Haemostasis Experience on Completion of Specialist Training in Gastroenterology - Analysis of the JETS e-Portfolio
by Paul Dunckley
Acute upper gastrointestinal bleeding (AUGIB) is a common life-threatening medical emergency. Gastroenterologists are typically expected to be competent in delivering endotherapy for AUGIB, with the Certificate of Completion of Training (CCT) often heralding the onset of participation in on-call AUGIB rotas. However, it is unknown whether CCT is sufficient to ensure competence in AUGIB. We aimed to analyse the volume of endotherapy training recorded by gastroenterologists up to CCT.
In this retrospective UK-wide study, gastroenterologists awarded CCT between April 2014 and April 2017 were identified from the GMC specialist register. Credentials were cross-referenced with the JETS e-portfolio to retrieve AUGIB endotherapy experience prior to CCT. Subjects without e-portfolio involvement or those not identified on cross-referencing were excluded from analyses. Endotherapy experience was measured only for JETS-supported modalities and collated according into variceal and non-variceal therapies. The outcome measured was the number of procedures requiring haemostasis, i.e. a procedure where three clips were applied was considered as one procedure. Comparisons of continuous variables were made using Mann-Whitney (between 2 groups) and Kruskal-Wallis tests (>2 groups).
Over the 3-year study period, CCT was awarded to 241 gastroenterologists. After exclusions (N=8), 233 were included for analysis. This cohort recorded a total of 12,932 procedures whereby AUGIB endotherapy was delivered, corresponding to a median of 42 (IQR 21-71) per gastroenterologist. Exposure to non-variceal modalities (median 27, IQR 15-52) was more frequent than variceal therapies (median 11, IQR 5-22; P<0.001). When analysed by modality (Figure 1), adrenaline injection (median 12, IQR 6-23) and variceal band ligation (median 10, IQR 5-20) were most commonly recorded, whilst sclerotherapy was seldomly reported (median 0, IQR 0-1). Overall exposure to AUGIB endotherapy (P=0.130) did not vary significantly by year of CCT. However, there was variation by deanery (P<0.001), with medians of endotherapy procedures ranging from 19 to 126 per gastroenterologist.
Exposure to endotherapy training, as recorded on the JETS e-portfolio, appears to vary significantly between gastroenterology CCT holders and by training deanery. Implementation of standardised AUGIB hands-on training courses and certification in endotherapy may help to support and quality assure training in endotherapy.