Assessments and skills improvement for endoscopists.

Different countries employ a range of assessment methods to monitor trainees from novice to independent practice. The optimal method to monitor and assess individuals' training in endoscopy has not been formally determined. The UK has developed a competency based assessment training and certification (credentialing) programme. The tools developed to provide endoscopy work based assessments (DOPS) have been validated and are used for trainees and independent endoscopists, providing formative feedback for targeted training. Summative assessments are used for trainee certification and independent colonoscopists wishing to provide part of the National Bowel Cancer Screening Programme. The UK was able to develop both clinical standards and an endoscopy training and certification process applied to all individuals and monitored by a single professional body. The supporting IT system enabled a structured and robust quality assurance process to be applied to all individuals and endoscopy units. Assessment of practising endoscopists relies on the development and measurement of surrogate measures, which represent key performance indicators for those individuals. These surrogates for performance are still evolving although they are now well established for colonoscopy practice. Monitoring of independent practice is dependent on clinical audit of these key performance indicators. Feedback of data to individuals helps benchmarking and identification of those with sub-optimal performance. Independent endoscopists now recognize the benefit of on-going training to help both skills development and to address sub-optimal performance. This chapter describes how the UK developed a web-based integrated training and certification system.