# Mapping Competence in Gastrointestinal Endoscopy Nursing Practice: An Item Response Theory Analysis of Perceived Skill Acquisition and Maintenance in Italy

## TL;DR

This study identifies how many times nurses in Italy need to perform specific endoscopic procedures to gain and maintain competence, highlighting the need for standardized training.

## Contribution

The study introduces a validated, procedure-specific competence map for gastrointestinal endoscopy nursing in Italy using item response theory.

## Key findings

- Complex or infrequently performed endoscopic techniques require higher repetition thresholds for competence acquisition.
- More experienced nurses set higher internal standards for competence, indicating stricter self-assessment.
- Competence maintenance generally requires fewer repetitions than acquisition, but varies by procedure.

## Abstract

Advanced gastrointestinal endoscopy requires specific nursing competences to ensure procedural safety, efficiency, and patient-centered care. International frameworks define core skills and assessment methods, but Italy lacks a standardized, nationally recognized competency model, leading to variability in training and practice.

What are the main findings?
This study quantifies perceived procedural repetition thresholds for both competence acquisition and maintenance across 30 endoscopic procedures. It demonstrates that complex or infrequently performed techniques require higher perceived thresholds and that more experienced nurses set stricter internal standards. The findings provide a validated, procedure-specific competence map for Italian endoscopy nursing.

This study quantifies perceived procedural repetition thresholds for both competence acquisition and maintenance across 30 endoscopic procedures. It demonstrates that complex or infrequently performed techniques require higher perceived thresholds and that more experienced nurses set stricter internal standards. The findings provide a validated, procedure-specific competence map for Italian endoscopy nursing.

What are the implications of the main findings?
The results support the development of national competence standards, modular and adaptive training programs, and structured mentorship for gastrointestinal endoscopy nurses in Italy. Adoption of such a model could harmonize practice, enhance skill development, and improve patient outcomes.

The results support the development of national competence standards, modular and adaptive training programs, and structured mentorship for gastrointestinal endoscopy nurses in Italy. Adoption of such a model could harmonize practice, enhance skill development, and improve patient outcomes.

Objective. The aim of this study was to define a structured competence model for nurses working in gastrointestinal endoscopy in Italy and to assess nurses’ perceptions of the number of procedural repetitions required to acquire and maintain competence across different endoscopic procedures. Methods. A cross-sectional online survey targeted registered nurses working in Italian gastrointestinal endoscopy units. The questionnaire, developed from guidelines and expert consensus, covered demographics, organizational context, and perceived repetition thresholds for 30 procedures. Partial Credit Models (PCMs) estimated acquisition and maintenance thresholds; Differential Item Functioning (DIF) tested differences by self-reported experience level. Results. A total of 332 nurses participated (68.4% female; mean age 47.1 years; mean endoscopy experience 10.1 years). For competence acquisition, most procedures were placed in the 11–30 or 31–50 repetition range, with higher values for complex techniques. Competence maintenance generally required fewer repetitions, but thresholds varied by procedure. Advanced or infrequently performed techniques were perceived as more demanding. More experienced nurses reported higher thresholds, reflecting stricter internal standards. Conclusions. Acquisition and maintenance of gastrointestinal endoscopy competences differ in intensity and frequency requirements, supporting the need for tailored, modular training pathways. Findings highlight the importance of national competence standards, adaptive learning technologies, and structured mentorship to enhance skill development, reduce variability, and promote consistent, high-quality patient care across Italy.