Prospective cohort study of surgical trainee experience of access to gastrointestinal endoscopy training in the UK and Ireland

UK endoscopy trainer survey: perspectives on current endoscopy training delivery, experience, barriers and opportunities

Objective

UK endoscopy training is delivered by trainers possessing well developed endoscopy and teaching skills to help learners perform high-quality endoscopy. Train The Trainer (TTT) courses are effective, but additional trainer support is variable with little formal quality assurance. We performed a survey to map UK endoscopy training, assess trainer perspectives on training delivery and identify factors that would enhance training.

Design/Method

An online survey was designed by trainer representatives, in collaboration with the JAG training committee, and collected responses from trainers registered on JAG endoscopy training system e-portfolio from April to June 2022.

Results

There were 1024 responses from all trainer disciplines, with 813 (79%) completing TTT courses and 584 (57%) having job planned dedicated training lists (DTLs). Clinical endoscopists most frequently had job-planned DTLs (71%), and DTLs occurring at least weekly (58%). 293 (29%) respondents participated as course faculty. Trainers reported high levels of pre-procedure preparation, effective dialogue and frequent feedback. The DOPS forms were 'always/often' completed by 81% of clinical endoscopists, 73% of gastroenterologist and 58% of surgeons. 435 (42%) trainers never had peer feedback. Responses suggested training could improve by protecting training time, attending courses, participating as faculty and receiving feedback from experienced trainers.

Conclusion

This survey demonstrates substantial proportions of highly motivated UK trainers who value time spent teaching and learning how to teach. Skills taught on the TTT courses are often actively used in everyday training. Improved trainer course access, protected training time and formal use of existing feedback tools by peers were highlighted as measures that could support trainers' development.

Upper gastrointestinal training in the UK and Ireland: a Roux Group Study

INTRODUCTION

Surgical training programmes in the United Kingdom and Ireland (UK&I) are in a state of flux. This study aims to report the contemporary opinions of trainee and consultant surgeons on the current upper gastrointestinal (UGI) training model in the UK&I.

METHODS

A questionnaire was developed and distributed via national UGI societies. Questions pertained to demographics, current training evaluation, perceived requirements and availability.

RESULTS

A total of 241 responses were received with representation from all UK&I postgraduate training regions. The biggest discrepancies between rotation demand and national availability related to advanced/therapeutic endoscopy and robotic surgery, with 91.7% of respondents stating they would welcome greater geographical flexibility in training. The median suggested academic targets were 3-5 publications (trainee vs consultant <3 vs 3-5, p<0.001); <3 presentations (<3 vs 3-5, p=0.002); and 3-5 audits/quality improvement projects (<3 vs 3-5, p<0.001). Current operative requirements were considered achievable (87.6%) but inadequate for day one consultant practice (74.7%). Reassuringly, 76.3% deemed there was role for on-the-job operative training following consultant appointment. Proficiency in diagnostic endoscopy was considered a minimum requirement for Certificate of Completion of Training (CCT) yet the majority regarded therapeutic endoscopy competency as non-essential. The median numbers of index UGI operations suggested were comparable with the current curriculum requirements. Post-CCT fellowships were not considered necessary; however, the majority (73.6%) recognised their advantage.

CONCLUSIONS

Current CCT requirements are largely consistent with the opinions of the UGI community. Areas for improvement include flexibility in geographical working and increasing national provisions for high-quality endoscopy training.

The Call for Neuroendoscopy Cadaveric Workshops in Lower-Middle Income Countries

OBJECTIVE

This study aims to assess the impact of the workshops organized during Neuroendocon 23 on the perspective and confidence of neurosurgeons toward endoscopy in a lower-middle income country.

METHODS

Neuroendocon 23 had cranial and spinal endoscopy cadaveric workshops with 30 delegates each. A pre and postworkshop survey was disseminated among the delegates, and statistical analysis was performed with SPSS (version 26) using P < 0.05.

RESULTS

A total of 24 delegates (40%) consented to participate in the study, with only 1 female respondent (4.17%). After the cranial endoscopy workshop, there was an increase in the level of confidence of delegates in cranial endoscopic approaches (P < 0.001). Similarly, after the spine endoscopy workshop, the respondents had increased confidence in managing spine conditions with the endoscopic approach (P = 0.040), to the extent that they preferred the endoscopic over the microsurgical technique (P < 0.001). All respondents (n = 24, 100%) believed that endoscopy should be promoted in lower-middle income countries and integrated into residency curricula.

CONCLUSIONS

Cranial and spinal endoscopy cadaveric workshops could be the first step in stimulating the interest of neurosurgeons in endoscopy.

Hospital compound-level endoscopy training quality performance: scoping the spectrum

Background and study aims  This study aimed to assess the quality of endoscopy training in a UK Statutory Educational Body compared with Joint Advisory Group on Gastrointestinal Endoscopy Training standards (JETS). Methods  A total of 28,298 training procedures recorded by 211 consecutive cross-specialty trainee endoscopists registered with JETS in 18 hospitals during 2019 were analyzed. Data included trainer and trainee numbers, training list frequency, procedures, direct observation of procedural skills (DOPS) completion, and key performance indicators. Results  Annual median training procedures per hospital were 1395 (interquartile range (IQR) 465-2365). Median 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 Joint Advisory Group (JAG) standard (n = 20, P = 0.001, effect size -0.56). Median points per adjusted training list were 11 (5-18). Median DOPS per trainee and trainer were three (1-6) and four (1-7) respectively; completing 0.2 DOPS (0.1-0.4) per list and amounting to six (2-12) per 200 procedures: fewer than half of the JAG standard (20 per 200) (P < 0.001, -0.61). Esophagogastroduodenoscopy median KPI: J maneuver 94 % (90-96), D2 intubation 93 % (91-96); Colonoscopy KPI: cecal intubation 82 % (72-90), polyp detection rate 25 % (18-34). Compound hospital score ranged from nine to 26 (median 17 [14-20]). Conclusions  Important performance disparity emerged with three-fold variation in compound hospital training quality and most units underperforming compared with JAG standards. Trainees and training program directors should be aware of such metrics to improve quality endoscopy educational programs and consider formal adjuncts to optimize training.

Endoscopy training in the UK pre-COVID-19 environment: a multidisciplinary survey of endoscopy training and the experience of reciprocal feedback

OBJECTIVE

Training in gastrointestinal endoscopy in the UK occurs predominantly in a real world one-to-one trainer to trainee interaction. Previous surveys have shown surgical and gastroenterology trainees have had mixed experiences of supervision and training, and no surveys have explored specifically the role of trainee to trainer feedback. This study aimed to explore the experience of training and of providing trainer feedback for all disciplines of endoscopy trainees.

DESIGN/METHOD

An online survey designed in collaboration with Joint Advisory Committee training committee and trainee representatives was distributed from January 2020 but was interrupted by the COVID-19 pandemic and hence terminated early.

RESULTS

There were 129 responses, including trainees from all disciplines and regions, of which 86/129 (66.7%) rated the culture in their endoscopy units favourably-either good or excellent. 65/129 (50.4%) trainees reported having one or more training lists allocated per week, with 41/129 (31.8%) reporting only ad hoc lists. 100/129 (77.5%) respondents were given feedback and 97/129 (75.2%) were provided with learning points from the list. 65/129 (50.4%) respondents reported their trainer completed a direct observation of procedure or direct observation of polypectomies. 73/129 (56.6%) respondents reported that they felt able to give feedback to their trainer, with 88/129 (68.2%) feeling they could do this accurately. Barriers to trainer feedback cited included time constraints, lack of anonymity and concerns about affecting the trainer-trainee relationship.

CONCLUSION

Overall, the training environment has improved since previous surveys. There are still issues around interdisciplinary differences with some surgical trainees finding the training environment less welcoming, and trainee perceptions of hierarchical barriers and trainer responsiveness to feedback limiting the accuracy of their feedback.

Innovation in surgical practice: The Association of Surgeons in Training conference - Belfast 2019

The Association of Surgeons in Training (ASiT) advocates for and represents surgical trainees throughout the United Kingdom and the Republic of Ireland. It promotes excellence in surgical training for the benefit of both surgeons and patients. Originally founded in 1976, ASiT is independent of the National Health Service (NHS), Surgical Royal Colleges, and Specialty Associations. The 2019 Annual Conference in Belfast hosted a record number of delegates (n = 855) over the 3-day educational weekend. The conference theme, "Innovation in Surgical Practice" focused on the latest educational and technological innovation to enhance trainee's knowledge and experience of surgical innovation to ultimately enhance patient care. A record number of technical and non-technical pre-conference courses (n = 13) covering a diverse range of topics was offered. A new feature, a 24-h Hackathon, was successfully delivered in parallel to the Conference. This opportunity generated productive, cross speciality collaboration, to address and solve current problems in healthcare. Over 1000 abstract submissions were received and there were over 30 poster and oral prizes on offer for winning submissions. The ASiT conference and the Association continues to grow annually and we look forward to welcoming delegates to Birmingham from the 6-8th March 2020 to enjoy another action packed weekend focused on "Optimising Performance".