The DOPS will be followed by an assessment of candidates endoscopic skills over two consecutive cases. The assessors will use DOPS (and where polypectomy is undertaken DOPyS) to assess the candidates performance. Each assessment is carried out by two trained assessors.
The DOPS assessment lasts a maximum of 45 minutes per case; this includes obtaining consent, which should take no more than 5 minutes. The caecum should have been reached after 30 minutes – if not, an assessor may take over. At 45 minutes the assessment ends whatever the circumstances, and an assessor will complete the case. If there is an unexpected burden of pathology to deal with the assessment may be extended at the assessors’ discretion, provided the candidate is proceeding satisfactorily.
Because colonoscopies vary considerably in difficulty and are unpredictable, completing all cases to the caecum is not required. Terminal ileal intubation is not a prerequisite for successful completion. Candidates may be allowed to miss small (< 5 mm) polyps and still meet the screening criteria. Candidates should, however, mention any lesions that they have seen but have chosen to leave. The degree of difficulty of each case will be recorded and taken into account by the assessors.
In difficult cases the candidate may ask for assistance and use that particular procedure as a learning experience. This would not automatically result in a candidate ‘not yet meeting the criteria’; indeed, the assessors themselves might be unable to fully complete the procedure. If, at any time, the assessors agree that an assessment is endangering the patient they may suspend it. This will be taken to indicate that the candidate does not yet meet the criteria. All candidates will be alerted to this policy prior to the assessment.
In the unlikely event of a case where both assessors have serious concerns about the competence of the colonoscopist, they will advise the candidate of those concerns. The assessors may feel professionally obliged to alert the medical director of the candidate’s Trust immediately and in confidence. Notwithstanding any immediate action taken, a full report will be made to the Accreditation Panel, who will forward any recommendations for further training confidentially to the medical director of the candidate’s Trust.
Viewing the magnetic imager is permitted but not obligatory; candidates should be advised that if they are unfamiliar with viewing the image it might be counterproductive to do so however assessors may wish to view the images to aid analysis and feedback.
The candidate will be assessed taking consent, giving sedation, inserting to the caecum, examining during withdrawal, applying any appropriate therapy, and discussing results and management with the patient. If polyps are encountered and are suitable for removal during the examination the candidate will be expected to remove them, although this can be discussed at the time.
Any information leaflets received by the patient should be made available to the candidate. The pre-endoscopy patient documentation containing past medical and medication history and details of any allergies should be made available to the candidate.
Issues have occurred where a full consent is not taken as part of the assessment process. Some simple omissions have been noted by assessors, and some candidates have considered the subsequent pre-procedure WHO checklist or equivalent sufficient to cover certain aspects of the consent.
The purpose of assessing consent is to:
1. assess knowledge
2. assess communication and other non-technical skills
3. enable a relationship to develop between endoscopist and patient.
The areas that are expected to be covered by a potential screener as part of the BCSA assessment are:
- Brief overview of the procedure including need for biopsy or polypectomy
- Confirm indication and explain procedure is most appropriate investigation (if this is correct)
- Potential complications – including bleeding, perforation, missed lesions and pain (including the need to discuss stoma formation if perforation and sequelae are raised by patient)
- Option of sedation/analgesia and what effect is expected
- Relevant medical issues – cardiac and respiratory that may affect procedure or medications administered
- Any allergies
- Opportunity for patient to ask questions.
The DOPS assessment will be conducted according to defined criteria. The assessors will determine whether the candidate:
- meets the criteria or
- does not yet meet the criteria/needs further development.
To guide assessors the DOPS assessment form is divided into four sections: pre- procedure, procedure, post procedure and ENTS (endoscopic non- technical skills). Each includes sub domains for discrete areas of practice. To pass the DOPS assessment, candidates must score ‘achieved’ (or N/A where appropriate) in each individual item of the DOPS form.
If polypectomy is performed the technique will be assessed using the DOPyS form (a polypectomy-specific DOPS). In the event that more than one polypectomy is performed during a case, each will be scored using the DOPyS form. To pass the DOPyS each of the sections must have an overall score of ‘achieved’, or where relevant ‘does not apply’.