief at the end of each case.

In summary, we designed and validated the SAFE-T evaluation tool, a concise and web-based means of assessing real-time gastroenterology fellow performance in colonoscopy. As a future direction, we are currently designing a multi-center study to validate learning curves and competency thresholds using the SAFE-T tool and ultimately intend to make the application available for any interested fellowship programs.

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