COMMITTEE OVERVIEW
The Conjoint Committee for the Recognition of Training in Gastrointestinal Endoscopy (CCRTGE) 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).
The Conjoint Committee recognises training of endoscopists who have completed their training in Australia or who are now practising in Australia.
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 dependent on the completion of training, experience and supervision pursuant to those Training Programs. Recognition of endoscopy training will be given at the completion of Specialist Advanced Training. Trainees of other specialist medical colleges will be assessed on a case-by-case basis.
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.
Trainees are encouraged to attend relevant workshops to improve their skills in endoscopy.
Successful applicants are encouraged to maintain continuing medical education in the field of endoscopic practice, including regular audits of their own endoscopic practice.
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.
An updated list of all endoscopists, whose training has been recognised, is maintained by the Secretariat, and is available to view on the Conjoint Committee website at http://conjoint.gesa.org.au/.
REQUIREMENTS FOR CCRTGE RECOGNITION
REGISTRATION
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Prospective applicants for Recognition of Training must first register with CCRTGE using the forms available through the website at http://conjoint.gesa.org.au/. A fee of $275.00 is payable at the time of registration. See Fees for a list of all fees payable.
Once registered, the trainee will be sent a logbook on which they are to sequentially record details of each procedure undertaken.
It is a requirement that details of all procedures undertaken from the commencement of training be recorded, irrespective of the outcome. Individual entries on the log must be acknowledged by the supervisor immediately after the procedure is completed. Successful application for recognition is based on the trainee’s logbooks being an accurate reflection of the training experience.
From 1 February 2008 new trainees will be required to complete the logbooks using an online facility. Trainees will be given password protected access to an online logbook where details of all procedures are to be recorded. A hard copy log is not required when an online log is being kept. Supervisors will also be given their own username and password for the online system. Supervisors will acknowledge the procedures online and are not required to sign a hard copy logbook.
APPLICATION FOR RECOGNITION
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Applications for recognition by CCRTGE close on 15 March and 15 October. Applications are made by submitting the logbook and all required documentation to the Conjoint Committee. A fee is payable at the time of application. See Fees for a list of all fees payable.
The CCRTGE assesses each applicant against a strict set of criteria. Applicants are required to demonstrate a high level of technical competence by completing a minimum number of cases/procedures successfully and fulfilling all other requirements specific to that procedure.
The requirements for each procedure are listed in this document under Procedure Requirements.
The requirements are regularly being revised to better reflect standards of competence and trainees are reminded to check the website http://conjoint.gesa.org.au/ frequently to ensure that they are aware of any changes.
TRAINING
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The Committee expects that gastrointestinal endoscopic training would be completed within a five (5) year period.
Trainees may apply for Recognition in their final year of Advanced Training, however, endorsement will not be granted until the Committee receives notification that the prospective applicant has successfully completed Specialist Advanced Training.
Applicants are expected to demonstrate cognitive and interpretative skills combined with a clear understanding of the role of endoscopy in patient management. These skills are considered by the committee to be as important as technical skills.
The committee expects applicants:
- to have received training in radiological and pathological findings as well as the technical aspects of endoscopy;
- to have received training in sedation practices pertaining to endoscopic procedures based on the current document, "Guidelines on Sedation for Gastrointestinal Endoscopy Procedures - Review PS9";
- to demonstrate an understanding of the principles of and practice of cleaning and disinfection of modern endoscopic instruments as outlined in the current edition of "Infection Control in Endoscopy";
- to familiarise themselves with the drugs of sedation and have experience in airway support;
- keep abreast of current endoscopic literature obtain training in fluoroscopic theory and practice. 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 Endoscopic Retrograde Cholangiopancreatography (ERCP) or Endoscopic Ultrasound (EUS).
LOGBOOKS
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Details of all cases attempted from the commencement of training to the completion of training, including those not successfully completed, must be recorded prospectively and sequentially in the logbooks provided.
PROCEDURE REQUIREMENTS
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Applicants must ensure that the following requirements are met or exceeded before submitting their application. Requirements vary for each procedure and it is the responsibility of the applicant to check the website regularly and familiarise themselves with any updates or changes.
Upper Gastrointestinal Endoscopy (UGI)
Trainees are required to perform at least 200 unassisted and complete examinations independently under supervision.
Examinations must include a minimum of 20 therapeutic procedures (excluding polypectomy). It is expected that a minimum of 10 therapeutic procedures involve control of upper gastrointestinal haemorrhage.
Paediatric Upper Gastrointestinal Endoscopy
Trainees are required to perform at least 200 unassisted and complete examinations independently under supervision.
Examinations must include a minimum of 100 upper gastrointestinal endoscopies in paediatric patients under the supervision of a recognised paediatric upper gastrointestinal endoscopy supervisor.
Examinations must include a minimum of 10 therapeutic procedures of which a minimum of 5 involve control of upper gastrointestinal haemorrhage.
Endoscopic Retrograde Cholangiopancreatography (ERCP)
Trainees are required to have previous recognition of training in upper gastrointestinal endoscopy.
Trainees must perform a total of 200 unassisted ERCP examinations in patients with intact papillary sphincters.
Procedures performed must include a minimum of 80 supervised, independently performed, sphincterotomies in patients with intact papillary sphincters and a minimum of 60 stents.
Cannulations performed in patients with previous sphincterotomies should also be prospectively recorded in the logbook to permit assessment of the entire training experience.
Endoscopic Ultrasound (EUS)
Trainees are encouraged to undertake training in both gastro-oesophageal and pancreatico-biliary areas of EUS. However, there will be a small number of practitioners who will only require training in gastro-oesophageal EUS.
Gastro-oesophageal and pancreatico-biliary EUS.
Trainees are required to:
- have recognition of previous training in upper gastrointestinal endoscopy prior to applying for EUS;
- independently perform a minimum of 200 examinations, including;
- a minimum of 100 examinations for gastro-oesophageal lesion/tumour
- a minimum of 100 examinations for pancreatico-biliary investigation
- independently perform a minimum of 50 FNA examinations with at least 25 being pancreatico-biliary.
EUS guided, Fine Needle Biopsy (FNA) examinations can be counted within those for either gastro-oesophageal or pancreatico-biliary conditions
Catheter probe EUS that is placed down a gastroscope can be counted but must not represent more than 10% of all cases.
Gastro-oesophageal only EUS.
Trainees are required to:
- have recognition of previous training in upper gastrointestinal endoscopy prior to applying for EUS;
- independently perform a minimum of 150 examinations
- independently perform a minimum of 50 FNA examinations.
EUS guided FNA can be counted towards the minimum 150 examinations.
Catheter probe EUS that is placed down a gastroscope can be counted but must not represent more than 10% of all cases.
Colonoscopy
CCRTGE assessment for certification of training in colonoscopy primarily involves assessment of the caecal intubation rate in intact colons at the completion of training.
Trainees are required to:
- perform a minimum of 100 unassisted, supervised, complete colonoscopies to the caecum and preferably to the ileum in patients with intact colons (i.e. with no prior colonic resection).
- perform successful snare polypectomies on a minimum of 30 patients.
- to achieve at least a 90% caecal intubation rate by the completion of training.
Procedures on patients with obstructing cancer and/or severe colitis must be recorded but are excluded from the calculation of overall intubation rate.
Paediatric Colonoscopy
Trainees are required to:
- perform a minimum of 100 unassisted, supervised, complete colonoscopies to the caecum and preferably to the ileum in patients with intact colons (i.e. with no prior colonic resection), including; a minimum of 75 procedures in paediatric patients under the supervision of a recognised paediatric colonoscopy supervisor.
Some polypectomy experience is expected.
A success rate of at least 90% for intubation of the caecum (preferably into the ileum) should have been achieved on the completion of training.
Procedures on patients with severe colitis must be recorded but are excluded from the calculation of overall intubation rate.
Cleaning and Disinfection
It is required that a minimum of 15 instruments be cleaned under the supervision of an experienced endoscopy nurse. See current edition of, "Infection Control in Endoscopy" for guidelines: available to download from: http://conjoint.gesa.org.au/.
SUMMARY OF RESPONSIBILITIES
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Trainees
Trainees must:
- register with the Conjoint Committee at the commencement of training;
- prospectively record all procedures including unsuccessful and assisted procedures in the logbook from the commencement of training until completion of training;
- have the logbook entries acknowledged by the supervisor on the day of the procedure. (NB no more than 25 procedures can be recorded on a logbook without acknowledgment from a supervisor. Once this limit is reached a supervisor must acknowledge some, or all of the procedures before more procedures can be recorded).
- demonstrate competence in a wide variety of skills including clinical management, cleaning and disinfection, technical expertise and interpretation of pathology and radiology.
- complete at least the minimum number of unassisted and supervised procedures required for each procedure type. It is understood that most trainees will require more procedures than the minimum required in order to achieve
- competence and satisfy all criteria;
- inform the Conjoint Committee of any changes in contact information or withdrawal from the program;
- regularly check the website for updates relevant to the training program;
- 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; and
- notify the secretariat of any intention to undertake training overseas.
Supervisors
Supervisors must:
- be recognised by the Conjoint Committee for the relevant procedure;
- have personally supervised some of the applicant’s training.
- acknowledge the procedures logged in the logbook of the trainee;
- assess competence after the trainee has independently completed the minimum number of procedures required. It is expected that most trainees will require more than the stated minimum number of procedures.
- attest that the candidate is:
- competent to perform the specific procedure and/or specific therapy safely and expeditiously;
- able to competently integrate indications for endoscopy and endoscopic findings and therapy into patient management;
- able to understand risk factors, recognise and manage complications; and
- 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. Late applications will be assessed at the following meeting. Results of the assessment will be sent to the applicant in writing, and a certificate issued to successful applicants on successful completion of training.
Applications submitted for assessment must meet the criteria. Applications that are considered to be inadequate will be returned and the applicant asked to undertake further training or provide further evidence of training to meet the criteria.
Applicants will be given two (2) years from the date of original assessment to provide additional information requested by the Committee. After this time the applicant will need to reapply and may be asked to fulfil additional requirements.
FEES
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The current fees from 1 July 2007 are:
Registration Fee
A non-refundable registration fee of $275.00 (GST inclusive) is to be submitted with the completed registration form.
Application for Recognition of Training - Fees
Application fees are based on a per procedure type basis and payable when the completed registration forms are submitted for recognition.
The fee for each procedure type is $330.00 (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.
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