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Endoscopy courses

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Introduction

1. The JAG has strongly recommended that both trainees and trainers should undertake appropriate courses  relevant to their practice. All trainees in gastroenterology are required to attend a Basic Skills (Foundation) Course in Upper Gastrointestinal Endoscopy, as are any other practitioners who undertake upper endoscopy. Trainees in Colorectal surgery, and gastroenterology trainees undertaking colonoscopy are required to take the Basic Skills course in Colonoscopy. For the trainers, a ‘Training the Trainers (Endoscopy)’ course is recommended. Now that courses are widely available, it is intended that each endoscopist should undertake the Basic Skills (Foundation course) in Endoscopy at the start of their endoscopic career and then undertake the individual more specialised courses as they train in each skill.

2. To develop standard courses, the JAG worked initially with the Raven Department of Education at the Royal College of Surgeons of England, and more recently with the Training Leads in the National Endoscopy Training Programme. These ‘compliant’ Courses are now available in a number of centres, and details of their location, costs and contact points are available through the JETS link on the home page of this website.

3. Currently the following courses are available:

  • Basic skills in Colonoscopy
  • Basic skills (Foundation course) in Endoscopy
  • Training the Trainers (Endoscopy)
  • Flexible Sigmoidoscopy
  • Therapeutic Upper Endoscopy
  • ERCP

Content of JAG compliant courses

4. Each course consists of a basic theory part as well as hands on skills training in the relevant endoscopic area. Each course has evolved to ensure that they deliver the essential knowledge and practical skills training.

5. The precise details of each course are beyond the scope of this document, however, a brief summary is included to give a guide to the format of the courses. Each course, wherever taught, has the same syllabus, and regular cross-participation from visiting faculty helps maintain a common purpose and national standards.

Basic skills (foundation course) in endoscopy

6. This course is a 3-day course with the first 2 days devoted to the theory and background of the practice of safe endoscopy, as well as the training in the basic skills of upper gastrointestinal intubation and flexible sigmoidoscopy. To enable the skills training to be practiced, endoscopic models are used, complemented by use of the latest computer simulators. On the third day each trainee undertakes 3-5 Upper Gastrointestinal Endoscopies on patients who have given their prior informed consent.

7.    Between 8 and 12 trainees participate in the course.

The theoretical aspects include:

  • Instrument design and function
  • Indications and contraindications
  • Complications, their avoidance and management
  • Informed consent
  • Safe sedation
  • Diathermy theory and practice
  • Accessories and sample handling
  • Equipment fault finding
  • Cleaning and disinfection


The practical skills taught include;-

  • Control Handling
  • Torque steering
  • Retroversion in the stomach
  • Loop recognition and resolution during flexible sigmoidoscopy

Basic skills in colonoscopy

8. This is a 3-day course with a mixture of theory as in the above course together with skills training in torque steering using models. Additional topics include Polypectomy and Surveillance protocols

9. Each of the 4 trainees undertakes 4 colonoscopies under direct supervision of a trained consultant trainer. Each training centre running such courses has specifically designed split screen video projection facilities so that the other trainees can benefit from the training of their colleague. The training experience is complemented by the use of the 3D magnetic imager to help the trainee understand loop development and resolution.

Basic skills in sigmoidoscopy

10. The theory part is the same as that for the Colonoscopy course with appropriate alterations to the indications, contraindications and complications.

11. Skills training were also similar to that of the colon course with the use of the same models. It is planned that the course will run over three days, with each trainee undertaking 4 flexible sigmoidoscopies in appropriately consented and sedated patients. 3 trainers will be required for 6 trainees

Training the trainers (endoscopy) course

12. This course is run over 2 days with the first day being an intensive course on the principles of adult education and in particular training in the principles and practice of skills training. On the second day, the trainee trainers concentrate on skills training in endoscopy with particular reference to scope handling and torque steering. The structure and content of this course is changing as increasing numbers of trainers have attended generic “Training the Trainer” courses. More emphasis on assessment of trainees is to be introduced.

National initatives

13. The Department of Health through the Cancer Plan allocated significant funding for endoscopy training.This initiative currently only applies to England. JAG and the SAC (Gastroenterology) have written in support of similar funding to the funding bodies in Scotland, Wales and Northern Ireland.

14. Initially three national training centres and seven regional centres were appointed. Several other centres now also provide training, and all of these centres work closely togther on curriculum and course content to promulgate good endoscopy training.

15. JAG requires that centres deliver some or all of the mandatory JAG compliant courses to be "JAG Approved" - to ensure that all trainees have access to these required courses.

JAG approved courses

16. Now that a suite of bespoke endoscopy training courses is established, and in recognition that many units around the UK put on high quality training both as hands-on training and as endoscopy courses, the JAG approves suitable courses, delivered by individual centres. JAG standards for course approval are taken fropm the GMC and PMETB guidance on curricula. The previous terminology of JAG compliant or JAG approved has now been simplified - a course is either accredited or not.

17. Currently, the only mandatory course for trainees is the basic couurse in the procedure being learned,, restricted to upper endoscopy and lower endoscopy.  The basic ERCP course is not mandatory.

18. Those seeking approval of courses must apply to the JAG on the relevant form. Details of JAG approved courses are shown on the courses pages of the JAG website.

19. Guidelines for course organisers have been prepared and may be found here. 

20. Application forms for JAG approval of courses can be found here.

Criteria for training centres

Preamble

21. There are overarching requirements which need to be met in order to designate a centre as an endoscopy training centre. In addition to this there will be a need for resources within the training centres and specific requirements for resources associated with each type of JAG compliant/approved course. We are in the process of defining the specific requirements for resources by course type.

Training Centre Criteria

22. The overarching requirements for designation as an endoscopy training centre are that the endoscopy unit must:

  • Be a JAG Accredited Unit
  • Deliver JAG compliant courses (with both the total number of courses and mix of course types to comply with the standards set by the programme)
  • Agree and adhere to the Quality Assurance framework as outlined by PMETB http://www.pmetb.org.uk and the Quality Assurance Agency for Higher Education (QAA) http://www.qaa.ac.uk
  • Adhere to quality standards and ongoing quality monitoring frameworks as determined by commissioners/Deaneries
  • Adhere to set standards for:

 

Resources:
Training centres must have the following resources

  • Models
  • Audio-visual links
  • Magnetic Imagers
  • Web access, DVDs, CDs, textbooks
  • Rooms for presentation and discussion
  • Specific resources associated with each type of JAG compliant/approved course delivered

Faculty:
Trainers teaching on courses must adhere to guidance below:

  • The number of trainers specified for each type of JAG complaint/approved course delivered
  • All trainers should meet minimum standards for training centre trainers (see standards for endoscopy trainers below)
  • The majority of trainers per course should have clinical professional qualifications

Standards for endoscopy trainers

23. The JAG considers that whilst the broad aspirational aims above were currently appropriate for all trainers, more exacting standards should be agreed for trainers currently providing formal training in the regional and national training centres. It is recommend that as a starting point that all such trainers should:

  • Mandatory:
    • Be fully competent in the procedure they are teaching, to accepted national standards
    • Have attended a Training the Trainers course
  • Desirable
    • Participate in endoscopic CPD
    • Train others on a formal course for more than 2 days annually
    • Evaluate their performance as an endoscopic trainer as outlined above for all trainers.
  • For consideration
    • That we should aspire to lead trainers having a higher educational qualification.

 

    Current recommendations are that all centres should deliver at least three courses annually, with the capability to deliver a range of courses, including at least one for trainers (which could include the standard Training the Trainers course but not necessarily).

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