JAG consensus statements for training and certification in colonoscopy

Abstract

IntroductionIn the UK, endoscopy certification is awarded when trainees attain minimum competency standards for independent practice. A national evidence-based review was undertaken to update and develop standards and recommendations for colonoscopy training and certification.MethodsUnder the oversight of the Joint Advisory Group (JAG), a modified Delphi process was conducted between 2019 and 2020 with multisociety expert representation. Following literature review and Grading of Recommendations, Assessment, Development and Evaluations appraisal, recommendation statements on colonoscopy training and certification were formulated and subjected to anonymous voting to obtain consensus. Accepted statements were peer reviewed by JAG and relevant stakeholders for incorporation into the updated colonoscopy certification pathway.ResultsIn total, 45 recommendation statements were generated under the domains of: definition of competence (13), acquisition of competence (20), assessment of competence (8) and postcertification support (4). The consensus process led to revised criteria for colonoscopy certification, comprising: (1) achieving key performance indicators defined within British Society of Gastroenterology standards (ie, unassisted caecal intubation rate >90%, rectal retroversion >90%, polyp detection rate >15%+, polyp retrieval rate >90%, patient comfort <10% with moderate–severe discomfort); (2) minimum procedure count 280+; (3) performing 15+ procedures over the preceding 3 months; (4) attendance of the JAG Basic Skills in Colonoscopy course; (5) terminal ileal intubation rates of 60%+ in inflammatory bowel disease; (6) satisfying requirements for formative direct observation of procedure skills (DOPS) and direct observation of polypectomy skills (Size, Morphology, Site, Access (SMSA) level 2); (7) evidence of reflective practice as documented on the JAG Endoscopy Training System reflection tool; (8) successful performance in summative DOPS.ConclusionThe UK standards for training and certification in colonoscopy have been updated, culminating in a single-stage certification process with emphasis on polypectomy competency (SMSA Level 2+). These standards are intended to support training, improve standards of colonoscopy and polypectomy, and provide support to the newly independent practitioner.

Twitter debate: should upper gastrointestinal bleeding training and certification be formalised?

“…12 13 The current haemostasis training is dissimilar to the rigorous nationally agreed pathways and key performance indicators for training in diagnostic oesophagogastroscopy, 1 flexible sigmoidoscopy 2 and colonoscopy. 3 Finally, although there is currently no evidence that a formal certification process will improve mortality rate in patients with AUGIB, the inclusion of evidencebased key performance indicators, such as those used in diagnostic colonoscopy, 14 to assess trainees' performance is likely be beneficial. For all these reasons, 55% of the 56 individuals who took part in our poll during this #FGDebate believed that a formal certification process is required.…”

“…With recent recommendations from the Joint Advisory Group (JAG) in Gastrointestinal Endoscopy for training and certification in oesophagogastroscopy, 1 flexible sigmoidoscopy 2 and colonoscopy, 3 this #FGDebate discussed a controversial topic on whether training and certification for upper gastrointestinal bleeding should also be formalised. We were joined by an expert panel consisting of AJM and AMV who are both consultant gastroenterologists with an interest in interventional endoscopy and senior authors of the British Society of Gastroenterology (BSG)-led multisociety consensus care bundle for the early clinical management of acute upper gastrointestinal bleeding (AUGIB).…”

Exploring Endoscopic Competence in Gastroenterology Training: A Simulation-Based Comparative Analysis of GAGES, DOPS, and ACE Assessment Tools

“…Recently, the American Society for Gastrointestinal Endoscopy (ASGE) and the Joint Advisory Group for Gastrointestinal Endoscopy (JAG) have both made recommendations for establishment and maintenance of quality and standards of endoscopic training and intervention in the United States (US) and the United Kingdom (UK), respectively. [8][9][10] Various clinical assessment tools have been developed and validated to ensure competency in gastroenterology trainees. Two such prominent and validated tools include Direct Observation of Procedural Skills (DOPS) used by JAG for Gastroenterology in the UK, and the Global Assessment of Gastrointestinal Endoscopic Skills (GAGES) used by the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) in the US.…”

Training in Pediatric Gastrointestinal Endoscopy during Surgery Residency: Can Training Programs Currently Educate Proficient Pediatric Endoscopists? A Nationwide Assessment

“…Studies on adult endoscopy learning curves have recommended 100-200 esophagogastroduodenoscopies and 200-300 ileocolonoscopies as minimum thresholds for achieving competence [13][14][15][16][17][18][19].…”