Simulated Colonoscopy Objective Performance Evaluation (SCOPE): A non-computer-based tool for assessment of endoscopic skills

E. M. Ritter*, T. C. Cox, K. D. Trinca, J. P. Pearl

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


Background The Simulated Colonoscopy Objective Performance Evaluation (SCOPE) was developed to fill the need for a lower-cost, non-virtual-reality (VR)-based assessment tool. This study aimed to evaluate the ability of SCOPE to assess endoscopic skills objectively. Methods Four tasks were created using the Kyoto Kagaku colonoscopy model (Kyoto Kagaku Co., Ltd., Kyoto, Japan). The SCOPE tasks included Scope Manipulation (SM) requiring torque and tip deflection to align a shape in the colon with a matching shape on the monitor; Tool Targeting (TT) requiring coordination with biopsy forceps to contact a metal target; Loop Management (LM) requiring prevention, recognition, and reduction of a redundant sigmoid colon with navigation to the cecum; and Mucosal Inspection (MI) requiring identification of simulated polyps during withdrawal and retroflexion. Key performance metrics were identified, and a normalized scoring system was developed. For the study, 35 subjects were stratified into three cohorts based on colonoscopy experience: novice (0-50 colonoscopies; n = 11), intermediate (51-139 colonoscopies; n = 13), and experienced (>140 colonoscopies; n = 11). The subjects performed two trials of all four tasks. Results Across all four tasks, the experienced endoscopists (E) consistently outperformed the intermediates (I), who in turn outperformed the novices (N). The mean normalized scores with 95 % confidence intervals (CI) are as follows: SM: N (54; range, 26-82), I (92; range, 79-106), E (106; range, 93-118) (p = 0.0006). TT: N (40; range, 24-55), I (77; range, 63-91), E (88; range, 72-105) (p ≤ 0.0001). LM: N (51; range, 24-79), I (80; range, 59-101), E (101; range, 98-105) (p = 0.003). MI: N (73; range, 53-92), I (85; range, 76-95), E (100; range, 91-108) (p = 0.013). Total score: N (218; range, 155-280), I (335; range, 299-371), E (395; range, 371-419) (p ≤ 0.0001). The test-retest reliability (0.6) for the expert total score was respectable. Conclusions The validity evidence from this study shows that scores on SCOPE tasks can differentiate between groups expected to have different levels of technical skill. This model shows promise as a low-technology tool for objective assessment or training of endoscopic skills.

Original languageEnglish
Pages (from-to)4073-4080
Number of pages8
JournalSurgical Endoscopy
Issue number11
StatePublished - Nov 2013
Externally publishedYes


  • Endoscopic skills
  • Flexible endoscopy
  • Fundamentals of endoscopic surgery
  • Objective assessment
  • Simulated Colonoscopy Objective Performance Evaluation (SCOPE)
  • Simulation
  • Validation
  • Validity evidence


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