Accuracy of self-assessment in gastrointestinal endoscopy: a systematic review and meta-analysis

Abstract

Background Assessment is necessary to ensure both attainment and maintenance of competency in gastrointestinal (GI) endoscopy, and this can be accomplished through self-assessment. We conducted a systematic review with meta-analysis to evaluate the accuracy of self-assessment among GI endoscopists. Methods This was an individual participant data meta-analysis of studies that investigated self-assessment of endoscopic competency. We performed a systematic search of the following databases: Ovid MEDLINE, Ovid EMBASE, Wiley Cochrane CENTRAL, and ProQuest Education Resources Information Center. We included studies if they were primary investigations of self-assessment accuracy in GI endoscopy that used statistical analyses to determine accuracy. We conducted a meta-analysis of studies using a limits of agreement (LoA) approach to meta-analysis of Bland–Altman studies. Results After removing duplicate entries, we screened 7138 records. After full-text review, we included 16 studies for qualitative analysis and three for meta-analysis. In the meta-analysis, we found that the LoA were wide (−41.0 % to 34.0 %) and beyond the clinically acceptable difference. Subgroup analyses found that both novice and intermediate endoscopists had wide LoA (−45.0 % to 35.1 % and −54.7 % to 46.5 %, respectively) and expert endoscopists had narrow LoA (−14.2 % to 21.4 %). Conclusions GI endoscopists are inaccurate in self-assessment of their endoscopic competency. Subgroup analyses demonstrated that novice and intermediate endoscopists were inaccurate, while expert endoscopists have accurate self-assessment. While we advise against the sole use of self-assessment among novice and intermediate endoscopists, expert endoscopists may wish to integrate it into their practice.

Video-based interventions to improve self-assessment accuracy among physicians: A systematic review

“…Primarily, we could not quantify the impact of videos on self-assessment with a meta-analysis due to the lack of standardized outcome measures and different types of tasks in the included studies. In particular, the Bland-Altman analysis, a well described approach in the method comparison literature [ 37 ], is preferred, as this can allow for meta-analytic summation [ 8 , 38 ]. Similarly, we could not account for the potential confounding effect of accurate self-assessment at baseline, as noted in four studies.…”

“…In addition, most studies did not quantify intervention length, which restricted our ability to determine whether length of the video interventions influences outcomes. The other characteristic we could not control for was physician level of experience and specialty that preceded the intervention, especially as the former has shown to have a significant impact on physician self-assessment [ 8 ]. Third, we may have missed relevant studies due to language bias, as we only included English-language abstracts, and due to a lack of universal definition of self-assessment accuracy.…”

“…The current literature, however, suggests that physicians are inaccurate in their self-assessments, which may compromise opportunities for self-development [4,5]. In particular, self-assessment accuracy, the extent to which one's own evaluation corresponds to an external standard, is inaccurate among medical subspecialty physicians and surgeons alike [5][6][7][8]. Inaccurate selfassessment may impede opportunities for professional growth, allowing for mistaken overconfidence in one's own performance [9,10].…”