scholarly journals Certification of UK gastrointestinal endoscopists and variations between trainee specialties: results from the JETS e-portfolio

2019 ◽  
Vol 07 (04) ◽  
pp. E551-E560 ◽  
Author(s):  
Keith Siau ◽  
John Anderson ◽  
Roland Valori ◽  
Mark Feeney ◽  
Neil Hawkes ◽  
...  
Keyword(s):  
Performance Indicators ◽  
Gastrointestinal Endoscopy ◽  
National Standards ◽  
Advisory Group ◽  
Intubation Rate ◽  
Cecal Intubation ◽  
Endoscopy Training ◽  
Minimum Standards ◽  
Cecal Intubation Rate ◽  
The Uk

Abstract Introduction In the UK, endoscopy certification is administered by the Joint Advisory Group on Gastrointestinal Endoscopy (JAG). Since 2011, certification for upper and lower gastrointestinal endoscopy has been awarded via a national (JETS) e-portfolio to the main training specialties of: gastroenterology, gastrointestinal surgeons (GS) and non-medical endoscopists (NME). Trends in endoscopy certification and differences between trainee specialties were analyzed. Methods This prospective UK-wide observational study identified trainees awarded gastroscopy, sigmoidoscopy, colonoscopy (provisional and full) certification between June 2011 – 2017. Trends in certification, procedures and time-to-certification, and key performance indicators (KPIs) in the 3-month pre- and post-certification period were compared between the three main training specialties. Results Three thousand one hundred fifty-seven endoscopy-related certifications were awarded to 1928 trainees from gastroenterology (52.3 %), GS (28.4 %) and NME (16.5  %) specialties. During the study period, certification numbers increased for all modalities and specialties, particularly NME trainees. For gastroscopy and colonoscopy, procedures-to-certification were lowest for GS (P < 0.001), whereas time-to-certification was consistently shortest in NMEs (P < 0.001). A post-certification reduction in mean cecal intubation rate (95.2 % to 93.8 %, P < 0.001) was observed in colonoscopy, and D2 intubation (97.6 % to 96.2 %, P < 0.001) and J-maneuver (97.3 % to 95.8 %, P < 0.001) in gastroscopy. Overall, average pre- and post-certification KPIs still exceeded national minimum standards. There was an increase in PDR for NMEs after provisional colonoscopy certification but a decrease in PDR for GS trainees after sigmoidoscopy and full colonoscopy certification. Conclusion Despite variations among trainee specialties, average pre- and post-certification KPIs for certified trainees met national standards, suggesting that JAG certification is a transparent benchmark which adequately safeguards competency in endoscopy training.

Lower gastrointestinal polypectomy competencies in the United Kingdom: a retrospective analysis of Directly Observed Polypectomy Skills (DOPyS)

Endoscopy ◽  
2020 ◽  
Author(s):  
Arun Rajendran ◽  
Siwan Thomas-Gibson ◽  
Paul Bassett ◽  
Paul Dunckley ◽  
Rajaratnam Rameshshanker ◽  
...  
Keyword(s):  
Assessment Tool ◽  
Training System ◽  
National Database ◽  
Advisory Group ◽  
Cecal Intubation ◽  
Endoscopy Training ◽  
The United Kingdom ◽  
Cecal Intubation Rate ◽  
The Uk ◽  
Provisional Certification

Abstract Background Polypectomy is often the most hazardous part of colonoscopy. There is significant variability in polypectomy training and assessment internationally. DOPyS (Directly Observed Polypectomy Skills) is a validated assessment tool and is used to demonstrate polypectomy competency in the UK. This study aimed to describe the learning curve for polypectomy competency in UK trainees. Methods Retrospective DOPyS data (January 2009 to September 2015) were obtained from the UK Joint Advisory Group (JAG) for intestinal endoscopy training system (JETS) national database. The number of lower gastrointestinal (LGI) procedures, overall cecal intubation rate (CIR), procedure intensity, and time in days to the first DOPyS assessment were recorded, and time to JAG certification was calculated. Results 4965 DOPyS assessments from 336 trainees were analyzed. Within the study period, 124 and 53 trainees achieved provisional and full colonoscopy certification, respectively. Trainees started formative assessment of polypectomy after > 130 LGI procedures and with a CIR of > 70 %. Within 3 years from the first DOPyS assessment, 94 % of trainees achieved provisional certification, and 50 % full certification. Higher procedure intensity at baseline DOPyS assessment was associated with a higher likelihood of obtaining certification sooner. Conclusion There is a significant variation in time to competency, and this potentially reflects the time necessary to acquire polypectomy skills. There is a need to start polypectomy training earlier, once sufficient skills, such as tip control, have been achieved to shorten the time to competency. Overall, the CIR could be used as a guide for such technical skills. Increasing exposure to training lists also potentially reduces the time to polypectomy competency.

scholarly journals Weekend and evening planned colonoscopy activity: a safe and effective way to meet demands

2021 ◽  
Vol 09 (07) ◽  
pp. E1026-E1031
Author(s):  
Shimaa A. Afify ◽  
Omnia M. Abo-Elazm ◽  
Ishak I. Bahbah ◽  
Mo H. Thoufeeq
Keyword(s):  
Performance Indicators ◽  
Gastrointestinal Endoscopy ◽  
Working Hours ◽  
Key Performance Indicators ◽  
Advisory Group ◽  
Cecal Intubation ◽  
Related Data ◽  
Adenoma Detection ◽  
Cecal Intubation Rate

Abstract Background and study aims Colonoscopy is the “gold standard” investigation for assessment of the large bowel that detects and prevents colorectal cancer, as well as non-neoplastic conditions. The Joint Advisory Group (JAG) on Gastrointestinal Endoscopy recommends monitoring key performance indicators such as cecal intubation rate (CIR) and adenoma detection rate (ADR). We aimed to investigate the quality of colonoscopies carried out during evening and Saturday lists in our unit and compare them against JAG standards of quality for colonoscopies. Patients and methods We retrospectively collected and analyzed demographical and procedure-related data for non-screening colonoscopies performed between January 2016 and November 2018. Evenings and Saturdays were defined as the out-of-hour (OOH) period. We compared the outcomes of the procedures done in these against the working hours of the weekdays. We also wanted to explore whether the outcomes were different among certain endoscopists. Other factors that could affect the KPIs, such as endoscopist experience and bowel preparation, were also analyzed. Results There were a total of 17634 colonoscopies carried out; 56.9 % of the patients (n = 10041) < 70 years old. Key Performance Indicators (KPIs) of weekday, evening, and Saturday colonoscopies regarding the CIR and ADR met the JAG standards as they were above 93 % and 24 %, respectively. Advanced colonoscopists had better KPIs when compared to the non-advanced colonoscopists, with CIR at 97.6 % vs. 93.2 % and ADR at 40.8 % vs. 26 %, respectively. Conclusions JAG standards were maintained during colonoscopies done on weekdays, evenings, and Saturdays. Advanced colonoscopists had higher CIR and ADRs.

scholarly journals Variability in cecal intubation rate by calculation method: a call for standardization of key performance indicators in endoscopy

2019 ◽  
Vol 89 (5) ◽  
pp. 1026-1036.e2 ◽  
Author(s):  
Keith Siau ◽  
James Hodson ◽  
Srivathsan Ravindran ◽  
Matthew D. Rutter ◽  
Marietta Iacucci ◽  
...  
Keyword(s):  
Performance Indicators ◽  
Calculation Method ◽  
Key Performance Indicators ◽  
Intubation Rate ◽  
Cecal Intubation ◽  
Cecal Intubation Rate

scholarly journals Impact of the Joint Advisory Group on Gastrointestinal Endoscopy (JAG) on endoscopy services in the UK and beyond

2018 ◽  
Vol 10 (2) ◽  
pp. 93-106 ◽  
Author(s):  
Keith Siau ◽  
John T Green ◽  
Neil D Hawkes ◽  
Raphael Broughton ◽  
Mark Feeney ◽  
...  
Keyword(s):  
Quality Assurance ◽  
Gastrointestinal Endoscopy ◽  
Rating Scale ◽  
Population Based ◽  
Global Rating Scale ◽  
Advisory Group ◽  
Global Rating ◽  
Endoscopy Training ◽  
The Uk ◽  
The Impact

The Joint Advisory Group on Gastrointestinal Endoscopy (JAG) was initially established in 1994 to standardise endoscopy training across specialties. Over the last two decades, the position of JAG has evolved to meet its current role of quality assuring all aspects of endoscopy in the UK to provide the highest quality, patient-centred care. Drivers such as changes to healthcare agenda, national audits, advances in research and technology and the advent of population-based cancer screening have underpinned this shift in priority. Over this period, JAG has spearheaded various quality assurance initiatives with support from national stakeholders. These have led to the achievement of notable milestones in endoscopy quality assurance, particularly in the three major areas of: (1) endoscopy training, (2) accreditation of endoscopy services (including the Global Rating Scale), and (3) accreditation of screening endoscopists. These developments have changed the landscape of UK practice, serving as a model to promote excellence in endoscopy. This review provides a summary of JAG initiatives and assesses the impact of JAG on training and endoscopy services within the UK and beyond.

PWE-418 Endoscopy training in the uk; the joint advisory group on gastrointestinal endoscopy national survey

Gut ◽  
2015 ◽  
Vol 64 (Suppl 1) ◽  
pp. A393.1-A393
Author(s):  
RP Jones ◽  
NA Stylianides ◽  
AG Robertson ◽  
VS Yip ◽  
G Chadwick
Keyword(s):  
National Survey ◽  
Gastrointestinal Endoscopy ◽  
Advisory Group ◽  
Endoscopy Training ◽  
The Uk

Introduction of a quality index in a Hungarian endoscopy unit

2012 ◽  
Vol 153 (29) ◽  
pp. 1142-1152
Author(s):  
Tibor Gyökeres ◽  
Krisztina Rusznyák ◽  
Zsolt Visnyei ◽  
Eszter Schäfer ◽  
Tamás Szamosi ◽  
...  
Keyword(s):  
Gastrointestinal Endoscopy ◽  
Developed Countries ◽  
Intubation Rate ◽  
Cecal Intubation ◽  
Endoscopy Unit ◽  
Continuous Quality ◽  
Rate Base ◽  
Cecal Intubation Rate ◽  
Second Year

The quality of endoscopic examinations substantially determines their value. In developed countries, Continuous Quality Management is used to improve it permanently. In Hungary there is no example for measuring quality in the field of gastrointestinal endoscopy. Aim: The measurement and improvement of quality of endoscopy applying completeness index (cecum intubation rate) during colonoscopy. Patients and methods: The authors defined base values retrospectively from 841 colonoscopy reports, performed in the last quarter of the year, before starting the project. The next two years (3160 colonoscopy in 2009 and 3167 in 2010) every three months they calculated the cecum intubation rate for each endoscopist. Results: The cecum intubation rate was 81.6% in the base period. When the authors excluded examinations with poor preparations and those with a previously unknown stenosis that prevented the total colonoscopy, the adjusted cecal intubation rate was 90.9%. In the next 2 years, the cecum intubation rate was 84.2% and 85.7% (p = 0.0394), while adjusted cecum intubation rate proved to be 92.3% and 92.6% (p = 0.381 NS) for the whole endoscopy unit. Of the 14 endoscopists only 6 reached an adjusted cecum intubation rate of 90%, but in the second year of the project 10 of them reached this rate and only one endoscopist remained below 87%. The endoscopists performing more than 100 colonoscopies per year had better adjusted cecum intubation rate (base 91.2%; 92.7% and 93.1% during the 2 project years) compared to those with less than 100 colonoscopies per year (base, 86.7%; project period, 85.5 and 89%). Conclusions: The evaluation and publicity of the cecal intubation rate resulted in an improvement of the quality of colonoscopy. The authors also presented that endoscopists performing more than 100 colonosopies per year have better endoscopic quality. Orv. Hetil., 2012, 153, 1142–1152.

Cecal Intubation Rate Is a Better Milestone Parameter Than Polyp Detection Rate in Fellowship Endoscopy Training

2013 ◽  
Vol 108 ◽  
pp. S605
Author(s):  
Micheal Tadros ◽  
Kavitha Bagavathy ◽  
Deepika Devuni ◽  
Ethan Bortniker ◽  
Suzanne Rose ◽  
...  
Keyword(s):  
Detection Rate ◽  
Intubation Rate ◽  
Polyp Detection ◽  
Cecal Intubation ◽  
Endoscopy Training ◽  
Polyp Detection Rate ◽  
Cecal Intubation Rate

scholarly journals A117 PROPOFOL SEDATION DOES NOT IMPROVE MEASURES OF COLONOSCOPY QUALITY – FINDINGS FROM THE SOUTHWEST ONTARIO COLONOSCOPY COHORT

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 97-98
Author(s):  
M Sey ◽  
B Yan ◽  
Z Hindi ◽  
M Brahmania ◽  
J C Gregor ◽  
...  
Keyword(s):  
Detection Rate ◽  
Conscious Sedation ◽  
Intubation Rate ◽  
Polyp Detection ◽  
Cecal Intubation ◽  
Propofol Sedation ◽  
Serrated Polyp ◽  
Polyp Detection Rate ◽  
Cecal Intubation Rate ◽  
Colonoscopy Quality

Abstract Background The use of propofol during colonoscopy has gained increased popularity due to deeper anesthesia compared to conscious sedation. Prior studies examining the use of propofol sedation during colonoscopy have primarily focused on anesthesia outcomes. Whether propofol sedation is associated with improvements in colonoscopy outcomes is uncertain. Aims The primary outcome was adenoma detection rate (ADR). Secondary outcomes were the detection of any adenoma (conventional adenoma, sessile serrated polyp, and traditional serrated adenoma), sessile serrated polyp detection rate, polyp detection rate, cecal intubation rate, and perforation rate. Methods The Southwest Ontario Colonoscopy cohort consists of all patients who underwent colonoscopy between April 2017 and Oct 2018 at 21 hospitals serving a large geographic area in Southwest Ontario. Procedures performed in patients less than 18 years of age or by endoscopist who perform &lt;50 colonoscopies/year were excluded. Data were collected through a mandatory quality assurance form that was completed by the endoscopist after each procedure. Pathology reports were manually reviewed. Results A total of 46,634 colonoscopies were performed by 75 physicians (37.5% by gastroenterologists, 60% by general surgeons, 2.5% others) of which 16,408 (35.2%) received propofol and 30,226 (64.8%) received conscious sedation (e.g. combination of a benzodiazepine and a narcotic). Patients who received propofol were likely to have a screening indication (49.2% vs 45.5%, p&lt;0.0001), not have a trainee endoscopist present and be performed at a non-academic centre (32.2% vs 44.6%, p&lt;0.0001). Compared to conscious sedation, use of propofol was associated with a lower ADR (24.6% vs. 27.0%, p&lt;0.0001) and detection of any adenoma (27.7% vs. 29.8%, p&lt;0.0001); no difference was observed in the detection ofsessile serrated polyps (5.0% vs. 4.7%, p=0.26), polyp detection rate (41.2% vs 41.2%, p=0.978), cecal intubation rate (97.1% vs. 96.8%, p=0.15) or perforation rate (0.04% vs. 0.06%,p=0.45). On multi-variable analysis, the use of propofol was not significantly associated with any improvement in ADR (RR=0.90, 95% CI 0.74–1.10, p=0.30), detection of any adenoma (RR=0.93, 95% CI 0.75–1.14, p=0.47), sessile serrated polyp detection rate (RR=1.20, 95%CI 0.90–1.60, p=0.22), polyp detection rate (RR=1.00, 95% CI 0.90–1.11, p=0.99), or cecal intubation rate (RR=1.00, 95%CI 0.80–1.26, p=0.99). Conclusions The use of propofol sedation does not improve colonoscopy quality metrics. Funding Agencies None

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