Welcome to the JAG
Main Aims
- To set standards for individual endoscopists
The Royal Colleges and their Specialty Advisory Committees (SACs) tasked the JAG to agree uniform standards for endoscopy no matter the professional background of the endoscopist. The JAG also agrees appropriate evidence of meeting those standards. It assesses if the portfolio presented by a trainee endoscopist evidences that the individual meets the criteria. If the criteria are met, the JAG issues a certificate, thus making a recommendation to the SAC. The SACs take this into account when accrediting individuals.
- To set standards for training in endoscopy
JAG aims to ensure that all trainees should have one protected potential training list weekly in endoscopy, with that list being reduced in size to “8 points” (8 upper endoscopies or flexible sigmoidoscopies, or 4 colonoscopies, or 3 ERCPs). At least 50% of their trainers should have undertaken a “Training the Trainers” course, specific for endoscopy.
- To quality assure endoscopy units for training
There is evidence that high quality training can only take place in high quality units. The JAG sets standards for units, based around the Global Rating Scale (GRS), and assesses and accredits units against those standards. Currently this is a process under reform –see below under “Bowel Cancer Screening”.
- To quality assure endoscopy training courses
The JAG approves endoscopy courses, based on GMC and PMETB standards for courses. If a course is approved, JAG will list it via the JETS website. Attendance at a JAG approved basic skills course is a requirement for accreditation.
- To quality assure endoscopy units for the NHS Bowel Cancer Screening Programme
The BCSP asked the JAG to undertake this on their behalf. Accreditation is based on the GRS standards, with submitted evidence being validated by a site visit from trained professional assessors. Currently this applies in England. Scotland, Wales and Northern Ireland are also taking on this process.
- What JAG is not
- JAG does not accredit or licence endoscopists – that is the duty of the SACs and GMC respectively.
- JAG does not stop independent endoscopists (consultants, nurse endoscopists or others) performing endoscopy if their annual endoscopy numbers are low, or their performance data below that expected of competent trainees – that is the duty of a Trust or employer under clinical governance processes. Furthermore, there is guidance on available options to endoscopist and trust on what to do in these circumstances.
- JAG does not provide training courses – that is the business of the Training Centres.
- JAG does not tell the Colleges, SACs and specialist societies what to do – rather those bodies constitute the entire JAG membership, and task JAG to recommend standards, and to assess individuals and units against those standards on their behalf.
Background
The Joint Advisory Group on GI Endoscopy has been in existence since 1994. It is sponsored and funded by several Royal Colleges [The Royal Colleges of Physicians of the UK, the Royal Colleges of Surgeons of the UK, the Royal College of Radiologists and the Royal College of General Practitioners], set up to define the standards for the training of all endoscopists no matter their professional background. Thus, in addition to sponsoring Colleges, other members are co-opted from stakeholders, including most relevant specialist societies and the SACs - see the current membership list and the original constitution for the JAG.
There has been widespread acknowledgement that although JAG was initially aimed at doctors in training, much has changed, namely:
- greater emphasis on improved standards for training and education
- nurse endoscopists becoming a highly significant part of the workforce
- acceptance that high quality training can largely only take place in high quality units
- realisation that the impact of service cannot be removed from having an influence on training
- implementation of bowel cancer screening for the UK, for which JAG was asked to oversee quality of endoscopists and of endoscopy units
- increasing need for consultants & nurses to overtly demonstrate competence, becoming mandatory in 2009
Therefore, the remit of the JAG has changed; consultations are underway on further revision. Meanwhile, the JAG is focusing on a key areas:
The third version of the previous JAG guidelines from 2004 have now been revised and are now reproduced on these pages (version 4, 2007).
The new guidelines set out the general recommendations on facilities and endoscopic experience and the detailed competence-based curricula for training in diagnostic upper GI endoscopy, therapeutic endoscopy, colonoscopy, flexible sigmoidoscopy, endoscopic retrograde cholangiopancreatography (ERCP), enteroscopy and endoscopic ultrasound (EUS).
The guidance is divided, for convenience into sections for:
The guidelines also cover the provision of courses, both JAG designed [JAG Compliant] and those organised by units and meeting JAG criteria [JAG Approved], as well as providing advice and documentation to assist educational supervisors with workplace assessment.See under these areas for details:
The JAG maintains records of approved training units and individual practitioners in training from disciplines other than Gastroenterology and General Surgery (who are catered for by the relevant Specialist Advisory Committees [SACs] of the Medical & Surgical Royal Colleges). However, both SACs fully subscribe to the standards and processes laid out in the Guidelines and all trainees are encouraged to utilise the portfolio when in endoscopic training modules.
Professor Roger Barton
Chairman, JAG
April 2008