Introduction Colonoscopic polypectomy and endoscopic treatment of acute upper gastrointestinal bleeding (AUGIB) are key skills for the majority of consultant gastroenterologists. Competence in polypectomy is assessed by direct observation of polypectomy skills (DOPyS) with 4 competent level 2 (>1 cm) polypectomies required for full colonoscopy certification. Measures for defining competence in endoscopic treatment of AUGIB are in development. There is evidence of slow rates of progression to achieve basic endoscopic skills amongst gastroenterology trainees due to other service and training pressures.1
Method The BSG national training survey was open to all UK gastroenterology trainees from June–August 2014. Data on exposure to polypectomy and endoscopic treatment of AUGIB was analysed as well as trainees desire to train in advanced endoscopic techniques.
Results 32.6% (263/806) of UK trainees completed the survey. 68% of ST6 (year 4) trainees and 38% of final year trainees have performed <10 level 2 polypectomies without physical assistance. 10% of ST6 trainees and 7% of final year trainees have performed fewer than 10 level 1 polypectomies. 52% of trainees in their final 2 years (senior trainees) wish to formally train in endoscopic mucosal resection (EMR), with corresponding figures of 40% for ERCP, 29% for EUS, and 33% for enteroscopy. 28% of senior trainees report having the opportunity to perform endoscopy in a patient with AUGIB either monthly or less often (less than once per month/never). >95% of senior trainees feel they will be competent to perform variceal and non-variceal AUGIB endoscopic treatment as a newly qualified consultant. 91% feel they will be competent to place a Sengstaken-Blakemore tube if required.
Conclusion Exposure to level 2 polypectomy amongst senior gastroenterology trainees is limited, which may explain slow rates of progression to full colonoscopy certification.1Over a quarter of senior trainees have limited opportunity to perform endoscopy in cases of AUGIB. Virtually all trainees feel they will be competent in the endoscopic management of AUGIB as a new consultant, but the documented lack of exposure for some trainees suggests this may not be the case. Despite slow progression to basic endoscopy competencies, large numbers of trainees wish to train in advanced endoscopic techniques. These results suggest the need for focused training lists to develop key therapeutic endoscopic skills such as removal of level 2 polyps, and systems to guarantee dedicated supervised exposure to AUGIB cases.
Neale JR, Basford PJ. General medical training in gastroenterology: views from specialist trainees on the challenges of dual accreditation. Clin Med. 2015;15(1):35–9
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