The trainee certification process has undergone a thorough review by the JAG Quality Assurance of Training Working Group (JAG-QA-T-WG). The JAG-QA-T-WG will continue to review and develop the trainee certification process, however it will endeavour to keep any changes to a minimum and only where essential, to prevent confusion. The group welcomes feedback on the new trainee certification process through the JAG office (email@example.com).
Why change the current process?
Feedback received by JAG from trainees applying for JAG certification highlighted a lack of clarity in the current process’ requirements and method of application. Trainees also described frustration with a paper-heavy process. In response to these comments, and with the aim of modernising the trainee certification process, the JAG-QA-T-WG used the following principles when revising the certification process:
- The process needs to be streamlined with a reduction in the paper burden
- The process needs to be clear and comprehensible
- The process needs to be fair, applicable and relevant to all endoscopy trainees
- The process should test endoscopic competence
Changes to the process
In order to streamline the process, the JETS e-portfolio was designed, piloted and released UK-wide under the management of the JAG-QA-T-WG. In March 2011, trainees were able to begin applying for JAG certification using the JETS e-portfolio. A new tab has been created on the JETS e-portfolio which enables the trainee to access their certification page. This page lists the trainee’s eligibility criteria, allows summative DOPS completion and provides a means of electronically submitting the trainee’s portfolio for trainee certification. All applications now need to be submitted through the JETS e-portfolio using the new process certification criteria.
Focus on trainee endoscopic competence
The purpose of the JAG trainee certification is to assess trainee’s competence at performing an endoscopic procedure and recognise their ability to perform the procedure at a standard commensurate with indepentdent practice. Some of the eligibility criteria in the old certification process did not accurately reflect the trainee’s ability or practice. For example, the following requirements have been removed:
- Complication rate – most trainees will not have performed sufficient endoscopies at the time of application to make this a meaningful criteria
- Sedation – this often reflects the trainer’s practice, not the trainee’s. These requirements have been removed for applications bar those where a trainee is performing endoscopy independently from a trainer (i.e. if they have provisional certification in colonoscopy).
New criteria have been included:
- Formative DOPS scores – DOPS assessments provide a score on the trainee’s competence at a procedure whereby a "4" denotes a highly skilled performance and a "3" denotes a competent performance using the benchmark of an independent endoscopist (not the trainee’s stage of training). Trainee’s will now need to be scoring >90% "3"s and "4"s for parameters in all procedures over the previous 3 months to be eligible for a summative assessment.
- Physically unassisted – even if a trainee manages to reach the endpoint of a procedure (e.g the second part of the duodenum or caecum), they may have either been assisted for part of the procedure or assisted in the withdrawal of the scope (to ensure a thorough inspection of the mucosa). Trainees need to be competent at all aspects of endoscopy before being signed off. The new criteria of physically unassisted will be introduced for all procedures with a cut off of >90% (>95% for diagnostic gastroscopy). This data will be calculated over the previous 3 months.
Clarity on provisional and full certification
Feedback received from trainers and trainees also highlighted a lack of clarity on the rules for provisional and full certification. Within the new trainee certification process the only procedure to have a provisional certification stage is colonoscopy. For all other procedures, trainees will apply for full certification. The rationale for this approach is trainees may have gained sufficient expertise to perform diagnostic colonoscopy proficiently but had little exposure to polypectomy. Larger polyps are not very common on most colonoscopy lists but all independently practicing colonoscopists should have the skills to deal with them. Initially polypectomy competency will be dived into:
- Level 1 polypectomy – polyps<1cm
- Level 2 polypectomy – polyps>1cm
Trainees will need to demonstrate competence at basic polypectomy (polypectomy level 1) to be provisionally certified. A new DOPS form (the DOPyS ) provides the assessment tool for this purpose. Having been granted provisional certification, trainees should then run lists adjacent to the trainer’s list. If they encounter a larger (level 2) polyp, they should seek training on the polypectomy together with a DOPyS. When they are scoring >90% “3”s and “4”s on their last four DOPyS for level 2 polypectomy they can apply for full certification. Formal summative sign off will not be required.
The newly developed DOPyS provides a tool to better assess a trainee’s ability to perform polypectomy. Similar tools currently do not exist for therapeutic gastroscopy. The JAG-QA-T-WG decided that the assessment tools previously available were inadequate for certifcation in these procedures. JAG has therefore suspended applications for therapeutic gastroscopy from the certification process for the current time. Responsibility for allowing trainees to perform therapeutic gastroscopy independently is now under the remit of individual endoscopic unit’s governance processes until a new certification process has been developed. It is the intention of the JAG-QA-T-WG to develop assessment tools for therapeutic gastroscopy. Until this time, trainees will not be expected to provide JAG certification in therapeutic gastroscopy.
The JAG-QA-T-WG are currently reviewing the certification criteria for ERCP. The JAG has therefore suspended applications for ERCP from the certification process for the current time. Responsibility for allowing trainees to perform ERCP independently is now under the remit of individual endoscopic unit’s governance processes until the certification criteria has been reviewed. Until this time, trainees will not be expected to provide JAG certification in ERCP.