Endoscopy Training

Graeme Duthie, Chair Colonoscopy Sub- Committee ACPGBI

www.thejag.org.uk

BOTH TRAINEES AND TRAINERS SHOULD READ THE JAG GUIDELINES

JAG DOPS FORMS MUST BE USED DURING TRAINING

TRAINERS RULES

Read the JAG guidelines

Read the trainees rules (below) as well.

DO NOT PUT TRAINEES IN A POSITION THAT WILL COMPROMISE THEIR TRAINING RULES

Training experiences are often limited. Training is expected to be restricted to surgical registrars and above who have committed to GI surgery.

Trainers must be in the room to train – you cannot train a trainee in a parallel room

Trainers must fill in the DOPs forms contemporaneously – forms are procedure specific

Trainers are encouraged to be TCT/TTT trained

Try and offer multidisciplinary training (swap registrars with physicians)

Try and designate a list, or part of a list for training

Try and identify training requirements and form a training contract for the list

Support trainees even when assessed as competent – they will need help at times

Trainees must be assessed for competency at the end of their training period before they can run an independent list. The DOPS forms for assessment are available on the JAG website and the assessment should take the form of two assessors over two consecutive cases. The assessors have to be a minimum TTT trained and it would not seem to be appropriate that the principal trainer is one of the assessors.

TRAINEES RULES

TO START

You must be a surgical registrar.

You must be training in GI surgery

You should meet the training lead for your unit and form a training plan/contract

You must not work without a trainer in the room unless you have the appropriate JAG competency certificate

THEN – ENDOSCOPY TRAINING

You must do the appropriate JAG skills course (Basic Colonoscopy or Basic Skills (for upper endoscopy))

You must use the JAG DOPs forms to record your training

It’s your responsibility to make sure the forms are filled in

Colorectal trainees can commence training in colonoscopy as their primary endoscopic procedure. By definition, therefore you must do a JAG colonoscopy course. It would be sensible to progressively acquire a skill for example having training targets of

• intubating the rectum and sigmoid
• intubating to the transverse colon
• full intubation and withdrawal

Use the DOPs forms to formatively assess your competence and only get summatively assessed when ready – discuss this with your principal trainer. You must have achieved both the minimum numbers and quality standards –see the JAG website

Competence is assessed by two assessors over two endoscopies.

Your principal trainer should not be one of the assessors

You should try and arrange training by a selection of trainers (physicians, surgeons and nurses)

Ensure you are trained using torque steering (using other techniques will fail the exit assessment)

Competence in diagnostic endoscopies does not allow you to perform therapy

Build evidence of therapeutic competency separately, (and for upper endoscopy, only once you have a competence certificate for diagnostic endoscopy)

Identify a trainer ( TTT or TCT trained) to have overall responsibility for your training, but -

You should arrange training by a number of trainers (physicians, surgeons and nurses)

Use the JAG colonoscopy DOPs forms to record your training

Identify a regular list to train on.

Form a training contract with your trainer

Once you feel competent, discuss with your trainer and arrange for the exit assessment

Your DOPs forms, portfolio, summary forms AND the JAG competency certificate are required for your RITA/ARCP sign off – all on the JAG website

Be aware you will even when signed off as competent – you WILL need help for difficult and therapeutic cases – make sure you know where help is available

FINALLY REMEMBER

Competency is procedure specific – if you want to do upper GI endoscopy you must have the appropriate certificate

You do not need to be competent in endoscopy to get a consultant post

But you cannot take a job that has endoscopy session/s unless you have the necessary competency certificates (but you can train even as a consultant)

Expect to be locally “assessed” when going into any new unit – even as a consultant

Over the next two years, the GRS and JAG rules will almost certainly be applied in the private sector as well as the NHS