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Accreditation of colonoscopists for bowel screening: a proposed model for Wales

Genesis of Accreditation in Wales. In the beginning

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Accreditation of colonoscopists for bowel screening: a proposed model for Wales

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    1. Accreditation of colonoscopists for bowel screening: a proposed model for Wales Dr Neil Hawkes Consultant Gastorenterologist & Welsh Endoscopy Training Lead

    2. Genesis of Accreditation in Wales In the beginning… And they created… And they saw it was… So they created…

    3. National Intercollegiate Colonoscopy Audit Prospective 4 month audit: 9223 examinations Caecal intubation rate 77%, adjusted rate 57% perforation rate 1:769 only 17% had received supervised training and only 39% had attended a course Bowles et al Gut 2004

    4. Performance and competence

    5. Public & Public Health Perspective

    7. Colonoscopy performance

    13. Reviewing Accreditation Process in England (1) Assessor recruitment Assessor training Results over 2284 paired judgments 76 (88) assessments Stressful Time-consuming 75% pass rate 96% assessor agreement over pass/fail 60-83% absolute congruence between assessors 97% concordance - scores vs expert opinion

    14. Reviewing Accreditation Process in England (2) Grading correlated weakly with caecal intubation rates and MCQ scores (r= 0.24 & 0.27, p<0.01) respectively No correlation between the grading and colonoscopy number in previous year. 38/41 candidates felt the DOPS was fair /very fair overall 36/42 felt MCQ was fair /very fair Of the assessors, 15/20 felt DOPS was valid /very valid 21/21 overall felt process was fair /very fair.

    15. Issues raised by the process Candidates raised issue of sufficient preparation for summative DOPS assessment Courses Peer assistance Main areas causing ‘fail’ - Loop management & quality of mucosal visualisation Concerns over generation of ‘two-tier’ system

    17. Running with accreditation Preparation of Units for screening Accrediting Training Faculty & Panel of Assessors Benchmarking Accreditation Process Preparing nominated colonoscopists for the Accreditation Process Timetabling

    20. Eligibility criteria for colonoscopists in Wales (Applications considered on an individual basis by the Accreditation Panel) Minimum 150 procedures per year Lifetime 1000 procedures Pathology adjusted caecal intubation rate > 90% Lifetime perforation rate <1:1000 Adenoma retrieval rate >15% 6 month performance data submitted for review

    21. Supporting the Welsh Accreditation model Entry criteria to act as guideline for applicants Panel to review all applications for eligibility Incorporate two day review of technique & feedback held at base or local training centre Ongoing support for screening applicants Fairer accreditation process (in base unit, more cases) & adopt robust appeals process

    22. Proposed Welsh Accreditation model

    23. Proposed Welsh Accreditation model

    24. Unit Training Day Work with Trust team Aim to provide technical review Introduce Scopeguide Update on polypectomy techniques Provide overview of the accreditation process Undertake DOPS assessment Develop training plan with potential screeners

    25. Proposed Welsh Accreditation model

    26. Proposed Welsh Accreditation model

    31. Certification process: summary

    32. Summary Accreditation process ‘stood test of time’ Over riding need is for quality assurance of screening colonoscopists Able to learn from previous experience More choice & support for colonoscopists Proposed Welsh Model - ‘robust but fair’ with benchmarking to English standards

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