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

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.

Download Full-text

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.

Download Full-text

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.

Download Full-text

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.

Download Full-text

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

Endoscopy ◽

10.1055/a-1234-8233 ◽

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.

Download Full-text

Training pathway for small bowel capsule endoscopy in the UK

Frontline Gastroenterology ◽

10.1136/flgastro-2021-101810 ◽

2021 ◽

pp. flgastro-2021-101810

Author(s):

Foong Way David Tai ◽

Clare Parker ◽

Reena Sidhu ◽

Mark McAlindon ◽

Carolyn Davison ◽

...

Keyword(s):

Small Bowel ◽

Capsule Endoscopy ◽

Gastrointestinal Endoscopy ◽

Advisory Group ◽

Electronic Learning ◽

Professional Groups ◽

Learning Module ◽

Knowledge Based ◽

Accreditation Programme ◽

The Uk

The demand for small bowel (SB) capsule endoscopy (CE) is increasing in the UK. However, there remains a wide variation in the number of CE procedures performed in different centres. Across the UK there is a lack of a clear training pathway or certification process. A standardised national Joint Advisory Group (JAG) on Gastrointestinal Endoscopy approved a 1-year training and accreditation programme accessible to all professional groups that may wish to train in SB CE. Structured training is delivered using JAG-accredited CE courses and an electronic learning module. Prior to setting a knowledge-based assessment, a minimum of 50 SB CE cases are recommended to be read in tandem with a trainer at a local centre, with proficiency documented using Direct Observation of Procedural Skill (DOPS) assessments.

Download Full-text