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Guidelines in individuals in training

General Recommendations on Training in Gastrointestinal Endoscopy

Overview: The following applies to all practitioners training in endoscopy, including additional information for nurse and non-medical endoscopists, and for trainees in paediatric endoscopy.

Index

 

Endoscopic experience

Training principles and overview

  1. Any practitioner who undertakes gastrointestinal endoscopy should receive formal training in the principles and practice of safe endoscopy.
  2. In the best interests of patients, and to most efficiently teach trainee endoscopists, training should be prioritised for practitioners who aim to have a regular sessional commitment to endoscopy in their permanent posts.
  3. Training in endoscopy should take place in JAG-approved units
  4. Endoscopy training should be provided within a multi-disciplinary gastroenterology service. Joint working is desirable, and units should hold regular multi-disciplinary meetings in which trainees participate. General practitioners, nurses and non-medical endoscopists who undertake training in endoscopy must do so in units approved by the JAG, and should register with the JAG.
  5. Training should consist of protected, personalized, in-service teaching, and attendance at JAG courses (now called JAG compliant courses).  Trainees are expected to attend the unit endoscopy users group.
  6. Trained practitioners in gastrointestinal endoscopy are expected to maintain knowledge and skills through continuing medical education and professional development in endoscopy.
  7. Training should include formal instruction in:
    • The indications and contraindications for each endoscopic procedure
    • Obtaining informed consent from patients
    • Communicating endoscopic findings and their implications to patients, relatives and carers
    • Providing a high standard of written reports and communications with other doctors
    • Communicating bad news, including discussing complications of endoscopy
    • The technique of conscious sedation, and the avoidance and management of sedation-related complications
    • The skills of endoscopy
    • The causes, recognition, management and avoidance of endoscopy-related complications
  8. Therapeutic endoscopy should be taught only after adequate skills for diagnostic procedures have been acquired.  Procedures should be carried out only under supervision until competence is achieved, and has been formally assessed by the JAG process.
  9. Trainees should have wider knowledge of issues related to endoscopy, including surveillance protocols , the implications of findings at endoscopy, and the range of treatment options, or have access to such information.

Educational supervision

  1. Trainees are required to participate in regular endoscopic appraisal as well as supervised training. They should regularly seek formative assessments that contribute to their portfolio. They should respond positively to training, evaluation, feedback and assessment, to assist them in their preparation for accreditation and for lifelong learning. They should accept recommendations from trainers about their readiness or otherwise for formal summative assessment and potential accreditation, or the need further focussed training.   Use of the specific formative DOPS assessment forms is strongly recommended to provide a portfolio of assessed cases
  2. Trainees must ensure they have adequate supervision at all times, for procedures that they have not yet gained a certificate of competence in. For trainees, this means a supervisor in the room until Provisional Accreditation, or in the Unit until Full Accreditation.
  3. Trainees should not undertake independent endoscopy unless formally assessed as competent (Provisional Accreditation) by two assessors.

Assessment and appraisal - Overview

  1. Trainees must maintain an accurate portfolio of their experience, using the content and layout recommended and supplied by the JAG or appropriate SAC or College. These should be supplemented by an audit of the trainee’s endoscopic work, auditing the currently specified performance data.  A written record of the number and variety of procedures carried out under supervision and independently should be kept for inspection - a logbook. Use of the DOPS assessment forms included in this document is strongly recommended.
  2. Detailed assessed cases using the formative DOPS forms should be used to supplement the logbook.
  3. When trainees are meeting the criteria for experience and performance standards, they should discuss formal, summative, DOPS assessment with their supervisor, with a view to accreditation and the issuing of a certificate from the JAG.  See below.           

Courses

  1. All trainees must attend a Basic Skills (Foundation course) in Endoscopy for Upper Endoscopy, or a Basic Colonoscopy course, for lower GI endoscopy, compliant with JAG standards (JAG compliant course). 
  2. Courses on therapeutic endoscopy and ERCP are also valuable and recommended, although not mandated.
  3. Facilities for training or courses are widely available.
  4. Applicants for courses must meet the criteria – please see the specific procedures for details. 

Assessment of competence of trainees

Training in individual procedures

Audits of endoscopic practice across the UK have demonstrated the need for improved training. The relevant professional bodies and the NHS feel that it is imperative that practitioners are not only thoroughly trained and competent, but are demonstrably shown to be so. The JAG, with the backing of its’ constituent bodies, the support of the NHS National Endoscopy Programme and in keeping with the mandatory principles of training and assessment laid out by PMETB and the GMC, is now applying a formal assessment of competence in all endoscopic procedures for all trainees, in conjunction with the accrediting bodies.

The mainstay of teaching & training in endoscopy should be supervised practice by competent and trained trainers. Within guidance around numbers of procedures undertaken by trainees, and when performance criteria are met, trainers should be monitoring when a trainee is ready to undergo formal assessment of competence.

See the criteria for accreditation for each procedure - recommended minimum numbers, performance indicators, and summative DOPS criteria.

Training for nurse endoscopists & other Non-medical endoscopists – additional information

Many nurses now undertake diagnostic and therapeutic endoscopy. The UKCC (now NMC) document “The Scope of Professional Practice” supports nurses developing their professional practice, as long as the “nurse concerned is competent for the purpose, and mindful of the personal professional accountability they bear for their actions”. In addition, other professionals (e.g. radiographers) and non-medical practitioners are now being trained in endoscopy.

Regardless of professional background, all non-medical endoscopists should have been trained to the standards expected of a medical endoscopist and their training requirements should be addressed in a similar manner to those of nurses.

General recommendations

  1. It is the responsibility of nurses and other non-medical endoscopists to ensure they are fit to practise and of doctors (the responsible consultant) to ensure that any devolved responsibility for endoscopy is passed to a person fit to practise such a procedure.
  2. A situation such as endoscopy involves the use of special skill and each practitioner will be judged against the standard of an ‘ordinary skilled practitioner’, professing to have that special skill.

Endoscopy experience

  1. Trainee endoscopists, whatever their background, should ensure their endoscopy training is the same as that for any endoscopist. 
  2. The law does not recognise the term “Nurse Endoscopist“ or any other such title, but regards them as nurses, radiographers or others undertaking endoscopy as part of their role. Therefore any nurse undertaking any GI endoscopy, regardless of title, (e.g. Stoma Care Nurse, Colorectal Practitioner, Nurse Endoscopist), role or previous experience should be trained to the nationally accepted standards, outlined within this and associated documents.
  3. Trainees’ education should be at a level and depth required to support clinical work and patient management.
  4. Trainees should understand it is their responsibility to ensure their training and practice is contemporary, evidence-based and undertaken within national guidelines, including those in this document.
  5. Trainees and independent practitioners should develop processes to ensure continuous audit, professional development, and assessment of practice.
  6. The use of a professional portfolio, including a logbook, is required to confirm learning needs and evidence of adequate training.
  7. Trainees should be registered with JAG at the commencement of their training and will be issued with a certificate acknowledging completion of training.

Courses, training and future practice

  1. Any courses undertaken, including formal university-linked nurse endoscopy training courses should be accredited by the JAG (JAG approved).  Attendance at the relevant JAG initiated or compliant courses are mandatory (JAG compliant courses).
  2. The training process undertaken should recognise the differences between non-medical endoscopists training and medical training and address the deficiencies to achieve a common core standard of knowledge in endoscopy.
  3. Education and courses should be part of a Higher Award Scheme with standardised accreditation and transferability of training.
  4. Nurse and other non-medical endoscopists may act as endoscopy trainers for both doctors and nurses once they have achieved:
    1. Expert practice
    2. Competency in the training role
    3. Undertaken an appropriate Training the Trainers (Endoscopy) course.

Recommendations for training of paediatric endoscopists – additional information

The JAG recognises that the training requirements and experience required for Paediatric Endoscopy are different to those for the practice of adult gastrointestinal endoscopy. Pending the availability of formal validated assessment methods, adult gastroenterologists undertaking endoscopies in paediatric patients should ensure that they have adequate training and experience and have trained in paediatric gastroenterology referral centres if intending to undertake paediatric endoscopy procedures post-CCT.

UK paediatricians are currently working hard towards giving greater clarity of advice to trainees in this area, and progress will be reported via the JAG and the specialist societies and colleges.

Facilities

  1. Training in Paediatric Endoscopy must take place in units recognised by the RCPCH Speciality Advisory Committee on Paediatric Gastroenterology.
  2. The training unit should be equipped with modern video endoscopy equipment suitable for use in paediatric practice.  This should include high quality televisual display and image recording facilities, with access to training videos and ‘JPEG/MPEG’ programmes on the Paediatric Gastroenterology Society web pages.

Endoscopic experience

  1. Paediatric trainees should undertake at least 100 diagnostic upper gastrointestinal endoscopies under supervision and at least 100 diagnostic ileo-colonoscopies pending the introduction of formal training assessment methods.
  2. Trainees should have experience of removal of foreign bodies at upper gastrointestinal endoscopy and polypectomy at colonoscopy
  3. After achieving basic competence at these procedures it is expected that higher level training will provide experience in and competence to perform a wide variety of therapeutic procedures.   The accent is on ongoing skill assessment, i.e qualitative rather than quantitative.
  4. A written record of the number and variety of procedures carried out under supervision and subsequently independently should be kept for the trainee’s ‘procedure experience record’.

Courses in diagnostic and therapeutic paediatric endoscopy

  1. Trainees should attend courses in both diagnostic and therapeutic endoscopy and colonoscopy which are now available with pure paediatric orientation.
  2. Courses should be approved by the British Society of Paediatric Gastroenterology, Hepatology and Nutrition and be provided on a regional or national basis.

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