Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

Good evening everyone. I am. Thank you so much for joining today, first webinar of the academic year and we're very thankful to our speakers for joining just a couple of things. Um If you have any questions, please have them on the chat box and we'll try to answer them at the end of this. Um I'll hand over to Katie Siggins. Thank you. Yes, great. Thank you. So, um I'm Katie Siggins, the endoscopy rep. Um I might have met a few of you. Um We're really fortunate tonight to have two brilliant speakers from Scotland to go through how training is being run in Scotland. Um We ran a similar webinar for trainees in England with the training academies um earlier on in the year. So hopefully tonight, we'll give everyone an update for training in Scotland. So, um our first speaker is Mr Raymond Oliphant. He is a consultant colorectal surgeon at uh Raymo Hospital in Inverness and the Golden Jubilee University National Hospital in Clydebank. And he also sits on the colonoscopy subcommittee for A CPG B. And then our second speaker for tonight is Miss Michelle Thorson, who's a consultant colorectal surgery surgeon at University Hospital with and she is the National Endoscopy Training Lead and the National Clinical Lead for Endoscopy in Scotland. So without further ado, I'll hand you over to um Mr who's gonna uh talk about some of the curriculum? That's great. Thanks Katie. Um Thanks for the introduction and for inviting us along today. Um I'm going to start really by just painting a picture as to what surgical trainees can expect from colonoscopy training and where the problems might lie at the moment. Um Because what is required for CCT is not what is required for jag certification and colonoscopy. Um First of all, we're going to have a look at the IP curriculum and, and this is taken from the most up to date uh curriculum um on the ICP website. And we can see that there's mention of endoscopy and it mentions how you can log your cases and these should be available for the A A RCP process, but that's really where it stops. Um And we know that through the I AP, you know, we do love numbers and we do love um points, meaning prizes to progression through training. And this is what the the endoscopy or the colonoscopy numbers look like in general. So through your surgical training, phase two and into your specialty training into phase three, it really is just indicative that you should have knowledge and clinical skills required to the level appropriate with the phase of training in any given module and it's really a bit nebulous. Um Other than saying, you should be keeping up when we have a little bit more analysis of the numbers. Um I'm sure a lot of this in the audience will be well familiar with the requirements and the um the numbers required for CCT and this is the summary of the um numbers required. And of course, we hear from all our trainees about the numbers of anterior and segmental resections. And of course, it mentions that you should have 200 colonoscopies in your logbook and that's all very well and good. Um However, it is then possible to ct with your 200 numbers, but this does not mean that you are a colonoscopist far from it. Um the most, most units and certainly as um the lead for a endoscopy for, for a region, I would not be entertaining an independent colonoscopist who just had 200 numbers, but no other evidence to suggest um that their quality of endoscopy on the certification of endoscopy was a up to scratch. And so we would require anybody who's performing colonoscopy to have ideally jag certification, but certainly their KP is matching or exceeding the minimum requirements. Now, a lot of you will understand that the jag requirements for colonoscopy certification have changed and been updated. And as of last year, all trainees, majority of whom who have not achieved provisional certification um will be transitioned to the new jag requirements or the new curriculum. This requires a minimum of 280 procedures and also adequate K PS. Uh And here's a summary of some of the main ones. So in addition to your minimum number of 280 you have to have a minimum, a sequel intubation rectal retroversion. But in addition to PS now completed, having attended a big skills courses and then have a S and Dopp to ensure that not only can you perform a diagno colonoscopy, but also can remove level one and level two polyps adequately and independently. So the criteria are fairly um robust and it was really to highlight the difference between being able to cruise through a CCT in colorectal surgery, but then come to the end and realize that you technically would then still be a trainee for surgical trainees in the audience. I think it's important to, to acknowledge and to understand that to get to that your T ticket is all very well and good. But you will be at a competitive disadvantage if you're looking for a consultant colorectal job in the UK without being jag certified as a colonoscopist. Um because what employers don't want is to hire a trainee, they want a finished clinician who can then provide service to the IP requirements, do not equate to the jag requirements, which is really what you should be aiming for as a, as a, as a consultant, colorectal surgeon in the first year of um of uh being appointed, we recently had a had a look at the, the last 14 gi trainees in high um to see that only three of them had obtained full jag certification prior to CCT. Now, this is thankfully changed in the last 18 months and that we now have one of our ST sevens who has um just obtained JAG certification um which is excellent and is in part, not only due to how we've changed our training pathway, but also the involvement and input through the National Endoscopy Training program, which Michelle is going to speak more on. Uh And we'd be happy since as to how that program um is accessible and how it can help trainees and trainers um deliver um best quality trained colonoscopy. Um So it doesn't answer all the questions um or provide all the answers. Um but it is a very vital resource that can be used and accessed. So I think that pretty much highlights the problem there and I'm just going to uh stop presenting and hand over back to you Katie. Great. Thanks for that. Um I have not got any questions in the chat yet, but I have got a question for you. Um Do you need any level four PBS for Colonoscopy for your CT or is it just that you need to have 200? As far as I'm led to believe it is only 200 whether these were performed as IC numbers seem just to be focused on how many diagnostics you've done as for level four polyps, a lot of these are complex, er s and you know, for, and they're really specialist, really. Yeah, but you don't need any actual P DS on IP, you know how we do for the other. Not on IP, I don't believe it's all diagnostic colonoscopy, it's all diagnostic colonoscopy. Ok. Um And then the other thing I was gonna say is it sounds like certainly in Scotland, you know, the recommendation is, is where, you know, to make yourself competitive competitive for a consultant job. Get J right? Rather than just getting the 200 line of it. Yes, we've had um probably 33 recent, OK? You get a lot of feedback, ok? Get a lot of feedback. Uh Hopefully you can hear me a bit clearer now. Um Certainly um you are, you are at a competitive disadvantage not having a jag certificate. Um If you, if you came to Highland without the J A certificate or uh an auditable logbook for the last 18 months or the last 12 months to suggest that you were exceeding the, the basic K PS and numbers per annum as recommended by the B SG, then we would not allow you to independently scope and so to come out, not only with your CT but also your jag certificate, an auditable data of of reasons recent um performance. I think it would be very difficult for you to get um endoscopy as an independent colonoscopist anywhere really in the UK at present, an increasing focus on quality, an increasing focus on ensuring that K PS across the board are maintained and exceeded. Um So I think it, it should be seen as a prerequisite and I II certainly would wish that the ICP and the J and do you think that that's been the case since even before the curriculum changed? And the curriculum change has just sort of given people the stepping stone to getting better access to endoscopy. I think people have got, you know, mixed feelings about the curriculum change, but it sounds like if you're saying to be competitive for a consultant job then, yeah, so I two things have happened. One, there has been a curriculum change and that has really dumped the provisional certification which previously would have um opened the door to you performing independently. But with conditions on your practice to now having just a single certification, which is, uh you know, I mean, the, um the other thing that just happened obviously in the last few years is the impact of COVID on training, not only in surgical procedures, but also an endoscopy, which really from the last certainly from 24,022 is I think probably most trainees would agree that their endoscopy exposure and to training has suffered markedly. And so we're getting trainees who are coming through from COVID era training at a time where the curriculum has also changed, which is going to mean that they are being unable to come out of an old fashioned provisional colonoscopy certification, which would mean starting colonoscopy practice. Ok. You can give service, but then you can work towards full certification and time. I think that probably answers that. Right. So, um we've not got any questions at the moment. So if we move on to Miss Thornton, now, if that's ok. Ok. So hopefully you can see the screen um and you can hear me. So I think following directly on from what Raymond said for anyone on the call who is not from Scotland, endoscopy in Scotland is delivered by in the majority surgeons. So yes, there's a, a large gastroenterology cohort as well, but more than 50% of the diagnostic and probably more than 70% of the therapeutic colonoscopy is performed by surgeons, not by gastroenterologists. And that's very different from um south of the border. And so particularly in Scotland, given what, what Raymond has explained to you. That means that in, in Scotland, the changes in the curriculum for jag certification have had a significant impact. So apart from um the, the KPIS and the jump through hoops that, that Raymond has put, put there, I think because for so many of you, you do need to look at jag certification if you want a job in any of the health boards. Then it's about being mindful of how much work there is to be done apart from just that 280 in terms of numbers. So you actually have to get a lot of formative dops. There are your five reflections. You have to get the dopy in your level one and level two polyps. Um You have to be the K PS as well as the numbers and then you do your summative dops before submitting for local um sign off. And that's with your um local training lead before the national lead gives their final approval. So it's not something that you can just suddenly pick up and run with in the last six months or even the last two years of your uh surgical training. And I just ask you to be a little bit mindful of that. This is part of the reason that the National Endoscopy Training Program got such support from Scottish government and from National Education Scotland. And it's because of the change in that curriculum and also the change in the gastroenterology curriculum, reducing their training time. COVID had meant that many of the trainees couldn't get access to courses. And then the curriculum change meant a boost in the numbers and also a boost in the amount of uh quality indicators that were required. So we have now a National Endoscopy Training Program. It's a hub and spoke model. The base is at the golden jubilee, but we now have jag um accredited sites at Stop Hill, Tayside East Loving Community Hospital, Golden Jubilee and Highland isn't far behind. So hopefully within the next couple of months, we will also have uh an extra site in the north of the country. And within that funding comes a bespoke um endoscopy space. It also has dedicated time for faculty and protected training lists for trainees and it's these lists in particular, which are, I think really important at the moment. For the ST sevens and eights in colorectal surgery, we have one focus and that is promoting best endoscopy practice and best endoscopy training. I've stolen this from the geeks website which I will come back to. Um but it really is the reason that the endoscopy training program has the finance and the faculty backing that it currently does. So we've only been in existence since uh October 2021. But already we are um delivering 14 programs across the country. We've got a further five in development and upper gi training in particular is getting a a mega boost this coming week. But you can see from there, there's a lot of activity that's going on which is generating um enthusiasm for acro across the country across all of the domains, whether that be nonmedical endoscopist, your endoscopy nurses, trainees, but also your consultant staff, but specifically for you, you need to get your basic courses. And ideally you get those sooner rather than later, we would encourage you to apply on the Jets website. The funding is provided back through Nes um but you do have to apply through your trading program director um for the study leave budget and then um go onto the Jets website to register for this. Uh Up until now you could uh attend in Tayside or in Stop Hill. But as of 2024 there'll be basic courses at the Golden Jubilee and also in Lothian, if you're struggling to get your endoscopy numbers, and um I'm aware how busy the consultants staff are in terms of getting your assessments completed and completed in a timely fashion for the last 18 months. We've been offering immersion training and it's a little bit different to what's offered south of the border. So because we had such a big problem with senior trainees reaching CT without either their 200 or definitely without jag certification. Our focus with the immersion training is on the senior trainees or it has been for the last 18 months. So if you are looking like you're not going to reach your numbers, and again, you have to be proactive here approaching your TPD and your TPD will forward your name and contact details to Catherine Boylan who is our program lead and what we are currently offering is two weeks. So 20 lists a week of one on one training with an N ATP faculty. Um They are ring fenced time. You do get uh full training on every list. And we also have an obligation to complete um drops throughout. And if you're very near jag certification, we can also provide some of your summative assessments to back some of this up if you're earlier on and you really need to get your, your numbers up and running, but you don't have access to the lists. Raymond has actually developed a fantastic online training module that goes with the simulator and the simulator is accessible for most Scottish trainees somewhere in the local region. And I'm aware that for surgical training in particular, the non technical skills are also really important. Um And we are now offering endoscopy, non technical skills across a number of the sites in Scotland. And the uh they again will be on jets as of 2024. But where we are now, um we now have four jag training centers which is going to help you enormously. But we have over 30 trainees waiting for immersion training and we are booked out already to 2025. We've got 80 waiting for basic and upper courses and we've got 38 waiting for s training and that's in additional to the consultant demand. And that means that if you are wanting to have your 200 for a CCT or JAG certification, you have a responsibility to prioritize your endoscopy training. Now, if you are struggling to get access on the next side are the people that you can contact. So first protocol is always your training program director, but Catherine is a or Karen is the program lead in the based on the Golden Jubilee and can help you with access to courses and also to immersion training can also point you to a number of the online learning modules that we have developed on the website shown on the screen. There's myself and Aidan Cahill who is my co training lead. We are, I will be based at uh the Golden Jubilee next year for the training for training purposes and Aidan runs Stock Hill. So again, if you're having problems accessing either basic courses or access to training, whether that be basic or um more advanced skills, then there are some contact points and I have no doubt that Raymond would also be more than happy for you to contact him if there were any concerns. So I'm presuming that this will be available afterwards. Um Please have a look at the website and feel free to contact us if you're having any concerns. That's brilliant. Thanks very much both. Um So I think one question I'd ask is obviously, as you said, you're focusing on the senior trainees to get them through sort of the immersion training if they're near the ends, what advice would you give to sort of the ST threes or fours fives that definitely want to do colorectal surgery that are, it's too early on to be put through the dedicated training. How can they go about getting, you know, training missed in their own hospital? What advice would you give and I can give my advice afterwards as well. But what advice would you give for? How can they, you know, go about getting exposure early on? II Yeah, I'll take that first. Um Certainly. Um as Michelle had mentioned in, in Scotland, we've got access to endoscopy, high definition endoscopy simulators which are based across the country and there should be local access for most trainees. Um That would allow for very basic um colonoscopy uh training, which is akin to really learning how to sit in a car to learn what the gear sticks for and what the steering for and what the pedals are for prior to getting live endoscopy training. Um There's a variety of basic skills modules and basic skills programs through that, um which improves accelerated learning to begin with. So, if you're at the very beginning of your learning curve, certainly within the 1st 50 live scopes, then performing um some simulation training and getting a certificate for that, I think would be your first protocol. Secondly, TPD S will have some oversight but it might not be a correct or specific TPD that you have. And as we've alluded to, there's a difference between what is required for CT and what's required for jag certification. And so I would encourage all trainees to contact their local um endoscopy training lead for their region and explain to them where they are. And ideally training leads should be performing an endoscopy appraisal for all trainees. Um whether that's surgical, medical and nursing or non nonmedical endoscopy. Um ideally anybody who's training endoscopy should have an annual appraisal to work out where they are and what they need from that training unit. Um over the time period that you're attached to them, so speak to people early. And as Michelle said, you need to be proactive with us. And Katie, if I can just add on to that, we, there are over 40 dedicated N ETP faculty across the country now and they have built within their ns job plan time for local training. So there will be academy members who will have endoscopy lists who are required in their contract to, to help support that. Yeah, I think um one thing, I mean, just my personal experience um trying to get a dedicated training list, someone that will take you onto their wing and say to you every week we'll do this training list together was really great. And I did find anecdotally that doing an afternoon list was better than a morning list because after you'd get pulled onto the ward round, you felt guilty when you left your colleagues doing the ward round. So, you know, trying to negotiate locally. When can you have your training list? Find someone that will train you if that's a nurse endoscopist? Great. It doesn't have to be your boss. Um, and you know, an afternoon list you ii found that it was easier to make. Um, that's my opinion. I don't know what you think about those sort of little tips and bits of advice. Yeah. Well, no, absolutely. I think having that discussion with you, an endoscopy a training lead, they'll be able to, to take, you know, certainly my experience in the high is that I know all of our trainees were able to factor them into a rota so that we ideally can guarantee 20 training lists per year. Um, and that's over and above access to ad hoc service lists. Um, there's a requirement for all of our endoscopist to be well and to take trainees, regardless of whether they're surgical, medical and surgeon or a gastroenterologist, any trainees should be able to come to the department and get something out of your list with the prerequisite that training does not cause a list overrun. And there's been no service lists can be paid. I would to answer your first question as to where you get from ST three and ST five. What can you get out of it? It's really getting your hand on a scope and whether that's to withdraw the scope and insert the scope, see how you get on and to speak to your trainer to begin with and say, well, let's use, give me 10 minutes to see how we get on and you can do some almost micro teaching sessions in 10 minutes um which will add to your logbook, I will add to your endoscopic colonoscopic training, but it will also not require not lead to an over of list to over burden, not only nursing staff and units, but also to diminish service provision locally. And so it's having that conversation and to make sure that the rules of engagement are are not only discussed between trainer and trainee, but also room staff and the, the, the, the nursing staff that run the unit. I think it's, if you go in and you play by the rules of the game, then it will become easier. But, um, it is difficult but it requires communication to begin with. Do you think that um, most units would be happy to run as a training list? So with reduced lists or do you think that trying to go to even a list that's booked that's fully booked is still worthwhile again? I've got no problem with any trainee coming to a service list with the caveat that it can't cause an overrun. Um I think there are, as Michelle said, there's now a number of faculty across Scotland that ideally should have some time to aside in their job plan. And if they can negotiate local access to dedicated training lists, and that's ideal, that's a win win. And certainly I run a weekly training list on a Monday afternoon. So it's an afternoon that would suit you Katie. Um but it also allows um ring fenced a point reduction on the list. So that, that we absolutely know that that can be delivered not only just for training trainees, but also uh delivered for consultant upskilling. And those who certification who perhaps want to advance towards b screening colonoscopy or level three and four polypectomy. And I think it'd be find somebody who's an enthusiast and sit in their coattails. And then another thing I was going to ask, um obviously you're running the courses in Scotland. If people want to, can they book on to any course via the Jets website? Even if that means going to England Wales or do you encourage people to try and go on to one of the local courses? Definitely an encouragement to go local and the funding is for local. It's extended to England in exceptional circumstances such as it was uh coming out of COVID, but that's not what uh is, is desired. Yeah, there's no barrier for trainees if they wish to, to, to, to get um down South. And certainly I did some basic courses in the hull during my own training, but that was financed through my own. Um And there was very little study budget which came um for that. And certainly as, as trainees, you'll know that study budgets precious and it should be used for essential courses and targeted courses. Um And to be to use that therefore, for something which is funded in Scotland. Um doesn't make much fiscal sense to me. If anyone does have any questions, then feel free to post them in the chat. Um I think one sort of final question for me if we don't have any more questions from the audience is, I think endoscopy is something a lot of people really worry about, especially now it's been put into the CCT requirement. Do you think that overall your message to trainees would be of encouragement and reassurance that actually how you've changed delivery in Scotland means that people will be ok because I think people really worry about getting the the numbers they need for CCT. Um and it sounds like you've made really positive changes in Scotland. I think, you know, what would your final message be to trainees that are worried about it? Yeah, my message would be if you're proactive. Um Yes, you will be ok. Again, II would I would mirror that there is um processes in place to help people get and get training. Um But it's not something that can be left to your ST seven and ST eight a year. The numbers required 280 scopes. I think you need to be brutally honest with yourself as to where you are in your training and work out. How much training time do I have left? How many weeks of elective training does that give me per year? And realistically how many scopes per week, can I get on to, to, to acquire these for my log? And therefore you can work out pretty, pretty easy. And it's one of the first things I do when I'm having an appraisal with the trainees is to work out how many scopes per week they require to hit the target of the 280 by the time the T and it's often an eye opening to find that they need 567 scopes per week on average. And that's not including a immersion time and such like this is just getting into lists. So if you had to think that seven colonoscopies per week, well, actually two lists. In addition, you're juggling ward rounds, clinic duties, theater commitments on calls, time away, annual leave, leave sitting F RC exits. There's a lot to be crammed in for the last two years of training, start early. And as Michelle said, if you can get in in the proactive towards SD great, and that will certainly reduce some of the stress towards the end part of training. Um Of course, it doesn't help those who are at the end part of training. And of course, we'd like to everybody. Um But for those who are struggling come and contact us directly and we can see what kind of bespoke um plan we can create for you. We've got a question here about um it seems there's very well structured training for nurse endoscopist compared to doctors what are your sort of thoughts about that? My, my thoughts on that uh would be very clear that the nurse endoscopist only really have the one task that we're trying to teach them. So we are not also trying to teach them how to operate, how to run ward rounds, how to run clinics. So, with a focus, uh it's my much easier for their training to look more focused. And I guess as uh if you wanted to do just endoscopy as a surgeon, I'm afraid you still need to jump through all those other hoops even if you decided later on to let it go. But it's because of the central focus of their training. And then there's another question about training with nurse endoscopist. Is that something that generally is welcomed up there? So, you know, I was taught by a nurse endoscopist. Do you find that generally nurse endoscopist are happy to train or? Yeah, very much. So, some of the best endoscopist that I have have been nurse endoscopist II think the trainees need to be mindful of where the nurse endoscopist is in their training. So are they just jag cert just certified? Um Have they done a train the trainer course those sorts of things? So it's the same as when you go to a consultant list, not all nurse endoscopist will be good trainers and um not all nurse endoscopist will have the skills to be able to train either. So you do need to be sensible about who and where you receive your training from. And then another question we had was um what happens if people only decide that ST six that they want to do colorectal? Because obviously, you know, you technically don't subspecialized until the end of ST six. You know what happens in that scenario. My comment on that would be you're doing a lot of you're doing general during your, your, your phase three, so three and 45 and six. So if you haven't decided that you're not doing that, you're doing colorectal until six, you've still got plenty of opportunity to become scope adapt whether that's up or lower flexible sigmoidoscopy. And I'd be encouraging, you know, most of the trainees to, to get uh to get their hands on the simulator to think about whether the basic course is something that's worth doing early on. It may not if you, you know, you're very undecided about what type of practice you need to do. And I know that T pds would be um mindful of spending uh their precious study leave budget on trainees who are never going to do colonoscopy. Um But, but equally, there is plenty of opportunity in Scotland pre ST six before deciding that you're colorectal to have access to colonoscopy training. Thank you. Um We haven't got any other questions. So um I think we can probably wrap it up there unless either of you have any other closing comments. My only other comment WW would be a a plug for the for online training. So at the moment, we do their simulation training, there is hands on training, but trainees need to be mindful of the online training that that's out there. So in particular things like the geeks platform, um the Olympus webinars and um things like Kings live, which again are live. Uh So in Scotland, we are very much promoting the, the, the geeks website, which is, you know, basic endorsed copy everyday endoscopy. It covers everything that you could want to know about how to do a colonoscopy, how to do a Polypectomy. It's free to, to enroll a lot of the basic um content is free. Uh And uh even if you wanted to um upgrade your, your membership, it is still much, much cheaper than your Netflix membership per month. So you're talking about between 55 and 10 at maximum. Um as training membership to what is an exceptional online resource. That's great. I mean, I II think there's so many different educational events going on now for endoscopy. You know, King's Live is one of them and that's in November and it's free to attend. Um But yeah, I think, you know, people, we're going to be doing more and more endoscopy surgeons. And so, you know, people can develop an interest in it. I think it will certainly open future careers as well with more and more minimally invasive treatment for early cancers. So, you know, I'm, I'm keen to encourage it. Um and yeah, I think we'll, we'll wrap things up there, but I just want to thank you to you for giving your, to talk to us. Um The recording for this should be available on the medical website for people that um want to look back through anything, any of the links and email addresses. So, um thanks very much for your time tonight. Thank you. Thank you.