Hospital compound level endoscopy training quality performance: Scoping the spectrum

Introduction: Endoscopy training varies across specialties, with variation in access to training lists, and the need to accommodate endoscopy training amongst other elective and on call demands. This past year, the COVID- 19 pandemic has jeopardised training opportunities further. Currently the quality assurance of endoscopy training is assessed by the Global Rating Scale (GRS) in all UK Endoscopy Units, overseen by the Joint Advisory Group on Gastrointestinal Endoscopy (JAG). This is a bi-annual, self-assessed score rating training according to the training environment, trainers, and assessment and appraisal, yet does this provide a sufficiently detailed and objective measure of the delivery of training at unit level Aims & Methods: This study aimed to assess the quality of endoscopy training in a single UK Statutory Educational Body (SEB), related to individual hospitals, compared with the Joint Advisory Group on Gastrointestinal Endoscopy Training (JETS) certification standards. Training procedures numbering 28,928 recorded by 211 consecutive cross-specialty trainee endoscopists registered with JETS in 18 hospitals during 2019 were analysed. Data included trainer and trainee numbers, training list frequency, procedures, Direct Observation of Procedural Skills (DOPS) completion and Key Performance Indicators (KPI). Results: Annual median training procedures per hospital were 1395 (interquartile range (IQR) 465-2365). Median (IQR) trainers and trainees per unit were 11 (6-18) and 12 (7-16) respectively (ratio 0.8 (0.7-1.3)). Annual training list frequency per trainee was 13 (10-17), 35.0% short of JAG standard (n=20, p=0.001, effect size -0.56), and median points per adjusted training list were 11 (5-18). Median DOPS completion per trainee and trainer were 3 (1-6) and 4 (1-7) respectively;completing 0.2 DOPS (0.1-0.4) per list and amounting to 6 (2-12) per 200 procedures: less than half of the JAG standard (p<0.001, -0.61). Median KPI for OGD: J Manoeuvre 94% (90-96), D2 intubation was 93% (91-96);and for Colonoscopy: Caecal intubation 82% (72-90), and Polyp Detection Rate 25% (18-34). Compound hospital training quality score varied 3-fold, the highest performing hospital scoring 26;compared to the poorest performing scoring 9: median 17 (14-20). Conclusion: Important disparities in hospital endoscopy unit performance were observed and disguised by the cloak of clinical pressures currently prevalent in the NHS. Compound hospital training quality varied three-fold, and Trainees, Trainers and Training Programme Directors alike, should be aware of such data when planning educational programmes, so that the quality of endoscopy training may be focused and optimised. JAG now considers simulation to be an important and integral marker of training. Adding simulation to the training armamentarium should be urgently recognised as a paramount constituent of the recovery-phase of COVID-19 training catch-up strategy, in order to overcome rationed front-line clinical training opportunities and also to address the pressing clinical service back-log of urgent suspected cancer referrals. Development of a Nationally agreed and accredited curriculum allied to Endoscopic Virtual Reality Haptic Feedback will be key to recovery and improved endoscopy training.