Table 1

Summary of recommendation statements for training and certification in OGD.

Recommendation statement		Level of evidence	Strength of recommendation
1.1	Competence in diagnostic OGD is defined as the ability to perform procedures effectively and safely to national standards.	Very low	Strong
1.2	Competence in OGD will include attainment of relevant minimal performance standards as currently defined by BSG/AUGIS.	Low	Strong
1.3	Competence in OGD should include procedural completion, defined as D2 intubation and J-manoeuvre, in at least 95% of procedures.	Low	Strong
1.4	Competence in OGD will include attainment of additional standards of performance defined in this document, including preprocedural, procedural, postprocedural and endoscopic non-technical skills.	Low	Strong
2.1	Training should take place in a unit that is accredited for endoscopy training.	Very low	Strong
2.2	Training procedures should be uploaded onto the National Endoscopy Database.	Very low	Strong
2.3	Simulation training may be used to enhance the earlier development of technical skills but cannot currently be used as a substitute for more traditional skills and decision-making training.	Moderate	Weak
2.4	Trainees should attend the JAG Basic Skills in OGD course prior to certification, ideally during early training.	Very low	Strong
2.5	Trainees should only undertake the JAG basic OGD course when continued regular training at their base unit is confirmed.	Very low	Weak
2.6	Trainees should use a wide range of resources to support OGD training.	Low	Strong
2.7	Training resources should be developed to support competency acquisition in lesion recognition.	Low	Strong
2.8	Training resources should be developed to support competency acquisition in ENTS.	Low	Strong
2.9	Trainees should have access to a wide range of case-mix to enhance training in pathology recognition, periprocedural management and ENTS.	Very low	Strong
2.10	250 procedures should be the minimum required before eligibility for summative assessment, assuming all other metrics are satisfactory.	Low	Strong
2.11	All trainers delivering training in OGD should have taken part in an endoscopy-focused Train-the-Trainers course (eg, TGT/TCT).	Low	Strong
2.12	Trainees must complete a reflection tool on JETS every 50 procedures. This forms a framework for meetings with their endoscopy supervisor every 6 months or less.	Very low	Weak
3.1	DOPS should be used as the assessment tool for competency in OGD.	Low	Strong
3.2	DOPS should be mapped to current BSG/AUGIS standards for OGD.	Very low	Strong
3.3	Total procedure times (with inspection time for surveillance procedures) should be included in the endoscopy report and assessed within DOPS.	Low	Weak
3.4	Diagnosis specific DOPS should be developed to facilitate competency acquisition and assessment for OGD, for example, Barrett’s oesophagus.	Very low	Weak
3.5	DOPS should record the indication for and diagnosis of the procedure and be linked to the JETS e-portfolio/NED.	Very low	Strong
3.6	Trainees should have at least one formative DOPS performed per 10 procedures.	Low	Strong
3.7	Each formative DOPS should be performed on a single preselected case.	Very low	Strong
3.8	At least three formative DOPS from each of three different observers should be performed over the last 100 cases before summative assessment.	Low	Strong
3.9	Eligibility for summative assessment in OGD may be triggered once the following are met: Fulfil criteria for BSG standards for competence in OGD. Unassisted D2 intubation and J-manoeuvre rates of ≥95% (in the preceding 3 months). Attaining a minimum hands-on procedure count of 250. Attendance of JAG Basic Skills course. Meeting formative DOPS requirements. Minimum of 25 formative DOPS performed by ≥3 different assessors. Last five DOPS rated competent without supervision for 90%+ of all items. Evidence of engagement with the JETS reflection tool (minimum of 5 reflection entries).	Low	Strong
3.10	For successful completion of the summative DOPS assessment, the trainee should be rated as 'ready for independent practice' for all items within four DOPS, by two different assessors, neither of whom is their regular assessor.	Very low	Strong
4.1	Newly certified OGD practitioners should have access to a named supervisor to discuss cases and to review progress.	Very low	Strong
4.2	The ongoing training requirements of individuals should be identified and practitioners should undertake additional training/upskilling as defined within their personal development plan.	Very low	Strong
4.3	Newly certified practitioners may perform OGD without direct supervision, but should have systems in place to ensure appropriate list size and case load selection.	Very low	Strong
4.4	There should be appropriate mechanisms in place for performance monitoring and review during the early post-certification period.	Low	Strong
4.5	Significant adverse advents should be discussed with the supervisor and reflected on in their appraisal.	Very low	Strong
4.6	In the post-certification period, newly-independent endoscopists should perform at least 100 procedures a year to maintain competence.	Very low	Strong

AUGIS, Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland; BSG, British Society of Gastroenterology; DOPS, direct observation of procedural skills; ENTS, endoscopic non-technical skills; JAG, Joint Advisory Group; JETS, JAG endoscopy training system; NED, national endoscopy database; OGD, oesophagogastroduodenoscopy; PD, program director; TCT, train-colonoscopy-trainer; TGT, train-gastroscopy-trainer.