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

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.

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

Endoscopy International Open ◽

10.1055/a-0839-4476 ◽

2019 ◽

Vol 07 (04) ◽

pp. E551-E560 ◽

Cited By ~ 7

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.

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Variation in exposure to endoscopic haemostasis for acute upper gastrointestinal bleeding during UK gastroenterology training

Frontline Gastroenterology ◽

10.1136/flgastro-2019-101351 ◽

2019 ◽

Vol 11 (6) ◽

pp. 436-440 ◽

Cited By ~ 3

Author(s):

Keith Siau ◽

A John Morris ◽

Aravinth Murugananthan ◽

Brian McKaig ◽

Paul Dunckley

Keyword(s):

Gastrointestinal Bleeding ◽

Upper Gastrointestinal Bleeding ◽

Training System ◽

Advisory Group ◽

Endoscopic Haemostasis ◽

Endoscopy Training ◽

Acute Upper Gastrointestinal Bleeding ◽

The Uk ◽

Upper Gastrointestinal ◽

Adrenaline Injection

IntroductionGastroenterologists are typically expected to be competent in endoscopic haemostasis for acute upper gastrointestinal bleeding (AUGIB), with the Certificate of Completion of Training (CCT) often heralding the onset of participation in on-call AUGIB rotas. We analysed the volume of haemostasis experience recorded by gastroenterology CCT holders on the Joint Advisory Group on Gastrointestinal Endoscopy Training System (JETS) e-portfolio, the UK electronic portfolio for endoscopy, and assessed for variations in exposure to haemostasis.MethodsUK gastroenterologists awarded CCT between April 2014 and April 2017 were retrospectively identified from the specialist register. Credentials were cross-referenced with JETS to retrieve AUGIB haemostasis procedures prior to CCT. Procedures were collated according to variceal versus non-variceal therapies and compared across training deaneries.ResultsOver the 3-year study period, 241 gastroenterologists were awarded CCT. 232 JETS e-portfolio users were included for analysis. In total, 12 932 haemostasis procedures were recorded, corresponding to a median of 42 (IQR 21–71) per gastroenterologist. Exposure to non-variceal modalities (median 28, IQR 15–52) was more frequent than variceal therapies (median 11, IQR 5–22; p<0.001). By procedure, adrenaline injection (median 12, IQR 6–23) and variceal band ligation (median 10, IQR 5–20) were most commonly recorded, whereas sclerotherapy experience was rare (median 0, IQR 0–1). Exposure to haemostasis did not differ by year of CCT (p=0.130) but varied significantly by deanery (p<0.001), with median procedures ranging from 20–126.ConclusionExposure to AUGIB haemostasis during UK gastroenterology training varied across deaneries and procedural modalities which should prompt urgent locoregional review of access and delivery of training. Endoscopy departments should ensure the availability of supportive provisions in haemostasis (i.e. training/upskilling, supervision, mentorship) during the early post-CCT period.

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Expertise in colonoscopy intubation does not predict diagnostic accuracy: a simulation-based study

Endoscopy International Open ◽

10.1055/a-1618-5525 ◽

2022 ◽

Vol 10 (01) ◽

pp. E30-E36

Author(s):

Andreas S. Vilmann ◽

Christian Lachenmeier ◽

Morten Bo S. Svendsen ◽

Bo Soendergaard ◽

Yoon S. Park ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Assessment Tool ◽

Training System ◽

Endoscopy Training ◽

Technical Performance ◽

Adenoma Detection ◽

Simulation Based ◽

Cecal Intubation Rate ◽

Inspection Performance ◽

Insignificant Correlation

Abstract Background and study aims Studies have linked cecal intubation rate with adenoma detection rate; however, the direct association between technical performance during colonoscopy intubation and withdrawal has never been explored. Thus, it remains unclear whether gentle and efficient intubation predicts superior mucosal inspection. The aim of this study was to investigate the correlation between performance during intubation and withdrawal in a simulation-based setup. Methods Twenty-four physicians with various experience in colonoscopy performed twice on the Endoscopy Training System (ETS). Intubation skills were evaluated by assessing tasks on the ETS related to intubation (scope manipulation and loop management) and use of a computerized assessment tool called the 3D-Colonoscopy Progression Score (3D-CoPS). Diagnostic accuracy was defined by the number of polyps found during the ETS task of mucosal inspection. Pearson’s correlations were calculated to explore associations between intubation skill and diagnostic accuracy. Results The correlation analysis between 3D-CoPS and number of polyps found during mucosal inspection revealed a weak and insignificant correlation (0.157, P = 0.3). Likewise, an insignificant correlation was seen between ETS intubation and number of polyps found (0.149, P = 0.32). Conclusions We found no evidence to support that technical performance during intubation is correlated with mucosal inspection performance in a simulation-based setting.

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NATIONAL DATABASE OF METAL IN COMPARATIVE PERSPECTIVES OF THE UNITED KINGDOM & INDONESIA

BULLETIN OF THE MARINE GEOLOGY ◽

10.32693/bomg.36.2.2021.733 ◽

2021 ◽

Vol 36 (2) ◽

Author(s):

Rachma Puspitasari ◽

Raldi Koestoer

Keyword(s):

United Kingdom ◽

Best Practice ◽

Public Access ◽

Future Generations ◽

National Database ◽

Success Story ◽

The United Kingdom ◽

Research Institutes ◽

The Uk

The ocean is a source of mega-biodiversity that is supposed to perform optimally for current and future generations. The health of the ocean must be evaluated by measuring heavy metals in sediment because they can be accumulated and stored in long term. This metal can be released and absorbed by an organism, and affect the ecological risk and human health. The purpose of this article is to share viewpoints and those in a comparative study in terms of the metal database of both countries, the UK and Indonesia. The methodology used in this paper is critical review and analysis to compare a success story about compiling metal data into a national database in the United Kingdom (UK). Indonesia already has an open public access database issued by the Ministry of Environment and Forestry. The further step is to strengthen collaboration between research institutes, universities, and government to assign a Standard Operational Procedure (SOP) to collect, analyze and report the data to a national depository. This database will be worthwhile to describe the pollution status in Indonesia and basic data for best practice decisions.

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Introducing JETS Workforce

Gastrointestinal Nursing ◽

10.12968/gasn.2021.19.sup2.s14 ◽

2021 ◽

Vol 19 (Sup2) ◽

pp. S14-S16

Author(s):

Keyword(s):

Training System ◽

Advisory Group ◽

Endoscopy Training ◽

Structured Approach

The Joint Advisory Group (JAG) on Gastrointestinal Endoscopy's introduces the Endoscopy Training System Workforce programme, a structured approach to endoscopy training

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Trends in UK endoscopy training in the BSG trainees’ national survey and strategic planning for the future

Frontline Gastroenterology ◽

10.1136/flgastro-2017-100848 ◽

2017 ◽

Vol 9 (3) ◽

pp. 200-207 ◽

Cited By ~ 12

Author(s):

Sujata Biswas ◽

Laith Alrubaiy ◽

Louise China ◽

Melanie Lockett ◽

Antony Ellis ◽

...

Keyword(s):

British Society ◽

Endoscopic Management ◽

Advisory Group ◽

Subspecialty Training ◽

Training Experience ◽

Training Time ◽

Endoscopy Training ◽

Therapeutic Modalities ◽

Training Programmes ◽

The Uk

BackgroundImprovements in the structure of endoscopy training programmes resulting in certification from the Joint Advisory Group in Gastrointestinal Endoscopy have been acknowledged to improve training experience and contribute to enhanced colonoscopy performance.ObjectivesThe 2016 British Society of Gastroenterology trainees’ survey of endoscopy training explored the delivery of endoscopy training - access to lists; level of supervision and trainee’s progression through diagnostic, core therapy and subspecialty training. In addition, the barriers to endoscopy training progress and utility of training tools were examined.MethodsA web-based survey (Survey Monkey) was sent to all higher specialty gastroenterology trainees.ResultsThere were some improvements in relation to earlier surveys; 85% of trainees were satisfied with the level of supervision of their training. But there were ongoing problems; 12.5% of trainees had no access to a regular training list, and 53% of final year trainees had yet to achieve full certification in colonoscopy. 9% of final year trainees did not feel confident in endoscopic management of upper GI bleeds.ConclusionsThe survey findings provide a challenge to those agencies tasked with supporting endoscopy training in the UK. Acknowledging the findings of the survey, the paper provides a strategic response with reference to increased service pressures, reduced overall training time in specialty training programmes and the requirement to support general medical and surgical on-call commitments. It describes the steps required to improve training on the ground: delivering additional training tools and learning resources, and introducing certification standards for therapeutic modalities in parallel with goals for improving the quality of endoscopy in the UK.

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

Frontline Gastroenterology ◽

10.1136/flgastro-2018-100969 ◽

2018 ◽

Vol 10 (2) ◽

pp. 93-106 ◽

Cited By ~ 27

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.

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Effect of school closures on mortality from coronavirus disease 2019: old and new predictions

BMJ ◽

10.1136/bmj.m3588 ◽

2020 ◽

pp. m3588 ◽

Cited By ~ 4

Author(s):

Ken Rice ◽

Ben Wynne ◽

Victoria Martin ◽

Graeme J Ackland

Keyword(s):

Age Groups ◽

Mitigation Strategies ◽

Advisory Group ◽

School Closures ◽

The United Kingdom ◽

Age Profile ◽

The Uk ◽

The Cost ◽

Summary Data

Abstract Objective To replicate and analyse the information available to UK policymakers when the lockdown decision was taken in March 2020 in the United Kingdom. Design Independent calculations using the CovidSim code, which implements Imperial College London’s individual based model, with data available in March 2020 applied to the coronavirus disease 2019 (covid-19) epidemic. Setting Simulations considering the spread of covid-19 in Great Britain and Northern Ireland. Population About 70 million simulated people matched as closely as possible to actual UK demographics, geography, and social behaviours. Main outcome measures Replication of summary data on the covid-19 epidemic reported to the UK government Scientific Advisory Group for Emergencies (SAGE), and a detailed study of unpublished results, especially the effect of school closures. Results The CovidSim model would have produced a good forecast of the subsequent data if initialised with a reproduction number of about 3.5 for covid-19. The model predicted that school closures and isolation of younger people would increase the total number of deaths, albeit postponed to a second and subsequent waves. The findings of this study suggest that prompt interventions were shown to be highly effective at reducing peak demand for intensive care unit (ICU) beds but also prolong the epidemic, in some cases resulting in more deaths long term. This happens because covid-19 related mortality is highly skewed towards older age groups. In the absence of an effective vaccination programme, none of the proposed mitigation strategies in the UK would reduce the predicted total number of deaths below 200 000. Conclusions It was predicted in March 2020 that in response to covid-19 a broad lockdown, as opposed to a focus on shielding the most vulnerable members of society, would reduce immediate demand for ICU beds at the cost of more deaths long term. The optimal strategy for saving lives in a covid-19 epidemic is different from that anticipated for an influenza epidemic with a different mortality age profile.

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

Gut ◽

10.1136/gutjnl-2015-309861.864 ◽

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

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

Endoscopy International Open ◽

10.1055/a-1477-2963 ◽

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.

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