Guidelines for Unit Recognition

Index

Introduction

1. When the JAG was first formed, its remit was entirely concerned with standards of teaching, training, and curricula for trainees in endoscopy in the UK. Despite this limited remit the JAG instituted a programme of unit approval, based on a paper application, so that it could be reasonably sure that training was being undertaken in units that were appropriately equipped and staffed for that purpose. The documentation improved over time, but the JAG became aware that formal visits were the best way to quality assure training centres. With the advent of the NHS Bowel Cancer Screening Programme, http://www.bcsp.nhs.uk the NHS felt it important to ensure that any colonoscopy undertaken on a screened population was performed to the highest standards possible. The BCSP sought the collaboration of JAG, interested endoscopists, and the National Endoscopy Training Programme with its National and Regional Training Centres, to help devise a high level assessment of colonoscopy skills and performance. All centres approved for screening must meet agreed criteria and be accredited as such, the accreditation being endorsed by and issued following a formal JAG accreditation visit. The advent of BCSP visits enables the JAG to widen its role in the QA of all units.

2. In 2006 the JAG was been asked by the National Cancer Screening Project (England) to implement its unit accreditation process as the standard by which the BCSP centres will be appointed. The process involves professional visits to aspirant centres, as described below. Additionally it is recognised by both the profession and government that the provision of high quality endoscopy services will also enable the delivery of high quality training. The JAG intends to build on this realisation by reforming the way in which units are recognised as suitable for training. The current practice of paper-based accreditation will in due course be superseded by a more rigorous process involving formal visits.

Types of unit¹

1. JAG recognised training units. Recognised following application to the JAG. Each unit receives 5 years of recognition before being required to re-apply. Many re-accreditations have not been fully approved, pending the introduction of more robust (eg visits) QA processes, and these units have been given extended temporary accreditation pending a JAG visit. A spreadsheet indicating these units may be found here
2. BCSP accredited units. which are those visited and approved by the JAG under the aegis of the BCSP, to undertake screening colonoscopies. Colonoscopists must also be accredited by the JAG (see Guidelines for consultants).
3. The National and Regional training centres, funded initially by the beating bowel cancer charity and later the Department of Health, these centres were set up to deliver the JAG compliant courses to quality assured standards. There are 13 of these training centres, listed here.

5. In summary therefore there will be two forms of unit recognition:

• Accredited units Those appointed under the National Cancer Screening Project, which will have been formally visited and approved by the JAG. Up to 90 units over three years may expect to be appointed.

• Recognised units Those who deliver training, but are not screening units, who will continue to apply to the JAG for recognition but based on the same paperwork as that required for Bowel Cancer Screening Center status..

Quality assurance visits (priority given to BCSP screening centres)

6. Details of the process and the application form may be found here however the following gives a brief outline:

• Three months prior to the intended visit date, a detailed questionnaire based on the Global Rating Scale (www.grs.nhs.uk) will need to be completed on-line by the professional in charge of the unit. This will form the basis of the evidence for re-registration and will have to be formally signed off by both the lead Clinical Director and the Nurse Manager.
• A visiting team will be arranged by the JAG office made up as follows: a training lead, an SHA lead, and a nurse lead. Assessor team members will be trained. 

The visitors will compile a report that will indicate whether the unit can be recognised as a screening centre or what actions need to be undertaken for such status to be granted. It is hoped that where supplementary actions are required and undertaken, that accreditation will follow through by remote monitoring.

• Each training unit will be responsible for the costs of such visits

Application for unit recognition

7. It is clear that the training environment provided for the trainees should be assessed in its broadest terms, including compliance with nationally accepted standards of endoscopy including such matters as cleaning and disinfection of endoscopes and accessories, safe sedation techniques and monitoring and other matters of structure including adequate recovery space, access to resuscitation equipment, piped oxygen etc. i.e. the JAG accreditation visit standard.

8. It is the JAGs view that only units which follow these standards are suitable for training. The approval of the widening of JAG’s remit to include site visits will assist the JAG in ensuring that the re-registration is completed in a timely manner and that units do actually meet the requirements.

9. Therefore those units, that are not screening centres, wishing to be recognised as suitable for training endoscopists, will be expected to demonstrate equal standards.

10. The JAG office will manage a rolling process of accreditation and re-accreditation.

Training centre criteria

11. 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 programme²)
• Agree and adhere to the Quality Assurance framework as outlined by PMETB and the Quality Assurance Agency for Higher Education (QAA)
• Adhere to quality standards and ongoing quality monitoring frameworks as determined by commissioners/Deaneries
• Evaluate the course using key JAG domains and against the course objectives
• Adhere to set standards for:
• 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 compliant/approved course delivered

All trainers should meet minimum standards for training centre trainers (see Standards for Endoscopy Trainers)

• They should be TTT or TET trained
• There should be evaluations of trainer performance included as part of the course
• The majority of trainers per course should have a clinical professional qualification

12. Many units will fall into all three categories. The JAGs ultimate intention is to have instituted QA visits to all units.

Footnotes