Review of the impact of the Joint Advisory Group on gastrointestinal endoscopy (JAG) on accreditation services and training

Keith Siau; John Green; Neil Hawkes; Raphael Broughton; Mark Feeney; Paul Dunckley; John Barton; John Stebbing; Siwan Thomas-Gibson

doi:10.7861/clinmedicine.19-2-s80

Aims

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. With support from national stakeholders, national quality improvement initiatives were implemented, leading to the achievement of notable milestones in endoscopy quality assurance (QA), particularly in the three areas of endoscopy training (JAG Endoscopy Training System (JETS) e-portfolio and certification in endoscopy), accreditation of endoscopy services (including the Global Rating Scale (GRS)), and accreditation of screening endoscopists. These developments have changed the landscape of UK practice, serving as an integrated model to promote excellence in endoscopy. This literature review aims to amalgamate published evidence supporting the impact of JAG on quality of care, services or training in endoscopy.

Methods

A systematic review was conducted in July 2017 through EMBASE, Ovid and PubMed to identify relevant publications and conferences abstracts over the last 10 years. The search strategy involved the combination of the following terms: (‘Joint Advisory Group’ or ‘JAG’ or ‘Global Rating Scale’ or ‘JETS e-portfolio’ or ‘DOPS’ or ‘DOPyS’ or ‘bowel screening’) AND (‘endoscopy’ or ‘colonoscopy’ or ‘polypectomy’ or ‘accreditation’). Studies were limited to those in English, with accompanying abstracts, and those published after January 2007. To enable summation of the literature search results, thematic analysis was used to summarise suitable publications into the following categories; a) quality of care, quality of service provision and quality of training.

Results

Eight-hundred and eighty-seven articles were screened, of which 118 publications (42 full papers and 76 conference abstracts) were included. Studies exploring quality of care (n=37) mainly comprised audits involving different endoscopic procedures against JAG standards. Studies identified included the 2011 national colonoscopy audit that showed significant advances in performance standards since the 1999 audit, which was partly attributed to the role of JAG. Thirty-one studies were relevant to quality of service, of which the majority were related to audits of service performance and implementation of the GRS, including the novel settings of the private sector, community endoscopy and international settings (via JAG International). Fifty studies referred to quality of training, which covered implementation of JETS, and international validation of direct observation of procedural skills (DOPS) and direct observation of polypectomy skills (DOPyS) assessment tools. Trainee surveys and international research based on JAG tools were also identified.

Conclusion

This review provides evidence which supports the impact of JAG initiatives on quality of care, service and training in UK endoscopy over the last decade, of which the majority have demonstrated a positive effect of JAG. The JAG-hosted National Endoscopy Database, currently under development, aims to revolutionise QA by exporting performance metrics from endoscopy reporting systems, and to auto-populate future iterations of JETS and GRS. This is likely to further extend JAG's influence as an international model for facilitating endoscopy QA.