RESUMO
Purpose: Accurate and convenient evaluation tools are essential to document endoscopic competence in Gastroenterology training programs. The Direct Observation of Procedural Skills (DOPS), Global Assessment of Gastrointestinal Endoscopic Skills (GAGES), and Assessment of Endoscopic Competency (ACE) are widely used validated competency assessment tools for gastrointestinal endoscopy. However, studies comparing these 3 tools are lacking, leading to lack of standardization in this assessment. Through simulation, this study seeks to determine the most reliable, comprehensive, and user-friendly tool for standardizing endoscopy competency assessment. Methods: A mixed-methods quantitative-qualitative approach was utilized with sequential deductive design. All nine trainees in a gastroenterology training program were assessed on endoscopic procedural competence using the Simbionix Gi-bronch-mentor high-fidelity simulator, with 2 faculty raters independently completing the 3 assessment forms of DOPS, GAGES, and ACE. Psychometric analysis was used to evaluate the tools' reliability. Additionally, faculty trainers participated in a focused group discussion (FGD) to investigate their experience in using the tools. Results: For upper GI endoscopy, Cronbach's alpha values for internal consistency were 0.53, 0.8, and 0.87 for ACE, DOPS, and GAGES, respectively. Inter-rater reliability (IRR) scores were 0.79 (0.43-0.92) for ACE, 0.75 (-0.13-0.82) for DOPS, and 0.59 (-0.90-0.84) for GAGES. For colonoscopy, Cronbach's alpha values for internal consistency were 0.53, 0.82, and 0.85 for ACE, DOPS, and GAGES, respectively. IRR scores were 0.72 (0.39-0.96) for ACE, 0.78 (-0.12-0.86) for DOPS, and 0.53 (-0.91-0.78) for GAGES. The FGD yielded three key themes: the ideal tool should be scientifically sound, comprehensive, and user-friendly. Conclusion: The DOPS tool performed favourably in both the qualitative assessment and psychometric evaluation to be considered the most balanced amongst the three assessment tools. We propose that the DOPS tool be used for endoscopic skill assessment in gastroenterology training programs. However, gastroenterology training programs need to match their learning outcomes with the available assessment tools to determine the most appropriate one in their context.
RESUMO
OBJECTIVE: This study aimed to assess the International Quality Improvement Collaborative single-site data from a developing country to identify trends in outcomes and factors associated with poor outcomes. DESIGN: Retrospective descriptive study. SETTING: The National Institute of Cardiovascular Diseases, Karachi, Pakistan. PARTICIPANTS: Patients undergoing surgery for congenital heart disease (CHD). OUTCOME MEASURE: Key factors were examined, including preoperative, procedural and demographic data, as well as surgical complications and outcomes. We identified risk factors for mortality, bacterial sepsis and 30-day mortality using multivariable logistic regression. RESULTS: A total of 3367 CHD surgical cases were evaluated; of these, 59.4% (2001) were male and 82.8% (2787) were between the ages of 1 and 17 years. Only 0.2% (n=6) were infants (≤30 days) and 2.3% (n=77) were adults (≥18 years). The in-hospital mortality rate was 6.7% (n=224), and 4.4% (n=147) and 0.8% (n=27) had bacterial sepsis and surgical site infections, respectively. The 30-day status was known for 90.8% (n=3058) of the patients, of whom 91.6% (n=2800) were alive. On multivariable analysis, the adjusted OR for in-hospital mortality was 0.40 (0.29-0.56) for teenagers compared with infancy/childhood and 1.95 (1.45-2.61) for patients with oxygen saturation <85%. Compared with Risk Adjustment for Congenital Heart Surgery (RACHS-1) risk category 1, the adjusted OR for in-hospital mortality was 1.78 (1.1-2.87) for RACHS-1 risk category 3 and 2.92 (1.03-8.31) for categories 4-6. The adjusted OR for 30-day mortality was 0.40 (0.30-0.55) for teenagers and 1.52 (1.16-1.98) for patients with oxygen saturation <85%. The 30-day mortality rate was significantly higher in RACHS-1 risk category 3 compared with category 1, with an adjusted OR of 1.64 (1.06-2.55). CONCLUSIONS: We observed a high prevalence of postoperative infections and mortality, especially for high-risk procedures, according to RACHS-1 risk category, in infancy/childhood, in children with genetic syndrome or those with low oxygen saturation (<85%).
