Overview
The Conjoint Committee for the Recognition of Training in Gastrointestinal Endoscopy is a national body comprising representatives from the Gastroenterological Society of Australia (GESA), the Royal Australasian College of Physicians (RACP) and the Royal Australasian College of Surgeons (RACS).
Endoscopy training is assessed by the Conjoint Committee, usually in the context of the Specialist Advanced Training Program of either the RACP or RACS. Full recognition is therefore dependent on appropriate training, experience and supervision pursuant to those Training Programs. Recognition of satisfactory endoscopy training will therefore be given at the completion of Specialist Advanced Training.
Appropriate facilities for training in endoscopy should be available in major hospitals, with exposure to endoscopic procedures being available to all gastroenterology and general surgery trainees.
Registration of Training
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The Committee recognises training of endoscopists who have completed their training in Australia or who are now practicing in Australia.
Trainees may register in their final year of Advanced Training but endorsement will not be endorsed until notification to the committee of the successful completion of Specialist Advanced Training.
An updated register of all endoscopists whose training has been recognised will be maintained at the Secretariat, and on the Conjoint Committee website: http://conjoint.gesa.org.au/.
Guidelines
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The following recommendations are based on a current literature available.
The procedure numbers apply only to those procedures performed unassisted and under supervision.
Logbooks should include both assisted and unassisted procedures, both successful and unsuccessful. Cases should be recorded prospectively and sequentially.
Requirements
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Cognitive and interpretative skills combined with a clear understanding of the role of endoscopy in patient management are as important as technical skills. This includes attendance at radiological and histopathological teaching sessions and relevant operations.
The Conjoint Committee recommends that gastroscopy and colonoscopy procedures in children thirteen years of age and under should only be performed by those who have satisfied the training requirements for paediatric endoscopy.
It is recommended that trainees understand the principles and practice of cleaning and disinfection of modern endoscopic instruments, as outlined in the current edition of “Infection Control in Endoscopy”. This is available to download from the GESA website: http://www.gesa.org.au/members_guidelines/endoscopy_inf/index.htm
It is recommended that trainees also receive training in sedation and airway management. Guidelines for Sedation for Gastrointestinal Endoscopy Procedures are available to download from http://www.gesa.org.au/members_guidelines/ps24_2004.PDF/index.htm
It is recommended that appropriate training in fluoroscopic theory and practice be obtained. In some States it is a requirement that a licence be obtained for use of radiology equipment.
It is necessary to have received recognition of training in Upper Gastrointestinal Endoscopy prior to applying for recognition of training in ERCP or EUS.
The trainee must complete the specified minimum number of procedures under supervision before a supervisor’s report is obtained.
Successful applicants are encouraged to maintain continuing medical education in the field of endoscopic practice, including regular audits of their own endoscopic practice.
Procedural Requirements
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Log Book
Details of all cases attempted, including those not successfully completed, must be recorded prospectively and sequentially in the logbooks provided. These details include complications, degrees of success and time taken where requested. The time taken is recorded as a guide for the supervisor and is considered to be much less important than the successful completion of a procedure with minimal discomfort for the patient and no complications.
Upper Gastrointestinal Endoscopy
Trainees are required to perform at least 200 unassisted and complete examinations independently under supervision, including a minimum of 20 therapeutic procedures. It is expected that a number of the therapeutic procedures will involve endoscopic management of GI bleeding.
Paediatric Upper Gastrointestinal Endoscopy
Trainees are required to perform at least 200 unassisted and complete examinations independently under supervision, including a minimum of 10 therapeutic procedures. A minimum of 100 of the upper gastrointestinal endoscopies should be in paediatric patients under the supervision of a recognised paediatric upper gastrointestinal endoscopy supervisor.
ERCP
Trainees are required to have previous recognition of training in upper gastrointestinal endoscopy prior to applying for ERCP.
Trainees must perform a total of 200 ERCP’s, unassisted and complete, in patients with intact papillary sphincters. A minimum of 80 supervised, but independently performed, sphincterotomies are required in patients with intact papillary sphincters. A minimum of 60 stents and/or nasobiliary drains should be inserted during training.
Cannulations performed in patients with previous sphincterotomies should be recorded in the logbook but not counted as a successfully completed ERCP for gaining numbers.
EUS
Trainees are required to have previous recognition of training in upper gastrointestinal endoscopy prior to applying for EUS.
Training should be undertaken at centre(s) where EUS is performed regularly and at least 200 procedures are performed per year in the training program.
Trainees must show evidence of completing a minimum of 250 cases independently. At least 100 of these cases should be for gastro-esophageal lesion/tumour and at least 150 for pancreato-biliary cases.
EUS guided FNA cases can be counted within cases for either gastro-esophageal or pancreato-biliary conditions.
Catheter probe EUS that is place down a gastroscope can be counted but should not be any more than 10% of all cases.
Colonoscopy
Trainees are required to perform at least 100 unassisted and complete (at least to the caecum and preferably into the ileum) colonoscopies in intact colons, under supervision, including at least 30 patients with snare polypectomies. A success rate of at least 85% for intubation of the caecum (and preferably into the ileum) should have been achieved on the completion of training.
Paediatric Colonoscopy
Trainees are required to perform at least 100 unassisted and complete (at least to the caecum and preferably into the ileum) colonoscopies in intact colons, under supervision. A minimum of 75 of these procedures should be in paediatric patients under the supervision of a recognised paediatric colonoscopy supervisor. Some polypectomy experience is expected. A success rate of at least 85% for intubation of the caecum (and preferably into the ileum) should have been achieved on the completion of training.
Cleaning and Disinfection
It is required that a minimum of 15 instruments be cleaned under supervision by an experienced endoscopy nurse. This should be recorded in the logbook. See current edition of “Infection Control in Endoscopy” for guidelines: available to download from: http://www.gesa.org.au/members_guidelines/endoscopy_inf/.
Responsiblities
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Trainees must
- Apply to the Conjoint Committee to be registered as a trainee.
- Prospectively record all procedures including unsuccessful and assisted procedures in the logbook provided.
- Have the logbook signed by the supervisor on the day of the procedure.
- Demonstrate competence in a wide variety of skills including clinical management, cleaning and disinfection, technical expertise, pathology and radiology.
- Complete the minimum number of procedures required for each procedure. It is understood that most trainees will require more procedures than the number stated.
- Apply for recognition of training. This is permitted in the final year of training, with recognition being granted on completion of Specialist Advanced Training.
- Ensure that the relevant forms for the registration of training and the application for recognition of training are completed and correct. Incomplete or incorrect forms will be returned to the applicant for completion before acceptance and may result in a delay in assessment.
Supervisors must
- Be a senior person in an active unit.
- Be experienced in the procedure for which the application is being made.
- Be recognised by the Conjoint Committee for the relevant procedure or be considered to be of equivalent standing.
- Have personally supervised some of the applicant’s training.
- Endorse the procedures logged in the logbook of the trainee by initialling each procedure at the time the procedure is performed.
- Assess competence after the trainee has independently completed the minimum number of procedures required. It is understood that most trainees will require more than the stated minimum number of procedures.
- Attest that the candidate is competent to perform the endoscopy and specific procedures safely and expeditiously, plus be able to competently integrate indications for endoscopy and endoscopic findings and therapy into patient management, be able to understand risk factors, recognise and manage complications and be able to recognise personal and procedural limits.
Assessment
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The Conjoint Committee meets twice a year, generally April and November, to assess applications. Applications close on 15 March and 15 October. Late applications will be assessed at the following meeting. Results of the assessment will be sent to the applicant in writing.
Fees
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The current fees for 2006 are:
(a) Registration Fee
A non-refundable registration fee of $220.00 (GST inclusive) is to be submitted with the completed registration form.
(b) Application for Recognition of Training
Application fees are based on a fee per procedure basis and payable when the completed registration forms are returned for recognition. The following fee structure applies:
- The fee for each procedure is $275.00 (GST inclusive).
- Please note that fees are assessed on an annual basis and we advise you to check on the fee amount prior to submitting your application for recognition.
Application
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Registration and Application for Recognition of Training must be on the official forms. Facsimiles will not be accepted.
Please check all forms to ensure that you have supplied what is required, including the appropriate fee, as incomplete forms will hold up assessment.
Send to:
Conjoint Committee
C/O - GESA
145 Macquarie Street
SYDNEY NSW 2000