Table 1

Summary of the consensus statements for training and certification in FS

Recommendation statementLevel of evidenceStrength
1.1Competence in FS is defined as the ability to perform FS, including all relevant periprocedural and postprocedural aspects and demonstrating relevant endoscopic non-technical skills (ENTS) consistent with current UK endoscopy best practice standards and guidelines.Very lowStrong
1.2Competence in FS requires the ability to recognise normal findings, describe and document abnormal findings and take appropriate action.Very lowStrong
1.3Competence in FS includes the ability to identify and manage immediate and late complications of the procedure demonstrating effective clinical, endoscopic and ENTS to coordinate subsequent action.LowStrong
1.4Competent endoscopists should be able to recognise the adequacy of the endoscopic procedure performed and recommend subsequent action.Very lowStrong
1.5When sedation is used in FS, doses should be within those defined by the current BSG colonoscopy guidance.LowStrong
1.6Comfort scores in FS should be within those defined by the current BSG colonoscopy guidance.LowStrong
1.7Competence in polypectomy should be based on achieving all competencies defined in the DOPyS form rather than a set minimum no of procedures.LowStrong
1.8Endoscopists should be able to competently document polyps using the Paris classification.LowStrong
1.9Endoscopists should competently use at least one validated optical diagnosis system to classify and document polyps.ModerateStrong
1.10Competent endoscopists should be able to define the difficulty level of polypectomy using the SMSA scoring system.LowStrong
1.11Endoscopists in colonoscopy should be competent to perform safe and effective polypectomy of SMSA level 1 polyps as a minimum.LowStrong
1.12Endoscopists must be able to competently demonstrate safe and appropriate use of diathermy relevant to polypectomy.LowStrong
1.13Endoscopists should be able to competently manage postpolypectomy perforation and bleeding using endoscopic clips and at least one other method of haemostasis while demonstrating relevant ENTS.LowStrong
2.1Lower GI endoscopy training should take place in a unit that maintains its training environment to JAG standards.Very lowWeak
2.2FS trainers should meet trainer standards as defined by the JAG GRS training domainLowStrong
2.3The training programme should include opportunities to gain experience and competencies in ENTS.LowStrong
2.4Trainees in FS should attend a JAG approved Basic Skills in Colonoscopy course during training.LowStrong
2.5Lower GI endoscopy trainees should apply for a JAG approved basic skills course at the start of LGI endoscopy training and attend this within their first 70 procedures.LowStrong
2.6Virtual reality simulation training for endoscopic technical skills is encouraged in conjunction with conventional endoscopy training to enhance development of early endoscopic technical skills. Trainee simulator-based training should be directly supported by appropriately skilled trainers/supervisors.ModerateStrong
2.7Training in polypectomy should start early during FS training and continue in parallel with thisVery lowWeak
2.8Polypectomy training should include skills acquisition in cold biopsy, cold snare, hot snare and basic lift assisted polypectomy to a minimum of SMSA level 1.LowStrong
2.9Trainees should receive training in the Paris polyp classification system and validated optical diagnosis systems. When available supportive web-based training tools should be utilised and any relevant modules completed prior to the basic skills course.ModerateStrong
2.10Appropriate discussion and reflection related to polyp classification and management should occur throughout training.Very lowStrong
2.11Attendance at a hands on (tissue/tissue-like) model endoscopy course with exposure to differing polyp resection techniques, submucosal injection techniques, haemostatic therapy, polyp retrieval techniques and tattooing is encouraged.Very lowStrong
2.12All parameters described in DOPS/DOPyS should be included during skills training.Very lowStrong
2.13A trainee should undertake a minimum of 175 FS procedures during their training to be eligible for summative assessment.LowStrong
2.14A trainee should have a minimum no of dedicated training lists as defined by the JAG training standards.Very lowStrong
2.15It is recommended that a trainee should receive a minimum of one DOPS per training list.LowWeak
2.16It is recommended that a minimum of one DOPyS should be completed for every training list where a polypectomy has been attempted by a trainee.LowWeak
2.17Trainees 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.LowStrong
3.1DOPS should be used as the competency assessment tool in lower gastrointestinal endoscopy.LowStrong
3.2Each formative DOPS should be performed on a single pre-selected case.LowStrong
3.3The last five DOPS prior to summative assessment must be rated competent without supervision in >90% of all items, with none requiring maximal or significant supervision.LowStrong
3.4DOPyS should be used as the polypectomy competency assessment tool for both technical and non-technical skills.LowStrong
3.5For competence at SMSA level 1 polypectomy, a minimum of two SMSA level 1 DOPyS should be competently performed using the following methods: cold snare polypectomy, diathermy-assisted resection of stalked polyps and diathermy-assisted EMR. The last four DOPyS (level 1) should score ‘competent for independent practice’ in all items.Very lowStrong
3.6Eligibility for summative assessment in FS may be triggered once the following are met:
  1. Minimum FS procedure count of 175 (including colonoscopy numbers)

  2. Meeting minimum KPIs targets relevant to trainees over the preceding 3 months (table 2)

  3. Physically unassisted procedures ≥90%

  4. ≥15 procedures over the last 3 months period

  5. Attendance of JAG Basic Skills in Lower GI endoscopy course

  6. Meeting formative DOPS and DOPyS requirements

    • Minimum of 15 formative DOPS

    • Last 5 DOPS rated competent without supervision for 90%+ of all items

    • Evidence of competency in SMSA level 1 polypectomy

  7. Evidence of competency in SMSA level 1 polypectomy

3.7For successful completion of the summative DOPS assessment, the trainee should be rated as 'ready for independent practice' in all items within four DOPS by a minimum of two different assessors who are not the trainee’s usual trainer.LowStrong
4.1Newly certified endoscopists should have access to a named individual and meet on a regular basis to discuss cases and to review progress.Very lowStrong
4.2Endoscopy departments should have systems in place to ensure appropriate list size and caseload selection for newly certified endoscopists.Very lowStrong
4.3Certified endoscopists should perform at least 100 procedures a year to maintain competence.Very lowStrong
4.4Certified endoscopists should have access to mentored lists.Very lowStrong
  • BSG, British Society of Gastroenterology; DOPS, Direct observation of procedure skills; DOPyS, direct observation of polypectomy skills; FS, flexible sigmoidoscopy; GRS, global rating scale; JAG, Joint Advisory Group; JETS, JAG Endoscopy Training System; KPI, key performance indicator; LGI, lower GI; SMSA, size, morphology, site, access.