Impact of the Joint Advisory Group on Gastrointestinal Endoscopy (JAG) on endoscopy services in the UK and beyond.

The Joint Advisory Group on Gastrointestinal Endoscopy (JAG) was initially established in 1994 to standardise endoscopy training across specialties. Over the last two decades, the position of JAG has evolved to meet its current role of quality assuring all aspects of endoscopy in the UK to provide the highest quality, patient-centred care. Drivers such as changes to healthcare agenda, national audits, advances in research and technology and the advent of population-based cancer screening have underpinned this shift in priority. Over this period, JAG has spearheaded various quality assurance initiatives with support from national stakeholders. These have led to the achievement of notable milestones in endoscopy quality assurance, particularly in the three major areas of: (1) endoscopy training, (2) accreditation of endoscopy services (including the Global Rating Scale), and (3) accreditation of screening endoscopists. These developments have changed the landscape of UK practice, serving as a model to promote excellence in endoscopy. This review provides a summary of JAG initiatives and assesses the impact of JAG on training and endoscopy services within the UK and beyond.

The validity and reliability of a Direct Observation of Procedural Skills assessment tool: assessing colonoscopic skills of senior endoscopists.

BACKGROUND: Practitioners increasingly need to be able to evidence the quality of their care and their clinical competence for purposes of recredentialing and relicensing. Although this may be accomplished by audit and performance data, detailed and robust assessments of competence may be valuable in certain circumstances. OBJECTIVE: To develop and evaluate a detailed assessment of performance of colonoscopy. DESIGN: Evaluation of a Direct Observation of Procedural Skills (DOPS) method developed by an expert group of colonoscopists and clinical educationalists. SETTING: English National Health Service National Bowel Cancer Screening Programme (BCSP). SUBJECTS AND METHODS: Aspirant colonoscopists wishing to participate in the BCSP were assessed by using the DOPS. Reliability was estimated by using generalizability theory (G), and the candidates' and assessors' perspectives on validity were evaluated by questionnaire. INTERVENTIONS: Grading of performance by 2 assessors over 2 consecutive real cases. MAIN OUTCOME MEASUREMENTS: DOPS grades, global expert evaluation, performance data, evaluation questionnaire scores. RESULTS: The assessment had high relative reliability: G = 0.81. The DOPS grades correlated highly with a global expert assessment. The candidates and assessors believed that the DOPS was a valid assessment of competence. LIMITATIONS: Not guaranteed to assess therapeutic skills; evaluation questionnaire influenced by result of assessment. CONCLUSIONS: This is the first evaluation of a DOPS assessment on independent practitioners. It performs well, with good levels of reliability and validity, and is sufficient to be used in a high-stakes assessment. Similar approaches should be considered for assessment of competence in other areas of clinical practice for relicensing or recredentialing.

Academic training schemes reviewed: implications for the future development of our researchers and educators.

CONTEXT: There is an international crisis in academic medicine: numbers of academics are low; there is a split between teaching and research, and career progression is poorly defined. In the UK, academic career pathways have recently been reformed, but there is little readily accessible information on what a high-quality academic training scheme might comprise. METHODS: I conducted a wide review of medical and bio-psychosocial databases, coupled with a search of the grey literature. RESULTS: The review suggests both widespread support for training in research and dissatisfaction with training schemes. Insufficient training time is a major issue. High-quality supervision is crucial, with clear goals and expectations for research fellows. Structured training seems to be helpful, as is financial, administrative and statistical support. However, the vast majority of studies give a broad overview or opinion, or report the superficial results of questionnaire surveys. The focus is on research training; teaching is ignored. CONCLUSIONS: Although there appears to be broad agreement on a number of issues, the literature lacks sufficient depth, and little is known about factors that contribute to effective academic training schemes. Schemes must be studied in depth to determine what makes them successful, in order to ensure the future of teaching and research.

Describing clinical teachers' characteristics and behaviours using critical incidents and repertory grids.

CONTEXT: Completion of a rating questionnaire is the method used most frequently to evaluate a teacher's performance. Questionnaires that largely assess 'high-inference' teaching characteristics, such as 'enthusiasm' and 'friendliness', require the observer to make a judgement about the teacher but do not describe what the teacher actually did and so have limited use in providing feedback. Measures of 'low-inference' teaching behaviours (i.e. those that are concrete and observable), such as frequency, amount or types of verbal interaction, do not demonstrate how these are linked to good teaching. OBJECTIVES: To describe high-inference teacher characteristics and define the associated low-inference behaviours. METHODS: A purposive sample of consultants, postgraduate and undergraduate students, nurse lecture practitioners and patients were selected for semistructured interviews using repertory grids and critical incidents to elicit preferred characteristics and behaviours of clinical teachers. Interviews were audiotaped, transcribed and then content-analysed using a framework to pair teachers' characteristics and their behaviours. RESULTS: We identified a variety of preferred high-inference characteristics and their associated observable and recordable low-inference behaviours. DISCUSSION: We carried out a study that included all participants in clinical teaching and found that participants differed in their preferred characteristics and behaviours. It is important for future research to look at behaviours interdependently, rather than alone, and to take into account the evidence that participants tend to infer characteristics rather than think in terms of behaviours. This information will be used to inform the development of a formative tool for evaluating clinical teaching.

Predictors of quality of life in ulcerative colitis: the importance of symptoms and illness representations.

BACKGROUND: Establishing predictors of quality of life (QoL) in individuals with inflammatory bowel disease could help to identify those patients who are most likely to experience poor QoL and to target therapeutic interventions appropriately. We aimed to investigate how disease-specific QoL depends on demographic, diseaserelated, and physiological markers of disease activity, cognitive representations of illness, and perceived general health status. METHODS: A total of 111 individuals completed the Inflammatory Bowel Disease Questionnaire (IBDQ), the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), and the Illness Perception Questionnaire (IPQ). The extent of disease was determined from records, and disease activity was determined by a symptom index. Bivariate analyses and multivariate regression models were used to identify predictors of disease-specific QoL. RESULTS: Bivariate analyses showed that symptom-related disease activity, elements of illness representation measured by the IPQ, and elements of physical and mental health measured by the SF-36 were the only variables that were strongly or moderately correlated with disease-specific QoL. Multivariate regression modeling showed that disease activity was the major explanatory variable for each of the 4 domains and for the total score on the IBDQ. CONCLUSION: This study highlights the strong relationship between individuals' symptoms and all domains of their health-related QoL, but shows little association with age, gender, physiological markers of disease activity, or anatomic disease extent. Perceptions of the condition were relatively weak predictors of self-reported QoL. The best strategy for improving QoL among individuals with ulcerative colitis may be to find ways to reduce their symptoms.