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OC-050 The Ugib-dops: Improving Training In Gi Bleed Management In The Endoscopy Unit
  1. L China,
  2. G Johnson
  1. Gastroenterology, UCL, UCLH, London, UK

Abstract

Introduction The 2007 GI Bleed Audit highlighted significant deficiencies and inconsistencies in service provision and care of patients presenting with UGIB. There is a pressure on UK hospitals to provide a 24/7 endoscopy service to meet NICE guidance on timely endoscopic intervention in upper GI bleeding (UGIB), resulting in an urgent need to determine an endoscopist’s competence. JAG provide quality assurance in UK endoscopy by using compulsory summative assessment in diagnostic endoscopy and more recently polypectomy.

There is currently no structured, formal tool or criteria with which to assess and provide feedback for the specific generic and endoscopic skills required for effective management of UGIB. DOPS are used as a tool to assess endoscopic skills by providing a framework for experts to observe, assess and provide feedback on a procedure. We developed a new DOPS tailored to the specific aspects of therapeutic endoscopic management of UGIB to improve training, with a view to developing the tool for use in summative assessment for JAG accreditation.

Methods A working group of expert endoscopists was formed at University College London Hospital. UGIB task deconstruction was undertaken and, after multiple revisions, consensus was reached on the individual aspects of management, and then to define what was considered a satisfactory endoscopic performance in each of these domains. The performance rating scale was based on the degree of independence demonstrated by the trainee in each performance domain. These aspects of performance, definitions of standards and rating scales were then used to construct the UGIB-DOPS.

We evaluated the feasibility, validity and educational impact of UGIB-DOPS using 8 trainees paired with trainers using questionnaires and semi-structured interviews.

Results The trainee cohort displayed a range of experience from novices (n = 2) to trainees who had managed >80 cases (n = 2). Qualitative assessment of the educational impact of UGIB-DOPS found universal agreement that the tool’s defined assessment criteria facilitated structured feedback and it was perceived the overall grade awarded reflected trainee’s current competence. Thematic interview analysis revealed recurring concepts of how UGIB-DOPS facilitated training: creation of an observed teaching event, knowledge of the required standards and concrete formulation of action plans. All found UGIB-DOPS feasible to use and the rating scale more transparent than currently used DOPS.

Conclusion Creation of the UGIB-DOPS has for the first time introduced defined assessment standards in UK UGIB management facilitating formative assessment leading to a feasible improvement in workplace training. A larger pilot is now required to determine the reliability of UGIB-DOPS prior to considering its use as part of the summative assessment of endoscopist’s competence.

Disclosure of Interest None Declared.

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