Article Text

Download PDFPDF
PTU-016 Using the multi-assistant rating scale (mars) tool to assess endoscopic non-technical skills (ents) performance in independently practising endoscopists
  1. N Hawkes,
  2. F Kokwara1,
  3. B Davies1,
  4. J Cornish2
  1. 1Gastroenterology
  2. 2Surgery, CWM TAF UNIVERSITY HEALTH BOARD, Llantrisant, UK


Introduction Endoscopists regularly appraise the technical aspects of their performance as part of the delivery of a high-quality endoscopy service. Patient outcomes are however linked to team performance and the measurement of Endoscopic Non-Technical Skills (ENTS) may highlight areas where endoscopists can further improve their skills. We used the novel Multi-Assessor Rating Scale (MARS) to provide a 360 degree assessment of ENTS skills and performance enhancing feedback for endoscopists.

Method The MARS tool was used to rate nine colonoscopists who had consented to the assessment. This validated questionnaire comprises 10 items in each of 4 ENTS domains – Communication (COMM), Situational Awareness (SITA), Leadership (LEAD) and Judgement and Decision-making (J and DM). Each question is assessed on a seven point rating scale – these responses were then given a binary coding of good [GD] (very strong to quite strong rating) and need improvement [NI] (neutral to very poor ratings) which increases intra-rater reliability. A threshold of 90% good (GD) ratings in each ENTS domain was set as a performance standard. A report format was developed to provide the endoscopist with the percentage GD ratings in each ENTS domain as a graphic display, providing a comparison of their ratings against peers. Analysis of differences in proportion of GD/NI ratings was analysed using Kruskal-Wallis test.

Results 9 endoscopists were assessed using the MARS tool. Each was rated by 10 nurse (90 assessments, based on 40 item scores). 5 colonoscopists met the performance standard of 90% in all 4 ENTS domains, 1 colonoscopist met the standard in the COMM, SITA and J and DM domains but did not meet the standard in the LEAD domain. The remaining 3 colonoscopists failed to meet the performance standards in all 4 ENTS domain. Compared to the other colonoscopists their scores were significantly lower in the COMM and LEAD domains (both Kruskal-Wallis H=7.107, p<0.008). The SITA and J and DM domain scores did not quite meet statistical significance (H=5.312 and 5.4 respectively, p=0.006). The results were formatted in a standardised report represented as scatter plots, ‘traffic light’ (GREEN>90%, AMBER=80–90, RED <80) domain scores and highlighted specific MARS domain statements when 20% or more of ratings were NI for a given item.

Conclusion The MARS tool is a practical 360-degree assessment to measure of ENTS performance. Using 10 raters we demonstrated significant differences in performance in these domains and to provide performance enhancing feedback to endoscopists. A follow-up study is underway to provide further validation data and assess the effects of ENTS training interventions on MARS scores.

Disclosure of Interest None Declared

  • Endoscopy
  • Endoscopy training
  • ENTS
  • Key performance indicator

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.