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Gastrointest Endosc. 2018 Jan;87(1):262-269. doi: 10.1016/j.gie.2017.05.005. Epub 2017 May 10.

The SAFE-T assessment tool: derivation and validation of a web-based application for point-of-care evaluation of gastroenterology fellow performance in colonoscopy.

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Brigham and Women's Hospital, Division of Gastroenterology, Hepatology and Endoscopy, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA.
Massachusetts Institute of Technology, Cambridge, Massachusetts, USA.



Attending assessment is a critical part of endoscopic education for gastroenterology fellows. The aim of this study was to develop and validate a concise assessment tool to evaluate real-time fellow performance in colonoscopy administered via a web-based application.


The Skill Assessment in Fellow Endoscopy Training (SAFE-T) tool was derived as a novel 5-question evaluation tool that captures both summative and formative feedback adapted into a web-based application. A prospective study of 15 gastroenterology fellows (5 fellows each from years 1 to 3 of training) was performed using the SAFE-T tool. An independent reviewer evaluated a subset of these procedures and completed the SAFE-T tool and Mayo Colonoscopy Skills Assessment Tool (MCSAT) for reliability testing.


Twenty-six faculty completed 350 SAFE-T evaluations of the 15 fellows in the study. The mean SAFE-T overall score (year 1, 2.00; year 2, 3.84; year 3, 4.28) differentiated each sequential fellow year of training (P < .0001). The mean SAFE-T overall score decreased with increasing case complexity score, with straightforward cases compared with average cases (4.07 vs 3.50, P < .0001), and average cases compared with challenging cases (3.50 vs 3.08, P = .0134). In dual-observed procedures, the SAFE-T tool showed excellent inter-rater reliability with a kappa agreement statistic of 0.898 (P < .0001). Correlation of the SAFE-T overall score with the MCSAT overall hands-on and individual motor scores was excellent (each r > 0.90, P < .0001).


We developed and validated the SAFE-T assessment tool, a concise and web-based means of assessing real-time gastroenterology fellow performance in colonoscopy.

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