JAG consensus statements for training and certification in flexible sigmoidoscopy

Keith Siau; Stavroula Pelitari; Susi Green; Brian McKaig; Arun Rajendran; Mark Feeney; Mo Thoufeeq; John Anderson; Vathsan Ravindran; Paul Hagan; Neil Cripps; Ian L P Beales; Karen Church; Nicholas I Church; Elizabeth Ratcliffe; Said Din; Rupert D Pullan; Sharon Powell; Catherine Regan; Wee Sing Ngu; Eleanor Wood; Sarah Mills; Neil Hawkes; Paul Dunckley; Marietta Iacucci; Siwan Thomas-Gibson; Christopher Wells; Aravinth Murugananthan

doi:10.1136/flgastro-2022-102259

JAG consensus statements for training and certification in flexible sigmoidoscopy

Frontline Gastroenterol. 2023 Jan 27;14(3):181-200. doi: 10.1136/flgastro-2022-102259. eCollection 2023.

Authors

Keith Siau^{1

2}, Stavroula Pelitari³, Susi Green⁴, Brian McKaig⁵, Arun Rajendran⁶, Mark Feeney⁷, Mo Thoufeeq⁸, John Anderson⁹, Vathsan Ravindran¹⁰, Paul Hagan¹¹, Neil Cripps¹², Ian L P Beales^{13

14}, Karen Church¹⁵, Nicholas I Church¹⁶, Elizabeth Ratcliffe^{17

18}, Said Din¹⁹, Rupert D Pullan²⁰, Sharon Powell²¹, Catherine Regan⁵, Wee Sing Ngu²², Eleanor Wood²³, Sarah Mills^{24

25}, Neil Hawkes²⁶, Paul Dunckley²⁷, Marietta Iacucci^{2

28}, Siwan Thomas-Gibson^{25

29}, Christopher Wells³⁰, Aravinth Murugananthan^{5

31}

Affiliations

¹ Department of Gastroenterology, Royal Cornwall Hospital, Truro, UK.
² University of Birmingham College of Medical and Dental Sciences, Birmingham, UK.
³ Department of Gastroenterology, Royal Free London NHS Foundation Trust, London, UK.
⁴ Department of Gastroenterology, University Hospitals Sussex NHS Foundation Trust, Worthing, UK.
⁵ Department of Gastroenterology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK.
⁶ Department of Gastroenterology, Hillingdon Hospitals NHS Foundation Trust, Uxbridge, UK.
⁷ Department of Gastroenterology, Torbay and South Devon NHS Foundation Trust, Torquay, UK.
⁸ Department of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
⁹ Department of Gastroenterology, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK.
¹⁰ Department of Gastroenterology, St Mark's Hospital and Academic Institute Wolfson Unit for Endoscopy, Harrow, UK.
¹¹ Endoscopy, Royal Derby Hospital, Derby, UK.
¹² Colorectal Surgery, University Hospitals Sussex NHS Foundation Trust, Worthing, UK.
¹³ University of East Anglia, Norwich, UK.
¹⁴ Department of Gastroenterology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.
¹⁵ Endoscopy, NHS Lothian, Edinburgh, UK.
¹⁶ Department of Gastroenterology, NHS Lothian, Edinburgh, UK.
¹⁷ Department of Gastroenterology, Wrightington Wigan and Leigh NHS Foundation Trust, Wigan, UK.
¹⁸ Division of Diabetes, Endocrinology and Gastroenterology Faculty of Biology, Medicine and Health School of Medical Sciences, The University of Manchester, Manchester, UK.
¹⁹ Department of Gastroenterology, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK.
²⁰ Colorectal Surgery, Torbay and South Devon NHS Foundation Trust, Torquay, UK.
²¹ Endoscopy, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK.
²² Colorectal Surgery, City Hospitals Sunderland NHS Foundation Trust, South Shields, UK.
²³ Gastroenterology, Homerton University Hospital NHS Foundation Trust, London, UK.
²⁴ Colorectal Surgery, Chelsea and Westminster Hospital, London, UK.
²⁵ Imperial College London, London, UK.
²⁶ Department of Gastroenterology, Royal Glamorgan Hospital, Llantrisant, UK.
²⁷ Department of Gastroenterology, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK.
²⁸ Department of Gastroenterology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
²⁹ St Mark's Hospital and Academic Institute Wolfson Unit for Endoscopy, Harrow, UK.
³⁰ Department of Gastroenterology, North Tees and Hartlepool NHS Foundation Trust, Hartlepool, UK.
³¹ Faculty of Health, Education and Life Sciences, Birmingham City University, Birmingham, UK.

Abstract

Introduction: Joint Advisory Group (JAG) certification in endoscopy is awarded when trainees attain minimum competency standards for independent practice. A national evidence-based review was undertaken to update standards for training and certification in flexible sigmoidoscopy (FS).

Methods: A modified Delphi process was conducted between 2019 and 2020 with multisociety representation from experts and trainees. Following literature review and Grading of Recommendations, Assessment, Development and Evaluations appraisal, recommendation statements on FS training and certification were formulated and subjected to anonymous voting to obtain consensus. Accepted statements were peer-reviewed by national stakeholders for incorporation into the JAG FS certification pathway.

Results: In total, 41 recommendation statements were generated under the domains of: definition of competence (13), acquisition of competence (17), assessment of competence (7) and postcertification support (4). The consensus process led to revised criteria for colonoscopy certification, comprising: (A) achieving key performance indicators defined within British Society of Gastroenterology standards (ie, rectal retroversion >90%, polyp retrieval rate >90%, patient comfort <10% with moderate-severe discomfort); (B) minimum procedure count ≥175; (C) performing 15+ procedures over the preceding 3 months; (D) attendance of the JAG Basic Skills in Lower gastrointestinal Endoscopy course; (E) satisfying requirements for formative direct observation of procedural skill (DOPS) and direct observation of polypectomy skill (SMSA level 1); (F) evidence of reflective practice as documented on the JAG Endoscopy Training System reflection tool and (G) successful performance in summative DOPS.

Conclusion: The UK standards for training and certification in FS have been updated to support training, uphold standards in FS and polypectomy, and provide support to the newly independent practitioner.

Keywords: ENDOSCOPY.