Direct enquires to the Secretariat, Anna Pears, Executive Officer, Royal Australasian College of Physicians. DDI (04) 460 8126 All applications should be emailed.
Email anna.pears@racp.org.nz
Application of the processing of fees is now $300.00 for each pathway with the exception of a $50 admin fee for GESA/JAG recognition. Please pay online, to the NZ Conjoint Committee Account : 02-0500-0605655-00. Please include the initials of your first name and your full last name in reference code when making a payment
The NZ Conjoint Committee meets as required and applicants will be notified within 4 months of their application.
Please forward applications by email to the Secretary anna.pears@racp.org.nz.
If you wish to courier your application, please contact the secretary in the first instance. Please keep a copy of your application for your records.
Quality Endoscopy by Quality Endoscopists.
The Conjoint Committee is a National Body comprising representatives from the New Zealand Society of Gastroenterology, the New Zealand Committees of the Royal Australasian College of Physicians and Royal Australasian College of Surgeons. The Committee has responsibility for the provision of guidelines relevant to the acceptable standards of training in gastrointestinal endoscopic procedures and the maintenance of a register of specialists who have attained these standards.
Endoscopists who have received NZCCRTGE recognition of training may opt-in to have their details included on a publicly available online register. NZCCRTGE will not provide details of endoscopists to third parties except through this method. Inclusion of an endoscopist on the online register demonstrates that they met the recognition of training criteria at the time of application and is not a surrogate for current competence (which is determined through local credentialing).
In order to support the provision of quality endoscopy in New Zealand, the major purpose of the NZCCRTGE is to provide;
1) Guidelines regarding standards of training in Endoscopy for trainees in Advanced Training Programs.
2) A peer-review assessment as to whether a trainee has met these standards (recognition of training)
Once training has commenced, trainees must record their training according to the guidelines as outlined below. Trainees must complete a minimum number of supervised training procedures to gain experience before they can submit their application for recognition of training. Trainees applying for recognition of training in endoscopy should forward the log books of their experience together with their completed training assessment (PBA/ ANZ Conjoint DOPS) forms and two Referee reports as outlined below so that their application can be assessed against the criteria. NZCCRTGE does not directly provide endoscopy training, which is the responsibility of the Royal Colleges and designated training organisations.
The provision of documentation demonstrating recognition of training in endoscopy from NZCCRTGE may be used to support credentialing decisions. It does not replace usual hospital credentialing processes, which should ensure safe endoscopy practice over time. Responsibility for credentialing of endoscopists to practice in New Zealand remains with the host institutions e.g. DHBs, and responsibility for ongoing skill maintenance and continuing medical education (CME) remains with the practitioners.
GUIDELINES
The following requirements are based on current literature regarding the usual minimum exposure required to gain independence and utilise a variety of methods of assessment of skill. Some trainees will require substantially more than the minimum exposure, while others may acquire skill more rapidly. Logbooks should include all procedures attempted while under supervision on the training programme, whether independently completed or assisted.
Competence in endoscopy requires more than just gaining the technical skill to perform the procedure. It is important for trainees to have a comprehension of the anatomy and physiology of the GI tract, understand and recognise the pathology they may encounter and make sound management decisions. This knowledge is gained in other parts of the Advanced Training Programmes for Gastroenterology, General Surgery and Nurse Endoscopy and is not specifically assessed by NZCCRTGE.
At commencement of training, trainees must be registered with the NZCCRTGE. All trainees in the Advanced Training Programmes for Gastroenterology, General Surgery and Nurse Endoscopy are considered to be automatically registered in the first year of their training, and should be notified to the NZCCRTGE either by their training body or can individually inform the NZCCRTGE (nurse endoscopists should identify themselves when they apply for the basic endoscopy course). Registration as an endoscopy trainee will expire after a maximum of eight years, unless an extension is requested.
The NZCCRTGE specifically notes that at the time of establishment of the committee, Nurse Endoscopy was not considered as a future vocation. The role of the NZCCRTGE in relation to Nurse Endoscopists and Endoscopists who are not members of RACP or RACS (or the vocational equivalent as determined by MCNZ) is not explicitly stated. In the interests of providing a consistent peer-reviewed service for recognition of training that is accessible to Endoscopists from all backgrounds, NZCCRTGE will accept applications from Nurse Endoscopists to support DHB credentialing processes. It is expected that hospitals credentialing Nurse Endoscopists will have processes in place to manage sedation prescribing and patient follow up, as well as providing sufficient collegial support to Nurse Endoscopists. NZCCRTGE notes that recognition of training for nurses is not currently offered by CCRTGE in Australia and so reciprocal recognition for this group will not occur. Overall responsibility for governance of nursing practice remains with the Nursing Council.
The Medical Council of New Zealand (MCNZ) has noted that the only two medical specialties that have endoscopy as a part of their vocational scope are Physicians within the scope of Internal Medicine and General Surgeons. Other medical practitioners who wish to undertake endoscopy may only do so in a Collegial relationship with a practitioner who holds the correct vocational scope. While technical training in endoscopy may be acquired through an apprenticeship model, this does not necessarily provide the additional knowledge of anatomy, physiology, pathology and patient management that is gained in an Advanced Training Programme. NZCCRTGE recommends that where other types of medical practitioner wish to train in endoscopy, they must do so in a collegial relationship with a vocationally registered practitioner who holds the correct scope of practice. Prior to commencing training they must present to NZCCRTGE a training plan that outlines how the endoscopy syllabus learning objectives usually gained within an Advanced Training Programme will be met and how this will be documented, as well as how the technical training will occur. The RACP and/or RACS endoscopy syllabi may be used as a guide. It is strongly encouraged that evidence of DHB support be provided to ensure the practitioner has a clear expectation that they can be employed performing endoscopy once training is complete. This should include a provision for appropriate ongoing collegial support, as required by MCNZ. NZCCRTGE reserves the right to decline recognition of training if there is concern that training outside an Advanced Training Programme has not adequately prepared the practitioner for practice.
The NZCCRTGE reserves the right to co-opt advisors with additional specialist knowledge where that may help to progress an application, e.g. senior Nurse Endoscopists, Paediatric endoscopists, ERCP specialists.
Principles
Details of all cases attempted must be included in an online logbook (SOLA, ProVation or GESA) as a complete record of training, with sign off by a designated supervisor on a regular basis. The logbook is expected to provide a validated and verifiable record of the training that occurred. A cover sheet demonstrating the essential KPIs will form the basis of the logbook assessment, with the complete logbook data supporting that. Patient privacy must be protected at all times, so unique identifiers must be removed prior to submission. Identifiers however must be accessible and able to be matched to the log in case of the need for verification. Paper logbooks will continue to be accepted for part or all of the training experience for trainees who commenced training prior to 2021. Procedures recorded in the GESA logbook for training that was conducted in Australia will be accepted, however to apply for recognition of training in New Zealand a proportion of the training must have been undertaken in New Zealand and there be a clear intention to work in New Zealand in the foreseeable future.
Successful independent completion of the procedure without assistance is the primary Key Performance Indicator (KPI). As recording of KPIs requires the denominator to be accurate, an attempted colonoscopy is defined as a colonoscopy undertaken with the intention to inspect the entire colon (reach the caecum/TI/neo-TI) in a patient with a fully prepared colon (e.g. has taken oral bowel prep). A procedure is considered to be independently performed if the supervisor did not need to physically intervene in any part of the procedure in order to ensure completion. Where a trainee has successfully completed the diagnostic part of the procedure (e.g. reached the caecum) but the supervisor needs to undertake an intervention (e.g. polypectomy) the trainee should record the procedure as being completed independently but should not log the intervention.
Interventions undertaken by the trainee and complications should be recorded. All procedures must be verifiable. The NZCCRTGE reserves the right to check the accuracy of applications as required. This may involve audit of a proportion of applications, including run-sheets and visual confirmation of completeness of procedure from reports (e.g. picture of TI, appendix orifice). Suspected falsification of logbooks will automatically be referred to the MCNZ or NCNZ Professional Standards Team for review. Logbooks must be signed off by the designated trainee supervisor..
Logbooks must be submitted within five years of completion of training (the date of the final entry in the logbook). Logbooks must clearly include interventions performed, with skill in injection and endoscopic clipping demonstrated. These skills are transferrable.
These requirements take effect for trainees immediately, as the KPIs remain unchanged. Training assessment forms (PBA/DOPS) and Safe Sedation Training are required for all applications.
Trainees are required to -
These specific requirements take effect for trainees commencing their ERCP training in 2021 and beyond. Trainees who commenced training prior to 2021 may choose to submit their logbook under the previous requirements, or the updated requirements. Safe Sedation Training is required for all applications from 2021, regardless of when training commenced.
Trainees are required to -
For calculating KPIs, unadjusted Colonoscopy Completion Rate (CCR) is calculated for all procedures attempted on patients who have had mechanical bowel prep and where the intention is to inspect the entire colonic mucosa. There are no exclusions, so the CCR is the total number of unassisted successes (to caecum, TI or neo-TI) divided by the total number of attempts.
Trainees who commenced training prior to 2021 may choose to submit their logbook under the previous requirements, or the updated requirements. Training assessment forms (PBA/DOPS) and Safe Sedation Training are required for all applications from 2021, regardless of when training commenced.
Trainees are required to -
Due to low volumes of training applications and the need for further consultation in this area, NZCCRTGE will not be offering recognition of training for Paediatric endoscopy currently. This option will be reintroduced in the future once recognition criteria that meet the needs of the local Paediatric Endoscopy community have been developed.
Trainees are required to complete an appropriate basic course in safe sedation technique. Currently the American Society of Anaesthesiologists-endorsed SST-Moderate online course (https://www.safesedationtraining.com/) is recommended. Where available, local team based scenario training is acceptable and encouraged, as long as equivalent learning objectives (especially around sedation safety and rescue) can be demonstrated. Documentation of local scenario training must be provided and verifiable. Other courses or training methods must be approved prior by NZCCRTGE. Safe Sedation Training will be a requirement for all applications submitted in 2021 onwards.
Trainees are required to submit a minimum of four satisfactory training assessments for each procedure type (gastroscopy and colonoscopy). Acceptable training assessment forms include the online Procedural Based Assessment (PBA) and the ANZ Conjoint DOPS forms. These must be completed by a minimum of two different assessors. There is no maximum requirement and submission of training assessment forms from early in training demonstrating progress through training is encouraged. This requirement will be phased in, with two forms required for applications submitted in 2021 and four from applications submitted in 2022 onwards.
A minimum of 15 endoscopes must be cleaned under supervision by an experienced endoscopy nurse/technician. This should be recorded in the log book and be verifiable (i.e. the cleaning supervisor should be contactable if required). This is a requirement for all procedure types, but only needs to be completed once.
There must be a designated endoscopy supervisor for each run during which endoscopy training occurs. The endoscopy supervisor should:
Applications must be lodged on the official form and emailed to the secretary. If you wish to courier your application, please contact the secretary in the first instance. Please keep a copy of your application for your records.
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Quality Endoscopy by Quality Endoscopists.
NZCCRTGE has provided recognition of training for Endoscopists within Advanced Training Programmes for decades. Responsibility for conducting training remains with the training bodies (RACP and RACS) with the role of NZCCRTGE being to provide a collegial review of whether submitted logbook data meets the criteria laid out for recognition of training. The overall goal is to provide consistency for all Endoscopists regardless of training background. For a range of historical reasons, many competent endoscopists were not able to apply for recognition of training at the completion of their advanced training. NZCCRTGE aims to support this group of capable endoscopists by providing a mechanism for gaining recognition of training where this is needed. While non-mandatory in New Zealand, holding NZCCRTGE recognition may be helpful in some circumstance (e.g. if wishing to practice in Australia).
NZCCRTGE recognition of training can be used in support of Hospital credentialing decisions, however the responsibility of determining practitioner competence for credentialing remains with the DHBs. As such, while encouraged, NZCCRTGE recognition of training is non-mandatory to gain Endoscopy credentialing in New Zealand. As Australia offers an EPP, the NZCCRTGE has introduced a comparable pathway to allow those who have not have the opportunity to obtain recognition of training to do so, should they wish to.
For calculating KPIs, unadjusted Colonoscopy Completion Rate (CCR) is calculated for all procedures attempted on patients who have had mechanical bowel prep and where the intention is to inspect the entire colonic mucosa. There are no exclusions, so the CCR is the total number of unassisted successes (to caecum, TI or neo-TI) divided by the total number of attempts. ADR is calculated for patients over 50 years old who had a complete colonoscopy.
EPP will be offered for gastroscopy and colonoscopy initially (adult) with a view to expanding to paediatric endoscopy and ERCP if there is demand.
Data from an electronic endoscopy reporting system (ERS) such as ProVation or Endobase (including retrospective) will be acceptable, but must include all sequential cases, and be verifiable (e.g. against hospital run sheets) where required. Data points for colonoscopy must include as a minimum Caecal (or TI/neo-TI) intubation, and polyp /adenoma detection for each case. Calculating ADR will require manual checking of histology outcomes unless the electronic reporting system includes this automatically. Where able, withdrawal time should be included also. For gastroscopy, extent of intubation (e.g. D2) must be recorded. Data should be contemporary with the final case in the logbook occurring within three months of submission (unless an explanation is given e.g. maternity leave).
If ProVation or Endobase data in a verifiable format is not available, then an Excel spreadsheet may be submitted as long as the data can be confirmed as accurate if required. Data should have any unique identifiers removed prior to sending, to preserve patient privacy, however it must be possible to rematch the identifiers to allow audit if needed. A proportion of applications may be audited for accuracy, with applicants expected to cooperate with and facilitate this process. Any applications where data manipulation (fraud) is suspected will be automatically referred to the NZMC. The EPP is not available for Nurse Endoscopists at this stage.
The EPP is based on retrospective and prospective performance data, with a focus on KPIs and formal observation based against a structured assessment tool (ANZ Conjoint DOPS).
Applicant must;
Applications must be lodged on the official form and emailed to the secretary. If you wish to courier your application, please contact the secretary in the first instance. Please keep a copy of your application for your records.
Reference for Australian EPP
https://www.conjoint.org.au/pathways.php#pathway4
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Quality Endoscopy by Quality Endoscopists.
All described options have independent assessment of practice as an underpinning principle.
IPP will initially be offered for adult gastroscopy and colonoscopy with a view to expanding to paediatric endoscopy and ERCP if there is demand. There will be a fee to process applications.
A de-identified CSV log of ProVation data (including retrospective) must be supplied with a completed summary sheet. The log must include all sequential cases, and be verifiable (e.g. against hospital run sheets) where required. Data points for colonoscopy must include, as a minimum, caecal (or TI/neo-TI) intubation and adenoma detection for each case. This will require post procedure pathology review. Where available, withdrawal time should also be included. For gastroscopy, extent of intubation (e.g. D2) must be recorded.
A proportion of applications may be audited for accuracy, with applicants expected to cooperate with and facilitate this process. Any applications where data manipulation (fraud) is suspected will be automatically referred to the MCNZ Professional Standards Team.
For all pathways, the practitioner must be intending to work in New Zealand for at least a year. This system is not intended for short term locums. Practitioners are advised to contact the Conjoint Committee for advice if needed.
For calculating KPIs, Colonoscopy Completion Rate (CCR) is calculated for all procedures attempted on patients who have had mechanical bowel prep and where the intention at the start of the procedure is to inspect the entire colonic mucosa. Procedures are recorded as complete if they reach the caecum, TI or neo-TI and are reported unadjusted. Adenoma Detection Rate (ADR) is calculated in patients over 50 years old who have had a complete colonoscopy.
Pathway A. Those holding a certificate for recognition of training from a known system
This pathway allows those who have obtained recognition of training in well-known overseas systems where the competency criteria are clear to submit their certificate without the need for further assessments. It recognises that those systems have already undertaken a process for recognition of training that is satisfactory. Recognition of ERCP training is available under this pathway.
Where the endoscopist has not had extensive practice with moderate/conscious sedation then evidence of completion of a Safe Sedation Training Course is also recommended for routine practice in New Zealand. The American society of Anaesthesiologists-endorsed SST-Moderate online course is recommended. Where applicable, this evidence should be provided directly to the DHB credentialing committee rather than NZCCRTGE.
Pathway B. Those from clearly equivalent International training schemes
This pathway is for practitioners from International training schemes that can be clearly assessed as being equivalent to Australasian training (at least three years of formal advanced fellowship training in endoscopy as a Gastroenterologist or General Surgeon), plus local assessment through a logbook and DOPS. This will be the default pathway for all applications other than GESA/JAG (under pathway A above). The committee may seek external advice to determine if a training scheme is likely to be equivalent to local training. Undertaking this pathway should not preclude practice as long as hospital credentialing requirements have been met.
The applicant must:
Minimum standards:
Pathway C. Those where the nature of the International endoscopy training is not clear
Occasionally applications may be received where it is hard to ascertain if the training undertaken has been the equivalent of a three year advanced training scheme. This pathway provides a mechanism for this group to work towards NZCCRTGE recognition of training should they wish to do so. The model is based on a logbook with KPIs, along with DOPS and referee support. If an application cannot be processed under Pathway B the applicant may be redirected to Pathway C to gather additional evidence of skill in endoscopy. Undertaking this pathway should not preclude practice as long as hospital credentialing requirements have been met.
The applicant will be required to:
Minimum standards:
APPLICATION
Applications must be lodged on the official form and emailed to the secretary. If you wish to courier your application, please contact the secretary in the first instance. Please keep a copy of your application for your records.
Reference for Australian IPP
https://www.conjoint.org.au/pathways.php#pathway2