Impact of the JAG Basic Skills in Colonoscopy Course on Trainee Performance
by Paul Dunckley
The JAG Basic Skills in Colonoscopy Course aims to standardise colonoscopy training within the UK and is mandated in JAG certification criteria, but its impact on trainee performance is unknown. The Gloucestershire Endoscopy Training Centre delivers these courses. We aimed to evaluate the impact of course attendance on colonoscopy performance, as measured using the unassisted caecal intubation rate (CIR) and the performance indicator of colonic intubation (PICI).
Trainees awarded colonoscopy certification between 2011-2016 were stratified into groups according to the number of procedures performed prior to the course, namely <70, 70-140 and >140 procedures. Within each group, outcomes rates were calculated for each of the 50 procedures before and after the course through analysis of the JAG Endoscopy Training System (JETS) portfolio. Interrupted time series models were then used to detect step-change improvements occurring after the course.
A total of 369 trainees were included in the analysis, who performed <70 (N=118), 70-140 (N=121) or >140 (N=130) procedures prior to the course. Over the 50 procedures prior to the course, all three groups saw significant improvements in CIR, with an average increase of 4.2, 3.6 and 1.7 percentage points per 10 procedures in the <70, 70-140 and >140 groups, respectively (all p<0.001). In those with <70 procedures at the time of the course, a significant step-change improvement in CIR was detected, from 46% in the last procedure before the course, to 51% in the first procedure afterwards (p=0.005). No significant improvement in CIR was detected in the other two groups, with changes of 68% to 71% (p=0.239) and 86% to 87% (p=0.354) for the 70-140 and >140 procedure groups, respectively. For PICI, all three groups saw a significant step change improvement, with average increases of 5.6 (p<0.001), 5.4 (p=0.003) and 3.9 (p=0.014) percentage points for the <70, 70-140 and >140 groups, respectively. Based on pre-course trends, this improvement was equivalent to that stemming from performing an additional 17-30 procedures.
Attendance of a standardised knowledge-based and hands-on colonoscopy course appears to improve colonoscopy performance, as measured by PICI. However, the optimal timing of course attendance appears to be at earlier stages of colonoscopy training (<70 procedures).