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Recertification in Colonoscopy
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| FAQs |
General
- Why should I undertake Colonoscopy Recertification?
- How long will it take for my application to be reviewed?
- Does Recertification imply a warranty on performance?
- I am working overseas. Can I log procedures from my overseas practice?
Definitions
- What lesions are accepted as a Sessile Serrated Adenoma/Polyp (SSA/P) for the purposes of the program?
- Does 'SSA' include Sessile Serrated Polyps as well as Sessile Serrated Adenomata?
- How is the SSA/P detection rate (SDR) calculated?
- Do I include patients who have had resections to the colon, or where the colonoscopy is supporting surgical intervention?
- Are adenocarcinoma counted as adenoma in the logbooks?
- Should "Flexible Sigmoidoscopies" procedures be logged in Colonoscopy Recertification Program logbooks?
Criteria
- Why a 95% adjusted rate for reaching the caecum?
- Why a 25% adenoma detection rate?
- How will my success rates be reviewed?
- Why is an SDR being introduced?
- What is the purpose of the “no-fail” Cognitive Review?
Participation
- Who may participate in the program?
- When can I apply for recertification?
- Can I claim Continuing Professional Development (CPD) points for my recertification logbook?
- Will the Colonoscopy Recertification Program notify me to remind me when to re-apply for recertification?
- If my Recertification expires when will I be removed from the "Recertified Colonoscopists" list?
- How can I show I am enrolled and actively participating in the Colonoscopy Recertification Program?
- Is my participation in the Colonoscopy Recertification Program mandatory if I am a paediatric colonoscopist?
Logging
- Why are consecutive procedures required?
- Are surveillance colonoscopies to be logged or just first colonoscopies?
- Do I include patients with previously noted polyps who have been referred for a polypectomy (which may inflate my polyp detection rate)?
- A proportion of my public hospital colonoscopies will also include an advanced trainee's name, although I will have carried out the procedure. Apart from my assurance I intend to only include my own procedures, what verification will you require that it was me who performed the procedure? That could become difficult after the event,but excluding those procedures would mean logged procedures are not consecutive?
- Is there an example of a patient consent form?
- Do I need to load intubation images and pathology reports as I go?
- How long are images and pathology reports retained in logbooks?
- How can I download supporting documents (such as images and reports) from my logbook?
- How long do supporting documents remain attached to procedures (eg. if a logbook is subjected to audit)?
Fees
Auditing
- What images will be considered sufficient evidence of completion of a procedure?
- Does the Add Attachments screen allow for the upload of pathology reports?
- How many applications for recertification will be reviewed?
Privacy
- Do uploaded images and histology reports need to be anonymous (i.e. patient identification information removed)?
- Images and reports may necessarily contain patient identifiers for my own record-keeping purposes. This may mean that some images or reports are not strictly anonymous. Do I need to inform my patients of any consent or privacy matters as a result?
- Who will see my personal, procedure and recertification information?
- Can I access specific detail regarding a practitioner's logbook or clinical performance?
Why should I undertake Colonoscopy Recertification?
Public and Government expectations regarding observable indicators of quality in health care are increasing.
Hospitals are increasingly looking towards such credentialing for individual practitioners and units. From 2019 all hospitals and day services providing colonoscopy in Australia will need to be accredited to the Colonoscopy Clinical Care Standard as part of the National Safety and Quality Health Service Standards. This requires facilities to demonstrate that all their colonoscopists have evidence of current certification by CCRTGE ("Conjoint Committee") and re-certification with GESA and meet the performance indicators in the Colonoscopy Clinical Care Standard.
Recertified colonoscopists will be included on a list available to both referring doctors and the public.
Most fundamentally the recertification program will help you track your standard against both industry standards (informed by world standards) and the standard of your peers in the program.
How long will it take for my application to be reviewed?
We anticipate contacting applicants within sixty days of their application being submitted. If you have not heard within this time please feel free to contact us.
Does Recertification imply a warranty on performance?
No. Successful completion of the recertification program indicates that a colonscopist has met the criteria at the time of receiving recertification. GESA makes no warranty as to any colonoscopist continuing to meet those criteria beyond the date of recertification.
GESA also makes no warranty as to the competency of any colonscopist or the standard of care administered or to be administered by any colonscopist beyond meeting the criteria at the time of recertification. GESA accepts no risk or liability for any loss (including consequential loss) or claim arising from any medical treatment or advice given by colonscopists who have received recertification under GESA’s recertification program.
I am working overseas. Can I log procedures from my overseas practice?
Only procedures performed within Australia are permitted.
Several issues have been considered for this decision such as patient consent surveillance interval differences adenoma rates in people from different racial backgrounds and demographics different indications for colonoscopy and the ability to effectively audit logbooks completed overseas.
You must also have an Australian practice address to be able to register for the program.
What lesions are accepted as a Sessile Serrated Adenoma/Polyp (SSA/P) for the purposes of the program?
Any serrated lesion proximal to the sigmoid colon including hyperplastic polyps (HP), sessile serrated adenoma (SSA), sessile serrated polyp (SSP) and traditional serrated polyps (TSA).
Does 'SSA' include Sessile Serrated Polyps as well as Sessile Serrated Adenomata?
Yes. For the purposes of Recertification both should be included.
How is the SSA/P detection rate (SDR) calculated?
The number of patients with any serrated lesion (HP, SSA/P, TSA) proximal to the sigmoid colon divided by the total number of eligible colonoscopies.
Do I include patients who have had resections to the colon, or where the colonoscopy is supporting surgical intervention?
Yes. These procedures are to be included in your logbook - BUT the "Intact Colon" value is to be set to "No". The procedure will not be counted in the calculations for the criteria involving intubation rate and adenoma detection rate.
Are adenocarcinoma counted as adenoma in the logbooks?
Adenocarcinoma are to be recorded separately in the logbook (as cancer) and does not count as an adenoma. A cancer diagnosis is relatively rare in day to day practice. Colonoscopy is mainly done to find adenomas in the screening population.
Should "Flexible Sigmoidoscopies" procedures be logged in Colonoscopy Recertification Program logbooks?
no - they should not be included in your logbook.
Why a 95% adjusted rate for reaching the caecum?
The rate has been set by the Committee and is based on discussions with a range of peers and leading practitioners on a review of domestic and international literature and on current domestic and international practice.
The current expectation for newly-qualified colonoscopists undertaking CCRTGE recognition is a success rate so a success rate is considered reasonable for the experienced practitioners in this program. The rate is measured across procedures in which patients had intact colons and where there was not a finding of acute IBD.
The rate is consistent with international standards.
Why a 25% adenoma detection rate?
The rate has been set by the Committee and is based on discussions with a range of peers and leading practitioners, on a review of domestic and international literature and on current domestic and international practice.
The rate is considered reasonable for the experienced practitioners in this program. The rate is measured across procedures in which the patient was fifty years or older, had an intact colon and where there was not a finding of acute IBD. This is analogous to the population undergoing screening through the National Bowel Cancer Screening Program.
The rate is consistent with international standards.
How will my success rates be reviewed?
The reviewer will ask you to provide sufficient information as is necessary to make a full and fair evaluation of your logbook. This is expected to include but is potentially not limited to:
- Photos of the terminal ileum and caecum matched to procedures (you may attach these to the log of the procedure at any time) which must be of a quality sufficient to allow the reviewer to determine that they are representative. Alternatively pathology reports of appropriate mucosa can be provided.
- Pathology reports to match against adenoma detection rates (you may attach these to the log of the procedure at any time).
Reviewers are members of the Committee or are senior colonoscopists appointed by the Committee.
Why is an SDR being introduced?
A growing body of evidence is emerging linking Sessile Serrated Adenomata / Polyps and the development of bowel cancer. Increasingly detection of these lesions is seen as a crucial key performance indicator of quality colonoscopy and the Committee believe that their detection should be given priority in the everyday practice of those who provide a colonoscopy service.
An initial SSA/P detection rate criterion of 4% will be introduced from 1 February 2019 and will apply to all logbooks submitted from this date. Practitioners should immediately place greater importance on the detection of these lesions.
Further reading on SSA/P detection can be found in the articles accessible via the following links.
https://www.ncbi.nlm.nih.gov/pubmed/28153571
https://www.ncbi.nlm.nih.gov/pubmed/20888435
https://www.ncbi.nlm.nih.gov/pubmed/22390284
https://www.ncbi.nlm.nih.gov/pubmed/22018551
https://www.ncbi.nlm.nih.gov/pubmed/20717107
What is the purpose of the “no-fail” Cognitive Review?
The quality of colonoscopy outcomes is not solely determined by the technical expertise of the practitioner. It is also dependent on cognitive issues such as understanding the strengths and weaknesses of various surveillance intervals and choosing the most appropriate interval based on polyp size and type in the context of the patient's past and present medical condition. The cognitive review is meant to stimulate and focus the practitioner's awareness of their own cognition processes and how they may be influencing patient outcomes.
The cognitive review is a no-fail exercise where practitioners review multi-choice answers to relevant contemporary questions. If an incorrect answer is selected a practitioner can try again until the correct answer is chosen. This can lead the practitioner to identify areas in which further self-training may be required. The system only records completion of the test not the score of first-time correct answers.
Who may participate in the program?
Participation in the program is limited to colonoscopists practising in Australia and who have CCRTGE (Conjoint) recognition of their training in adult or paediatric colonoscopy. Those currently practising overseas are unable to log procedures from their overseas practice.
When can I apply for recertification?
- For your first recertification you may apply as soon as you satisfy the criteria for logged procedures.
- Subsequently you are able to apply within 3 months of the 3rd anniversary of having been recertified previously and after you satisfy the criteria.
- You can enter logs at any time though at least 50 must be in the 12 months prior to applying to allow the reviewer to assess your recent practice.
Can I claim Continuing Professional Development (CPD) points for my recertification logbook?
The RACP has confirmed that time spent completing your recertification logbook can contribute to your CPD requirements.
Up to five hours can be allocated as category 2 for a completed logbook for a single triennial recertification cycle.
Category 2 attracts two credits per hour. CPD credits for recertification have not yet been confirmed by other colleges. Please contact your college for further information.
Will the Colonoscopy Recertification Program notify me to remind me when to re-apply for recertification?
After you have enrolled and successfully completed the recertification program the first time you will be sent automated reminder emails according to the schedule below to remind you to complete and submit your next logbook. Reminder emails are sent out to you:
- 24 months before your recertification expiry
- 12 months before your recertification expiry
- 6 months before your recertification expiry
- 4 months before your recertification expiry
- 2 months before your recertification expiry
- 1 month before your recertification expiry
- 1 month AFTER your recertification has expired
- 6 months AFTER your recertification has expired
If my Recertification expires when will I be removed from the "Recertified Colonoscopists" list?
You will be sent several automated email reminders prior to your Recertification expiry date but if your subsequent recertification application (your submitted logbook) has not been approved by the Recertification Committee (by either not meeting the assessment criteria OR if your logbook was not submitted leaving enough time for the Committee to perform their review and assessment and/or subsequent audit) your name will be removed from the list on the date that your recertification expires.It is for this reason that it is very important for you to complete and submit your logbook at least three months prior to your expiration date.Once your recertification application has been successful your name will then be placed back on the "Recertified Colonoscopists" list.
How can I show I am enrolled and actively participating in the Colonoscopy Recertification Program?
If you are asked by your hospital or auditing body to supply evidence that you are enrolled and actively logging your procedures it is suggested that you log into your recertification program logbook and then take a "screen shot" of your "Home - Dashboard" page. This page shows your logbook status, confirms that you are enrolled in the program and shows that you are actively participating in the program in order to attain your recertification under the program.
Is my participation in the Colonoscopy Recertification Program mandatory if I am a paediatric colonoscopist?
The Colonoscopy Clinical Care Standard (CCCS) relates to the care of adult patients undergoing colonoscopy procedures. As the CCCS does not apply to paediatric procedures, you are not required to participate in the program to adhere to the standard but if you perform procedures with adult patients your participation is required.
The goal of the CCCS is to ensure the safe and appropriate use of colonoscopy to maximise patient benefit and reducing the risk of avoidable harm in the interest of delivering these benefits to your patients. Your participation is strongly recommended and you may be required by your hospital or facility to participate in the program.
There is a paediatric pathway for recertification within the program and the criteria applicable to paediatric recertification has been adjusted accordingly - Paediatric Colonoscopists have different needs and circumstances which are reflected in the system and recertification criteria. It is recognised that paediatric practitioners perform fewer procedures than their counterparts practising adult colonoscopy.
Why are consecutive procedures required?
Consecutive procedures in minimum blocks of 50 where EVERY procedure is recorded are required to ensure the logbook provides an accurate view of a practitioner's practice.
If working across more than one location you may however choose the locations(s) to include as long as the logging is consecutive at those locations. This recognises that some practitioners work in locations where it is harder to get supporting information for their log entries.
Are surveillance colonoscopies to be logged or just first colonoscopies?
All procedures are to be logged.
- You should log all colonoscopies you undertake during a given period to provide a complete picture of your clinical practice.
- The Committee has reviewed this and considers that the population distortions balance out in the ADR rate.
- Having a past screening colonoscopy that is negative is associated with a lower likelihood of subsequent polyps but the repeat procedure cohort also includes an enriched proportion of polyp formers - hence no need to alter target ADRs.
- However if you are logging procedures and believe that the ADR rate is not being achieved due to the highly distorted population please contact us.The Committee will review the information and determine if special consideration should be applied.
- Surveillance colonoscopies undertaken as a result of an indication of IBD are not counted when calculating a practitioner's ADR rate.
Do I include patients with previously noted polyps who have been referred for a polypectomy (which may inflate my polyp detection rate)?
Yes. Your logbook should include all procedures you undertake. The current understanding of clinical practice it that is considered unlikely for these patients to make a significant statistical difference in demonstrating the overall capability of the practitioner over procedures.
A proportion of my public hospital colonoscopies will also include an advanced trainee's name, although I will have carried out the procedure. Apart from my assurance I intend to only include my own procedures, what verification will you require that it was me who performed the procedure? That could become difficult after the event,but excluding those procedures would mean logged procedures are not consecutive?
Consecutive procedures are intended to be the consecutive procedures performed by the practitioner applying for recertification.
If you are supervising a trainee the procedure would not be considered as your procedure even if you step in to assist. If the trainee performs anypart of the procedure it counts as the trainee's procedure regardless of whether you perform any part of the procedure or not. It does not count as yourprocedure unless you perform the entire procedure.
If you are performing a procedure under observation and you allow or ask a colleague to assist then it is considered to be your procedure but you should make a notein your log for that procedure to record the assistance.
So we are referring to consecutive procedures undertaken by the applicant not necessarily all the procedures for which they were present.
Is there an example of a patient consent form?
Yes. Please see this indicative patient consent form to cover this program. You may wish to have this altered to cover the particular needs of your practice or institution.
Do I need to load intubation images and pathology reports as I go?
No. The system allows practitioners to load images and pathology reports into the system as they go (on entering a procedure or later) as a convenience. However this supporting evidence may be kept outside the system and supplied when requested by a reviewer.
How long are images and pathology reports retained in logbooks?
From 1 October 2020, all pathology reports and images will be removed from the system after a logbook has been reviewed and approved by the Recertification Committee. Prior to that time you may download images and pathology reports individually from inside the logbook.
How can I download supporting documents (such as images and reports) from my logbook?
These supporting documents have been previously uploaded as attachments for each logbook entry and may have been uploaded when you initially submitted your logbook or as a result of an audit request. If you wish to download your attachments:
- Log into your RECERT profile,
- Click on the "My Data" option (on blue menu at the top of the screen),
- Click on the blue paperclip icon to the right of each logbook entry (the existence of this icon indicates documents have been uploaded - if it is not present for a logbook entry that indicates that no documents have been uploaded for that entry),
- From the "View Attachments" page click on the "Download Attachments" icon (upper right),
- Repeat this process for all logbook entries from which you require the supporting documents.
How long do supporting documents remain attached to procedures (eg. if a logbook is subjected to audit)?
Supporting documents that are uploaded to logbooks (if during the initial logging phase or if a logbook is selected for audit) will remain attached to the individual procedures until the logbook is assessed as being "Approved" and a recertification certificate is issued. The attachments are then usually deleted by a batch process the following evening. This was introduced in October 2020 to ensure patient confidentiality, system security and decrease the storage requirements of the website.
What are the fees?
Logbook submission fee is $840 (incl GST). Funding for the program was initially provided by the Federal Department of Health through the National Bowel Cancer Screening Program - this arrangement ended on 31 December 2018.
From 1 February 2019 a fee was introduced and is payable on the triennial (three yearly) submission of logbooks.
The fee is used to support the program and related activities and is reviewed annually. The levied fee amount is supported by the GESA Board..
What images will be considered sufficient evidence of completion of a procedure?
Please see the image quality guidelines here.
Does the Add Attachments screen allow for the upload of pathology reports?
Yes. Evidence of ileal or caecal intubation adenoma and SSA/P detection must be provided if a colonoscopist is reviewed on their application for Recertification. The required documentation is high-quality image(s) of intubation OR a pathology report of the relevant mucosa. Each adenoma and SSA/P logged should be supported by a pathology report. Note that the supporting evidence only needs to be provided if your application is chosen to be reviewed. You may also upload your documentation to the system for your own convenience.
How many applications for recertification will be reviewed?
10% of applications will be selected for review at random by the system at the time of application for recertification.
While not contemplated at this time the Committee reserves the right to selectively review proceduralists.
Do uploaded images and histology reports need to be anonymous (i.e. patient identification information removed)?
Yes all information uploaded to the system should be anonymous.
Images and reports may necessarily contain patient identifiers for my own record-keeping purposes. This may mean that some images or reports are not strictly anonymous. Do I need to inform my patients of any consent or privacy matters as a result?
In regards to consenting yes. The consent provided by your patients should include all information you provide to the Colonoscopy Recertification Program. It is your responsibility to ensure that the consent protocols of your practice/hospital cover this use of the information. See a sample patient consent form suitable for use with this program below.
In regards to privacy yes. The information should contain as little patient identification data as possible. We acknowledge that you need to have some patient reference data in your logbook for your own purposes and to allow verification of your data in the event of an audit. The Colonoscopy Recertification system uses data storage and access arrangements consistent with the Australian standards for medical records storage. Please also note that the online storage of images and pathology reports is provided as a convenience - it is not mandatory that you upload all images and reports for each procedure logged. These can be provided later if your Recertification application is selected for review.
Who will see my personal, procedure and recertification information?
Any or all information may be reviewed and reported at an aggregate anonymous level for the purposes of system performance such as data storage and access efficiency for research or for providing trend or summary information to appropriate bodies such as the federal government or the National Bowel Cancer Screening Program.
Your personal information may only be accessed by the people who administer and maintain the logbook system.
Your procedure information may only be accessed by the reviewer and by the people who administer and maintain the logbook system.
Your recertification status will be published in the list of recertified colonoscopists which will be publicly available on this website.
Can I access specific detail regarding a practitioner's logbook or clinical performance?
The GESA Recertification program publishes a list of practitioners that have been recognised by the Conjoint Committee for the Recognition of Training in Gastrointestinal Endoscopy (CCRTGE) and who have provided information that credibly has shown them to be meeting the Colonoscopy Recertification Programs criteria (currently every 3 years). Due to Australian privacy legislation, GESA is not permitted to provide individual practitioner's information without explicit permission.
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