Introduction Rigid sigmoidoscopy is an invasive lower gastrointestinal investigation. It requires good communication and procedural skills and knowledge of relevant anatomy and pathology. However, there is no formal structure for training and assessment of this procedure in England and Wales. There are advocates for phasing it out in favour of better access to flexible sigmoidoscopy especially in view of reduced waiting times for this procedure. However rigid sigmoidoscopy is still frequently performed in outpatient and inpatient settings and therefore as with all clinical procedures training requirements should be standardised nationally.
Methods This study aims to assess gastroenterology and general surgery trainees' experience and training in the use of rigid sigmoidoscopy. An Internet survey was distributed via the Regional Training Programme Directors for all gastroenterology trainees in England and Wales and all general surgery trainees in England.
Results There were 74 responses. 46% were gastroenterology trainees and 54% were surgical trainees (of these 35% were colorectal surgery trainees). There was an even representation of different stages in training: ST3 19%, ST4 24%, Year 3 16%, Year 4 15%, Year 5 9% and Out of Programme 16%. 46% of trainees had performed >100 rigid sigmoidoscopies and only 12% <10. 62% had been supervised in performing 1 to 5 procedures but 18% had never been supervised. 85% took verbal and 4% written consent but 62% did not inform patients about the risk of haemorrhage and perforation. No trainee surveyed had ever attended a formal training course and 88% had never had either a formative or summative Direct Observation of Procedural Skills (DOPS) assessment. Despite this, 55% of trainees felt that their training was adequate and 5% that it was excellent. 40% felt that training was either insufficient or non-existent. For future trainees 53% did not feel any formal training was necessary, 35% thought that formative and summative DOPS assessments would be beneficial and 7% wanted a training course with a further 4% wanting both a training course and DOPS assessments.
Conclusion Rigid sigmoidoscopy is a widely used procedural skill among general surgery and gastroenterology trainees. This survey highlights some worrying facts: a large proportion of current trainees were never supervised when first learning the procedure and although the majority take some form of consent, 62% do not inform the patients of the relevant risks of the procedure. While the response rate was disappointing (5.6%), this study clearly suggests a need for structured training and assessment in rigid sigmoidoscopy and improved availability of training courses throughout England and Wales.
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