Table 1

Summary of recommendation statements for training and certification in OGD.

Recommendation statementLevel of evidenceStrength of recommendation
1.1Competence in diagnostic OGD is defined as the ability to perform procedures effectively and safely to national standards.Very lowStrong
1.2Competence in OGD will include attainment of relevant minimal performance standards as currently defined by BSG/AUGIS.LowStrong
1.3Competence in OGD should include procedural completion, defined as D2 intubation and J-manoeuvre, in at least 95% of procedures.LowStrong
1.4Competence in OGD will include attainment of additional standards of performance defined in this document, including preprocedural, procedural, postprocedural and endoscopic non-technical skills.LowStrong
2.1Training should take place in a unit that is accredited for endoscopy training.Very lowStrong
2.2Training procedures should be uploaded onto the National Endoscopy Database.Very lowStrong
2.3Simulation 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.ModerateWeak
2.4Trainees should attend the JAG Basic Skills in OGD course prior to certification, ideally during early training.Very lowStrong
2.5Trainees should only undertake the JAG basic OGD course when continued regular training at their base unit is confirmed.Very lowWeak
2.6Trainees should use a wide range of resources to support OGD training.LowStrong
2.7Training resources should be developed to support competency acquisition in lesion recognition.LowStrong
2.8Training resources should be developed to support competency acquisition in ENTS.LowStrong
2.9Trainees should have access to a wide range of case-mix to enhance training in pathology recognition, periprocedural management and ENTS.Very lowStrong
2.10250 procedures should be the minimum required before eligibility for summative assessment, assuming all other metrics are satisfactory.LowStrong
2.11All trainers delivering training in OGD should have taken part in an endoscopy-focused Train-the-Trainers course (eg, TGT/TCT).LowStrong
2.12Trainees 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 lowWeak
3.1DOPS should be used as the assessment tool for competency in OGD.LowStrong
3.2DOPS should be mapped to current BSG/AUGIS standards for OGD.Very lowStrong
3.3Total procedure times (with inspection time for surveillance procedures) should be included in the endoscopy report and assessed within DOPS.LowWeak
3.4Diagnosis specific DOPS should be developed to facilitate competency acquisition and assessment for OGD, for example, Barrett’s oesophagus.Very lowWeak
3.5DOPS should record the indication for and diagnosis of the procedure and be linked to the JETS e-portfolio/NED.Very lowStrong
3.6Trainees should have at least one formative DOPS performed per 10 procedures.LowStrong
3.7Each formative DOPS should be performed on a single preselected case.Very lowStrong
3.8At least three formative DOPS from each of three different observers should be performed over the last 100 cases before summative assessment.LowStrong
3.9 Eligibility for summative assessment in OGD may be triggered once the following are met:
  1. Fulfil criteria for BSG standards for competence in OGD.

  2. Unassisted D2 intubation and J-manoeuvre rates of ≥95% (in the preceding 3 months).

  3. Attaining a minimum hands-on procedure count of 250.

  4. Attendance of JAG Basic Skills course.

  5. 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.

  6. Evidence of engagement with the JETS reflection tool (minimum of 5 reflection entries).

3.10For 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 lowStrong
4.1Newly certified OGD practitioners should have access to a named supervisor to discuss cases and to review progress.Very lowStrong
4.2The ongoing training requirements of individuals should be identified and practitioners should undertake additional training/upskilling as defined within their personal development plan.Very lowStrong
4.3Newly certified practitioners may perform OGD without direct supervision, but should have systems in place to ensure appropriate list size and case load selection.Very lowStrong
4.4There should be appropriate mechanisms in place for performance monitoring and review during the early post-certification period.LowStrong
4.5Significant adverse advents should be discussed with the supervisor and reflected on in their appraisal.Very lowStrong
4.6In the post-certification period, newly-independent endoscopists should perform at least 100 procedures a year to maintain competence.Very lowStrong
  • 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.