Colorectal trainees in the UK struggle to meet JAG certification standards in colonoscopy by the end of their training

Abstract

Aim Colonoscopy certification in the UK is taken in two parts – provisional and full – mandating lifetime procedure counts of 200 or 300, respectively. The aim of this study was to determine the number of procedures performed by colorectal trainees by the end of training compared with their gastroenterology peers and to determine the factors associated with achieving the 300‐procedure target for full certification. Method Dates of entry onto the specialist register were obtained from the General Medical Council. This list was cross‐referenced with procedure counts from the Joint Advisory Group on Gastrointestinal Endoscopy (JAG) Endoscopy Training System database to determine the number of colonoscopies and polypectomies performed during training. Factors associated with achieving 300 procedures were analysed by logistic regression. Results Procedures numbers were obtained for 234 gastroenterology and 148 colorectal surgery trainees. Over the last 5 years, the number of colonoscopies performed during training has declined for colorectal surgery trainees but increased for gastroenterology trainees. Gastroenterology trainees are more likely to achieve provisional and full certification. For trainees completing training in 2017, 19% of colorectal surgery trainees compared with 88% of gastroenterology trainees were able to reach the threshold of 300 procedures for full certification. Conclusion Colorectal surgery trainees lag behind their gastroenterology counterparts in accruing endoscopy experience. This affects the ability of colorectal surgery trainees to achieve certification prior to completion of training. An urgent debate is required to decide what endoscopy training is required of a colorectal surgeon and how a robust training system can be put in place to ensure this is achieved.

National census of UK endoscopy services in 2019

“…This echoes previous studies that highlight the lack of accessible training for surgical trainees 15 and differences in list accessibility between trainee types, 16 which ultimately may have an impact on competency acquisition. 17 Cumulatively, this perhaps signifies a change in how training occurs. We may see this amplified with the advent of ‘Shape of Training’, which will shorten the effective training time for endoscopy within training programmes.…”

Joint ACPGBI and the Dukes' Club statement on colonoscopy training

“…indicating the Joint Committee on Surgical Training's commitment to colonoscopy training. However, several studies have reported a marked deficiency in colonoscopy training opportunities and accreditation for surgical trainees compared with gastroenterology trainees [2][3][4]. These challenges have been dramatically accentuated by the COVID-19 pandemic, reflecting a wider detrimental impact on endoscopy training across the world [5] The Joint Advisory Group on Endoscopy (JAG) has done much to improve the quality of colonoscopy in the UK in the past 20 years.…”

“…Meanwhile, the new UK General Surgical curriculum now includes an indicative requirement of 200 diagnostic colonoscopies for surgical trainees who have declared a colorectal subspecialty interest (hereafter termed ‘colorectal trainees’), indicating the Joint Committee on Surgical Training’s commitment to colonoscopy training. However, several studies have reported a marked deficiency in colonoscopy training opportunities and accreditation for surgical trainees compared with gastroenterology trainees [2–4]. These challenges have been dramatically accentuated by the COVID‐19 pandemic, reflecting a wider detrimental impact on endoscopy training across the world [5] highlighting the urgent need for a more robust and equitable colonoscopy training programme in the UK.…”

COVID-19 and endoscopy training

“…A further publication highlights this baseline deficiency in endoscopic training among colorectal trainees, with only 19% achieving 300 colonoscopies for full certification in 2017. 4 As many units are well under way in planning their return to endoscopy service delivery, it is unlikely that training will resume in the same capacity as it did beforehand. How long this is likely to be the case as yet remains unknown.…”

“…A further publication highlights this baseline deficiency in endoscopic training among colorectal trainees, with only 19% achieving 300 colonoscopies for full certification in 2017. 4 …”