Introduction The Global Rating Scale (GRS) and Joint Advisory Group on GI Endoscopy (JAG) auditable outcome standards have been used to improve quality and define minimum standards for colonoscopy across the UK.1 JAG also provides a clear competency based framework to assess trainee performance; however, there is reluctance in some units to allow independent senior registrars, who have passed JAG assessment, to practise independently. At our teaching centre we encourage appropriately trained registrars to perform their own lists. Supervision is available if needed and departmental protocols define limits of therapy to be undertaken independently (eg, large polypectomies). Attendance at training lists to continue development is also actively encouraged. Our aim was to evaluate whether this provided a quality of service comparable to national standards.
Methods We used data collected retrospectively from endoscopy reporting software (Ascribe-Scorpio) on the caecal intubation rate, polyp detection rate, sedation usage and complication rate, to evaluate the performance of senior gastroenterology trainees between 2007 and 2011, against the JAG auditable outcomes for colonoscopy.
Results Over a 4-year period, 17 senior gastroenterology registrars performed a total of 2917 colonoscopies. 2221 (76.1%) procedures were unsupervised and 696 (23.9%) were supervised. An uncorrected caecal intubation rate of 94.9% was achieved during unsupervised procedures, 96.6% with supervision (p=0.93, X2). Polyp (all type) detection rate was 30%. Average sedation dose for patients aged >70 years, was pethidine 30 mg and midazolam 1.96 mg; aged <70 years, pethidine 35.5 mg and midazolam 2.54 mg. Flumazenil was used on four occasions and naloxone on one occasion. There were two major complications. One perforation, following argon therapy to an angiodysplasia, treated conservatively and one major post polypectomy bleed, treated endoscopically but admitted for observation. None of the registrars were outliers on the comfort score data.
Conclusion Our findings show that given appropriate training and support, independently practising senior UK gastroenterology registrars contribute significantly to service delivery, providing high quality colonoscopy, meeting JAG auditable outcome standards.
Competing interests None declared.
Reference 1. Roland V. BSG Quality and Safety Indicators for Endoscopy (JAG). 2007.