Introduction Although certification in diagnostic gastroscopy has been established in the UK, there is no formal process for quality assurance (QA) in endotherapy for upper gastrointestinal bleeding (UGIB). Training opportunities are variable, with 11% of gastroenterology ST7s citing inadequate exposure, despite an expectation to independently manage UGIB upon completion of training. Data on endotherapy exposure during endoscopy training is limited. We aimed to assess whether trainees are receiving adequate exposure to endotherapy at the time of gastroscopy certification.
Method Trainees awarded certification in gastroscopy between September 2009–2016 were identified from the national JETS e-Portfolio. Trainee inputs and formative assessments (DOPS) for UGIB therapy, up to their certification date, were analysed. Only trainees with ³200 procedures were included, thereby excluding those who had submitted baseline information which may have contained therapeutic data. Exposure rates from medical endoscopists (physician and surgical trainees) were compared with non-medical endoscopists (NME).
Results 885 trainee portfolios were analysed (765 medical and 120 NMEs), with a median procedural count of 276 (IQR 124). The median number of therapeutic entries and DOPS were 4 (IQR 11), and 1 (IQR 3) respectively. Overall rates for endotherapy and DOPS were 2.9% and 0.8% per procedure. When stratified by therapy, the median exposure to each therapy was either 0 or 1, with means displayed in Table 1. 25.2% of trainees had no exposure to any type of endotherapy (67.5% of NME and 18.6% of medical endoscopists, p<0.0001). Of medical endoscopists awarded certification, 37.1% had not performed band ligation, 50.7% had not placed a clip, and 54% had not used heater probe. NME had significantly less exposure to each modality of endotherapy considered (overall odds ratio 0.10, p<0.0001).
Conclusion Training on endotherapy prior to certification is limited. The current UGI certification process does not ensure competency in endotherapy for UGIB. In response, the JAG QA team have recently released new DOPS forms specific to UGIB, and are consulting on introducing formal certification in endotherapy for UGIB.
GMC National Training Survey Results 2016, Gastroenterology, http://www.gmc-uk.org/education/gastroenterology.asp
Disclosure of Interest None Declared
- endoscopy training
- gastrointestinal bleed