Endoscopy training

JAG Accreditation

Certification in colonoscopy is not a requirement for CCT in General Surgery with a colorectal interest. Nevertheless, colorectal trainees are anxious to attain certification as they anticipate that it will be a desired (if not essential) part of the person specification for a consultant post.  A logbook of trainees’ procedures and the certification process is conducted through JETS (the JAG Endoscopy Training System).

The certification process, as it currently stands, is taken in two parts: ‘provisional’ followed by ‘full’.  A minimum of 200 procedures with a caecal intubation rate of at least 90% is required for provisional certification.  The trainee also must have completed a basic colonoscopy course and have achieved satisfactory scores in DOPS and DOPyS (a DOPS for polypectomy) for level 1 polyps (polyps <1cm).  Detailed requirements are available in the ‘Downloads’ section of the JETS website.  Once all of these criteria are met, four summative DOPS must be performed with at least two different trainers to gain provisional certification – this allows trainees to scope independently as long as there is a trainer immediately available in the department.

Full certification allows trainees to scope fully independently without other endoscopists around.  A lifetime procedure count of 300 is required along with a caecal intubation rate of at least 90%, a polyp detection rate of 10% and satisfactory scores in DOPyS for level 2 polyps (polyps >1cm).

JAG are concerned that many trainees never progress from provisional to full certification, perhaps viewing provisional certification as the only goal.  This was never the intended consequence of a 2-part certification process and JAG are in the process of evaluating a change to the certification criteria.  It is anticipated that in the future there will only be one certification level perhaps requiring a lifetime procedure count of 250.  These ‘extra’ 50 procedure may make it harder for colorectal trainees to attain certification by the time of CCT.

Optimising your endoscopy training

Here are some tips on how to get the most out of your endoscopy training:

  1. Register with JETS:  This is very important as any procedures/training performed will not be recognised unless it is recorded on JETS.
  2. Start early in your training: It is easy to focus on the operating in the early years but your endoscopy numbers need to steadily tick over!
  3. Do the Basic Skills Course early. You need it at some point anyway but it will also encourage trainers to train you.
  4. As soon as you’ve decided to a colorectal interest, make sure you have regular access to endoscopy.  If you are not getting any access, report it to your AES ± PD – it’s an important part of your training!
  5. Meet with the endoscopy lead early on in your new placement. JAG views this person as being responsible for training and training forms part of the unit’s JAG Global Rating Scale. This person can help plan access to endoscopy lists for you and needs to know if you’re having any problems.
  6. Discuss problems with endoscopy training in your ARCP. Endoscopy data isn’t on the ISCP system so it can be easily forgotten.
  7. Aim to do a DOPS every list.  Similarly, aim to do a DOPyS for every case you perform a polypectomy. These assessments are often squeezed in when getting closer to the magic number 200, but it’s typical to go 20 cases without a polyp when you need one!
  8. On the new junior doctor’s contract, shortcomings in training need to be reported as an exception. Trusts are potentially fined for exceptions. If endoscopy trainees are promised 20 training lists a year and don’t get it, then report it!