Table 1

Summary of the consensus statements for training and certification in colonoscopy

Recommendation statement		Level of evidence	Strength
1.1	Competence in colonoscopy is defined as the ability to perform colonoscopy, including all relevant peri-procedural and post-procedural aspects consistent with current BSG colonoscopy best practice standards and guidelines.	Very low	Strong
1.2	Terminal ileal intubation should be attempted in all cases where indicated. Trainees should attain an unassisted terminal ileal intubation rate of >60% where colonoscopy is indicated for suspected IBD (ie, chronic diarrhoea, iron-deficiency anaemia, abdominal pain, IBD assessment).	Low	Strong
1.3	Competence in colonoscopy requires the ability to recognise normal findings, describe and document abnormal findings and take appropriate action.	Very low	Strong
1.4	Competent endoscopists in colonoscopy should be able to demonstrate endoscopic non-technical skills (ENTS) as defined in DOPS and DOPyS.	Low	Strong
1.5	Competence in colonoscopy includes the ability to identify and manage immediate and late complications of the procedure demonstrating effective clinical, endoscopic and Non-Technical Skills (ENTS) to coordinate subsequent action.	Low	Strong
1.6	Competent endoscopists should be able to recognise the adequacy of the endoscopic procedure performed and recommend subsequent action.	Very low	Strong
1.7	Competence in polypectomy should be based on achieving all competencies defined in the DOPyS form rather than a set minimum number of procedures.	Very low	Strong
1.8	Competent endoscopists should be able to define the difficulty level of polypectomy using the SMSA scoring system.	Low	Strong
1.9	Endoscopists should be able to competently document polyps using the Paris classification.	Low	Strong
1.10	Endoscopists should competently use at least one validated optical diagnosis system to classify and document polyps.	Moderate	Strong
1.11	Endoscopists in colonoscopy should be competent to perform safe and effective polypectomy of SMSA level 2 polyps as a minimum.	Low	Strong
1.12	Endoscopists must be able to competently demonstrate safe and appropriate use of diathermy relevant to polypectomy.	Low	Strong
1.13	Endoscopists 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.	Low	Strong
2.1	Lower GI endoscopy training should take place in a unit that maintains its training environment to JAG standards.	Very low	Weak
2.2	Colonoscopy trainers should meet colonoscopy standards as defined by JAG GRS and BSG quality standards.	Low	Strong
2.3	The training programme should include opportunities to gain experience and competencies in ENTS.	Low	Strong
2.4	Trainees in colonoscopy should attend a JAG approved Basic Skills in Colonoscopy course during training.	Low	Strong
2.5	Lower 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.	Low	Strong
2.6	Virtual 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.	Moderate	Strong
2.7	Training in polypectomy should start early during basic colonoscopy training and continue in parallel with this.	Very low	Strong
2.8	Attendance at a hands on (tissue/tissue-like) model endoscopy course with exposure to differing polyp resection techniques, submucosal injection techniques, haemostatic therapy and tattooing is encouraged.	Very low	Strong
2.9	Polypectomy training should include skills acquisition in cold snare, hot snare and basic lift assisted polypectomy to a minimum of SMSA level 2.	Low	Strong
2.10	Trainees should receive training in Paris polyp classification and validated optical diagnosis systems. When available, supportive web-based training tools should be used and any relevant modules completed prior to the basic skills course.	Moderate	Strong
2.11	Appropriate discussion and reflection related to polyp classification and management should occur throughout training.	Very low	Strong
2.12	All parameters described in DOPS/DOPyS should be included during skills training.	Very low	Strong
2.13	Water-assisted insertion techniques may improve patient comfort levels and technical success, and should form part of training in colonoscopy.	Low	Weak
2.14	Where available, magnetic endoscopic imaging should be used for colonoscopy training and should be preferentially used for training lists.	Low	Weak
2.15	A trainee should undertake a minimum of 280 colonoscopy procedures to be eligible for summative assessment in colonoscopy.	Low	Strong
2.16	Trainees who hold JAG certification in flexible sigmoidoscopy should have a minimum of 200 lifetime colonoscopy procedures to be eligible for summative assessment in colonoscopy.	Very low	Strong
2.17	A trainee should have a minimum number of dedicated training lists as defined by the JAG training standards.	Low	Strong
2.18	It is recommended that a trainee should receive a minimum of one DOPS per training list.	Low	Weak
2.19	It is recommended that a minimum of one DOPyS should be completed for every training list where a polypectomy has been attempted by a trainee.	Low	Weak
2.20	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.	Low	Strong
3.1	DOPS should be used as the competency assessment tool in lower gastrointestinal endoscopy.	Low	Strong
3.2	Each formative DOPS should be performed on a single pre-selected case.	Low	Strong
3.3	The last 5 DOPS prior to summative assessment must be rated competent without supervision in>90% of all items, with none requiring maximal or significant supervision.	Low	Strong
3.4	DOPyS should be used as the polypectomy competency assessment tool for both technical and non-technical skills.	Low	Strong
3.5	For competence at SMSA Level 1 polypectomy, a minimum of 2 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 4 DOPyS (Level 1) should score ‘competent for independent practice’ in all items.	Very low	Strong
3.6	For competence at SMSA Level 2 polypectomy, a minimum of 2 SMSA Level 2 DOPyS should be competently performed for each of the following methods: cold snare polypectomy, diathermy-assisted resection of stalked polyps and diathermy-assisted EMR. The last 4 DOPyS (level 2) should score ‘competent for independent practice’ in all items.	Very low	Strong
3.7	Eligibility for summative assessment in colonoscopy may be triggered once the following are met: Meeting criteria for BSG standards for competence in colonoscopy relevant to trainees—averaged over a 3-month period (ie, unassisted caecal intubation rate 90%+, rectal retroversion 90%+, polyp detection rate 15%+, polyp retrieval rate 90%+, patient comfort: <10% with moderate–severe discomfort) Attaining minimum colonoscopy procedure count of 280 (200 if certified in flexible sigmoidoscopy) Have performed at least 15 procedures over the last 3-month period Attendance of JAG Basic Skills in Colonoscopy course Terminal Ileum intubation rates (60%+ in suspected IBD) Meeting formative DOPS and DOPyS requirements Minimum of 25 formative DOPS Last 5 DOPS rated competent without supervision for 90%+ of all items Evidence of competency in SMSA level 1 polypectomy Evidence of competence in SMSA level 2 polypectomy Evidence of engagement with the JETS reflection tool (minimum of 5 reflection entries)	Low	Strong
3.8	For 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.	Low	Strong
4.1	Newly certified endoscopists should have access to a named individual and meet on a regular basis to discuss cases and to review progress.	Very low	Strong
4.2	Endoscopy departments should have systems in place to ensure appropriate list size and caseload selection for newly certified endoscopists.	Very low	Strong
4.3	Certified endoscopists should perform at least 100 procedures a year to maintain competence.	Very low	Strong
4.4	Certified endoscopists should have access to mentored lists.	Very low	Strong

BSG, British Society of Gastroenterology; DOPS, direct observation of procedure skills; DOPyS, direct observation of polypectomy skills; ENTS, endoscopic non-technical skills; IBD, inflammatory bowel disease; JAG, Joint Advisory Group; JETS, JAG Endoscopy Training System; SMSA, Size, Morphology, Site, Access.