Reliable and valid assessment of competence in endoscopic ultrasonography and fine-needle aspiration for mediastinal staging of non-small cell lung cancer

L. Konge; P. Vilmann; P. Clementsen; J. T. Annema; C. Ringsted

doi:10.1055/s-0032-1309892

Endoscopy, Table of Contents

Endoscopy 2012; 44(10): 928-933
DOI: 10.1055/s-0032-1309892

Original article

Reliable and valid assessment of competence in endoscopic ultrasonography and fine-needle aspiration for mediastinal staging of non-small cell lung cancer

Authors

L. Konge

¹Centre for Clinical Education, University of Copenhagen and the Capital Region of Denmark, Copenhagen, Denmark
P. Vilmann

²Department of Surgical Gastroenterology, Copenhagen University Hospital Herlev, Denmark
P. Clementsen

³Department of Pulmonology, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
J. T. Annema

⁴Leiden University Medical Center, Pulmonology Department, Leiden, The Netherlands

⁵Pulmonology Department, Academical Medical Center, Amsterdam, The Netherlands
C. Ringsted

¹Centre for Clinical Education, University of Copenhagen and the Capital Region of Denmark, Copenhagen, Denmark

Abstract

Background and study aims: Fine-needle aspiration (FNA) guided by endoscopic ultrasonography (EUS) is important in mediastinal staging of non-small cell lung cancer (NSCLC). Training standards and implementation strategies of this technique are currently under discussion. The aim of this study was to explore the reliability and validity of a newly developed EUS Assessment Tool (EUSAT) designed to measure competence in EUS – FNA for mediastinal staging of NSCLC.

Patients and methods: A total of 30 patients with proven or suspected NSCLC underwent EUS – FNA for mediastinal staging by three trainees and three experienced physicians. Their performances were assessed prospectively by three experts in EUS under direct observation and again 2 months later in a blinded fashion using digital video-recordings. Based on the assessments, intra-rater reliability, inter-rater reliability, and construct validity were explored.

Results: The intra-rater reliability was good (Cronbach’s α = 0.80), but comparison of results based on direct observations and blinded video-recordings indicated a significant bias favoring consultants (P = 0.022). Inter-rater reliability was very good (Cronbach’s α = 0.93). However, one rater assessing five procedures or two raters each assessing four procedures were necessary to secure a generalizability coefficient of 0.80. The assessment tool demonstrated construct validity by discriminating between trainees and experienced physicians (P = 0.034).

Conclusions: Competency in mediastinal staging of NSCLC using EUS and EUS – FNA can be assessed in a reliable and valid way using the EUSAT assessment tool. Measuring and defining competency and training requirements could improve EUS quality and benefit patient care.

Full Text

References

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