Objective The aim of this study was to evaluate UK trainee experience in endoscopy for acute upper gastrointestinal bleeding (AUGIB). Methods Data was prospectively collected from all patients presenting to South Yorkshire Hospitals with AUGIB from September 2011 to December 2011 and compared with data from 1996. Concurrently, all gastroenterology trainees registered with the British Society of Gastroenterology were invited to respond to a web-based questionnaire regarding their experience in AUGIB management. Results 77% (589/766) of the patient cohort underwent endoscopy for AUGIB; 15% (90/589) were performed by trainees. 7.2% (9/125) of the out of hours endoscopy case load was performed by trainees; all were low-risk or medium-risk cases ( pre-endoscopy Rockall score ≤4). During the study period, dual therapy was delivered by a trainee on only four occasions.Comparison with the 1996 cohort demonstrated a marked reduction in the number of trainee performed endoscopies (76% vs 15%; p<0.001). Questionnaires were returned by 51% (245/478) of British Society of Gastroenterology trainees. 81% (198/245) thought that <10% of the gastroscopies they had performed involved therapeutic intervention. 23% (57/245) felt they would not be competent in AUGIB endoscopy by completion of specialty training. Conclusions This study demonstrates the decline over time in trainee experience in AUGIB endoscopy. It also highlights a lack of trainee exposure to more challenging cases, out of hours endoscopy and therapeutic procedures. Furthermore, trainees are concerned that a level of competency may not be attained during specialty training. We advocate reviewing UK endoscopic training provision for AUGIB to ensure that experienced endoscopists are produced to meet future service needs.
INTRODUCTIONAcute upper gastrointestinal bleeding (AUGIB) is a common medical emergency that has a 10% hospital mortality rate.
may be diminished by the European Working Time Directive and a Consultant delivered service. There has been no published data on trainees' opportunities for UGIB endoscopic experience. This study evaluates GI trainee experience in the South Yorkshire (SY) region and nationally. Methods Rockall scores for patients requiring an endoscopy for an UGIB (n = 622, 5 hospitals) was prospectively collected in SY between Sept-Dec 2011. Trainee experience from this cohort was then compared with a historical SY UGIB cohort (n = 274) from 1996. Nationally, all BSG trainees (n = 478) were invited to respond to a custom designed web based questionnaire (Nov-Dec. 2012). Information was collected about OGD competency (both diagnostic and therapeutic) and trainees' confidence of acquiring sufficient endoscopic skills in UGIB prior to completing specialty training. Results Regionally, comparison between the 2011 and 1996 SY UGIB cohorts demonstrated comparable 30-day mortality rates (8.5% vs 8.1%, p = 0.78), with similar median post-endoscopy Rockall scores (6 v 5). When comparisons were made between trainee and non-trainee performed procedures, no mortality difference was identified (p = 0.286). However, when comparing trainee undertaken procedures between the two cohorts, a significant decline was observed with 76% (208/274) of endoscopic procedures for UGIB being performed by trainees in 1996 compared with only 16% (97/622) in 2011 (p < 0.0001). Nationally, questionnaires were returned by 51% (245/478) of BSG trainees (median = 4 years registrar training, range 1-9 years). Of these, 42% (104/245) had completed a basic upper GI endoscopy training course and 40% a therapeutic course. Median number of OGD's performed by trainees was 500, with therapeutic exposure < 10% in 76% of cases. 23% (57/245) of trainees felt their endoscopic skills in UGIB will be insufficient at the time of specialty training completion. Conclusion This study objectively demonstrates a decline in regional training for gastroenterology trainees in UGIB endoscopic procedures. Furthermore our regional audit is supported by the National audit, which suggests that trainees across the UK are both limited in their opportunities and concerned that a level of competency may not be attained during registrar training. We advocate reviewing UK endoscopic training provision for UGIB ensuring qualified and confident endoscopists are produced to meet future service needs.
BSG abstracts effective. 1 year mortality in MND patients is high and emphasises the importance of careful patient selection. We recommend that other institutions with a high 30 day mortality following PEG adopt the changes in practise outlined above. Ongoing audit of our practise is required. Disclosure of Interest None Declared.
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