Gastrointest Endosc 2014, 79(5), 808–810.
29 29 Ward ST, Mohammed MA, Walt R, Valori R, Ismail T, Dunckley P. An analysis of the learning curve to achieve competency at colonoscopy using the JETS database. Gut 2014, 63(11), 1746–1754.
30 30 Dafnis G, Granath F, Påhlman L, Hannuksela H, Ekbom A, Blomqvist P. The impact of endoscopists’ experience and learning curves and interendoscopist variation on colonoscopy completion rates. Endoscopy 2001, 33(6), 511–517.
31 31 Jorgensen JE, Elta GH, Stalburg CM, et al. Do breaks in gastroenterology fellow endoscopy training result in a decrement in competency in colonoscopy? Gastrointest Endosc 2013, 78(3), 503–509.
32 32 Cohen J. Training and credentialing in gastrointestinal endoscopy. In: Cotton PB (ed.). Digestive Endoscopy: Practice and Safety. Blackwell, Oxford, 2008, pp. 289–362.
33 33 Armstrong D, Enns R, Ponich T, Romagnuolo J, Springer J, Barkun AN. Canadian credentialing guidelines for endoscopic privileges, an overview. Can J Gastroenterol 2007, 21(12), 797–801.
34 34 Leichtner AM, Gillis LA, Gupta S, et al. NASPGHAN guidelines for training in pediatric gastroenterology. J Pediatr Gastroenterol Nutr 2013, 56 Suppl 1, S1–8.
35 35 BSPGHAN Endoscopy Working Group. JAG Paediatric Endoscopy Certification. https://bspghan.org.uk
36 36 Conjoint Committee for the Recognition of Training in Gastrointestinal Endoscopy. Requirements for CCRTGE Recognition. www.conjoint.org.au
37 37 Walsh CM. Training and assessment in pediatric endoscopy. Gastrointest Endosc Clin North Am 2016, 26(1), 13–33.
38 38 Cass O, Freeman M, Cohen J, et al. Acquisition of competency in endoscopic skills (ACES) during training: a multicenter study. Gastrointest Endosc 1996, 43(4), 308.
39 39 Sedlack RE. Training to competency in colonoscopy, assessing and defining competency standards. Gastrointest Endosc 2011, 74(2), 355–366.
40 40 Sedlack RE, Coyle W. Colonoscopy learning curves and competency benchmarks in GI fellows. Gastrointest Endosc 2015, 81(5S), AB34 (Abstract Su 1550).
41 41 Cass OW. Training to competence in gastrointestinal endoscopy: a plea for continuous measuring of objective end points. Endoscopy 1999, 31(9), 751–754.
42 42 Kramer RE, Walsh CM, Lerner DG, Fishman DS. Quality improvement in pediatric endoscopy: a clinical report from the NASPGHAN Endoscopy Committee. J Pediatr Gastroenterol Nutr 2017, 65(1), 125–131.
43 43 Poerregaard A, Wewer AV, Becker PU, Bendtsen F, Krasilnikoff PA, Matzen P. Pediatric colonoscopy. Ugeskr Laeger 1998, 160(14), 2105–2108.
44 44 Hassall E, Barclay GN, Ament ME. Colonoscopy in childhood. Pediatrics 1984, 73(5), 594–599.
45 45 Dillon M, Brown S, Casey W, et al. Colonoscopy under general anesthesia in children. Pediatrics 1998, 102(2 Pt 1), 381–383.
46 46 Stringer MD, Pinfield A, Revell L, McClean P, Puntis JW. A prospective audit of paediatric colonoscopy under general anaesthesia. Acta Paediatr 1999, 88(2), 199–202.
47 47 Israel DM, McLain BI, Hassall E. Successful pancolonoscopy and ileoscopy in children. J Pediatr Gastroenterol Nutr 1994, 19(3), 283–289.
48 48 Mamula P, Markowitz JE, Neiswender K, Baldassano R, Liacouras CA. Success rate and duration of paediatric outpatient colonoscopy. Dig Liver Dis 2005, 37(11), 877–881.
49 49 Thakkar KH, Holub JL, Gilger MA, Fishman DS. Factors affecting ileum intubation in pediatric patients undergoing colonoscopy. Gastrointest Endosc 2014, 79(5S), AB279–AB280.
50 50 Forget S, Walsh CM. Pediatric endoscopy, need for a tailored approach to guidelines on quality and safety. Can J Gastroenterol 2012, 26(10), 735.
51 51 Walsh CM. In‐training gastrointestinal endoscopy competency assessment tools: types of tools, validation and impact. Best Pract Res Clin Gastroenterol 2016, 30(3), 357–374.
52 52 Walsh CM, Ling SC, Walters TD, Mamula P, Lightdale JR, Carnahan H. Development of the Gastrointestinal Endoscopy Competency Assessment Tool for pediatric colonoscopy (GiECATKIDS). J Pediatr Gastroenterol Nutr 2014, 59(4), 480–486.
53 53 Walsh CM, Ling SC, Mamula P, et al. The Gastrointestinal Endoscopy Competency Assessment Tool for pediatric colonoscopy. J Pediatr Gastroenterol Nutr 2015, 60(4), 474–480.
54 54 Beard JD. Assessment of surgical competence. Br J Surg 2007, 94(11), 1315–1316.
6 Recertification and revalidation as concepts in pediatric endoscopy
Priya Narula and Mike Thomson
Direct Operational Procedural Skills (DOPS) assessment, as occurs in training, will become standard in due course in peer review of maintenance of endoscopic skill.
Ensuring ongoing competency in GI endoscopy in pediatrics will require monitoring of key performance indicators, reviewing outcome data and adverse event rates and evidence of engagement in educational and clinical activities.
Revalidation and/or recertification are processes whereby doctors demonstrate on a regular basis that they are up to date and fit to practice with the help of a portfolio of evidence or supporting information that can include continuous professional development, peer and patient feedback, quality improvement or audit and significant events [1]. They represent a shift towards a broader culture of accountability and a proactive approach. Medical revalidation was introduced in the UK in 2012 and is similar to New Zealand’s practicing certificate and recertification and the American maintenance of licensure and certification [2]. Revalidation and recertification schemes seek to improve patient care by the ongoing review of individual medical practice [2].
Such processes, considered predominantly summative, are underpinned by a progressive, intrinsically motivated ambition to define and drive up quality standards [1]. As professionals engaged with implementation and experienced the realities of revalidation in practice in the UK, stakeholders found that dealing with concerns about poor practice (professional regulation) and seeking to improve professional standards (professionalism) were complementary processes [1].
Whilst these schemes are more generic, there are currently no established revalidation or recertification schemes for pediatric endoscopists.
The goals of recredentialing or recertification in GI endoscopy are to ensure continued clinical competency, promote continuous quality improvement, and maintain patient safety [3]. Ensuring ongoing competency in GI endoscopy in adults requires monitoring of key performance indicators (KPIs), reviewing outcome data and adverse event rates and evidence of engagement in educational and clinical activities with a focus on continuous quality improvement [4]. There are unlikely to be opportunities to directly observe practice for independent endoscopists and therefore quality assurance is dependent on surrogates of performance such as KPIs. Upskilling and maintenance of competence for practicing endoscopists should be directed at technical (motor skills), cognitive (knowledge and recognition), and integrative skills, such as leadership and communication [5].
There is little in the pediatric literature on quality indicators or auditable KPIs tailored to pediatric endoscopy practice which can form the foundation of quality assured practice and can then be linked to a process that ensures accountability and improves and maintains professional standards of pediatric endoscopists. Auditing against an agreed set of KPIs and reviewing practice can help reduce variation in practice and standards between individual endoscopists and units.
The successful national pilot of a pediatric endoscopy Global Rating Scale (GRS) in the UK [6] is the first step towards a pediatric endoscopy quality improvement (QI) tool. Regular engagement with a QI tool like