Assessing competence in unsedated transnasal endoscopy: Development of the TransNasal Endoscopy Skills Assessment Tool

OBJECTIVES: Despite the growing use of unsedated transnasal endoscopy (uTNE) in pediatrics, no validated tool exists to assess competence in performing uTNE, hindering effective training and consistent, high-quality performance. Video-based assessment offers a scalable and reliable method for assessing and enhancing procedural skills. Using Delphi methodology, we aimed to identify key competencies and establish content validity evidence for the TransNasal Endoscopy Skills Assessment Tool (TNE-SAT), a video-based tool designed to assess clinician competence in performing uTNE. METHODS: North American pediatric uTNE experts iteratively rated potential assessment items, on a 5-point scale, based on their importance as indicators of endoscopist competence in performing uTNE. After each voting round, items scoring ≤3/5 were eliminated, and the remaining items were re-sent to the panel for further rating until consensus was reached, defined as ≥80% of panelists rating all remaining items ≥4. Items meeting this threshold were included in the final TNE-SAT tool. RESULTS: Twenty-seven experts from 19 sites across North America participated. One hundred thirty items were generated through literature review, task deconstruction, and Delphi panelist input. Three rounds of surveys were completed before consensus was achieved, with response rates ranging from 85% to 9. Seven items reached consensus for inclusion in the final TNE-SAT. CONCLUSIONS: This North American Delphi study identified core competencies required for effective uTNE performance and informed the development of the TNE-SAT, a structured, video-based tool to assess clinician competence. The TNE-SAT offers a promising tool to guide training and support quality improvement in pediatric uTNE.