Australia’s National Endoscopic Training Initiative

Australia is leading the world in gastrointestinal endoscopy training, certification and quality monitoring, ensuring enhanced access to quality, affordable services for all patients, explains David Hewett.
The Gastroenterological Society of Australia’s (GESA) Quality in Endoscopy program is the first national plan to achieve world’s best practice in colonoscopy training and has been widely acclaimed by stakeholders. As the peak national professional body for gastroenterology and hepatology, GESA has championed the need for a more rigorous focus on training, recertification and quality standards.
Through the National Endoscopic Training Initiative (NETI), GESA has developed a new approach to skills training and maintenance, with a comprehensive series of national, formalised and standardised endoscopy workshops conducted by expert, internationally-recognised endoscopists.
NETI’s suite of courses utilise an evidence-based curriculum, are multidisciplinary, and have ensured consistency in colonoscopy training and service provision across Australia. The learning methods are diverse, and include simulation-based skills training, live demonstration endoscopy, focused clinical updates from expert faculty, and online learning.
Aimed at physician and surgeon endoscopists and trainees, NETI provides Australia-wide support for the endoscopy workforce to ensure that each level of practitioner has the necessary skills, resources and motivation to deliver high quality, timely patient-centred care.
This includes, an annual Gut School for new trainees in gastroenterology, which since its introduction, has attracted between 95% - 98% of all new trainees. Other courses include:

• Introduction to Endoscopy Workshop: an introduction to the fundamental skills and equipment required for endoscopy, for trainees starting out in endoscopy.


• Basic Colonoscopy Workshop: for physician and surgeon trainee colonoscopists to review the basic principles and practice of colonoscopy.


• Advanced Colonoscopy Update: for physician and surgeon colonoscopists and senior trainees wishing to refine or update their practice.


• ERCP Training Workshop: an advanced practice workshop for those endoscopists to review the principles and practice of endoscopic retrograde cholangiopancreatography (ERCP).


• Capsule Endoscopy Training: an introduction to principles and practice of capsule endoscopy, for trainees or established endoscopists without previous experience.


• Train-the-Colonoscopist Trainer: for supervisors actively supervising trainees with attendance by invitation only.

As a result, NETI is improving the quality of care and patient safety in colonoscopy, by defining and improving the standards and methods by which colonoscopy is trained, assessed and practised in Australia.
In parallel with NETI, GESA strongly supports the maintenance of professional standards to foster continuing scholarship and drive excellence in clinical practice. NETI’s training benchmarks have informed the emergence of a recertification process for endoscopy that gives hospitals and the public a way to objectively evaluate practitioners’ qualifications and clinical competence.
GESA has introduced a quality assurance program for colonoscopists entitled ‘Quality in Endoscopy’, which builds on the growth in the number of certified proceduralists and the increasing importance of certification across hospitals and day surgeries throughout Australia.
Certified proceduralists are able to confirm every three years, through periodic and voluntary reassessment, that they meet quality standards for the provision of safe, highquality endoscopy. This is easily done via a newly developed online portal for practitioner self-assessment with a key set of endorsed quality criteria, derived from evidence-based, best practice clinical indicators.
These quality indicators include:

• caecal intubation rate (colonoscopy completion rate);


• polyp and adenoma detection rates;


• specimen retrieval rate; and


• annual colonoscopy volume.

Endoscopists prospectively record data on colonoscopy procedures and quality indicators, to inform determinations by the GESA Quality in Endoscopy Committee. Via the portal, endoscopists are also able to access NETI training materials, the certification site, continuous professional development, quality assurance and clinical guidelines, other self-improvement educational activities and career log books.
The Quality in Endoscopy initiative has been developed by GESA and supported by the Australian Government Department of Health and Ageing. This robust, prospective, quality monitoring program provides a further impetus to improve the quality of colonoscopy in Australia. The outcome is the full integration of training, certification and quality monitoring into a single new professional portal for endoscopists across Australia.
David G. Hewett, MBBS(Hons), MSc, PhD, FRACP
Associate Professor David Hewett graduated MBBS from the University of Queensland and undertook clinical and research training at the RBWH. He completed further studies at Indiana University, USA where he developed advanced skills in the technical performance of colonoscopy, including detection, characterisation and resection of colorectal polyps. His experience includes an NHMRCNICS fellowship on improving the quality of colonoscopy, a PhD (UQ) examining the impact of intergroup dynamics on patient care, a Master of Science in clinical research methods (IU), and leadership of a national project developing an Australian curriculum for colonoscopy training.
Associate Professor Hewett’s clinical research focuses on improving the effectiveness of colonoscopy for bowel cancer screening, with specific interests in serrated neoplasia, new endoscopic imaging techniques, and methods to improve colonoscopy performance and training. He has parallel interests in health services research and medical education, including quality of patient care and intergroup communication between health professionals.
David is active in national health policy and training initiatives. He is a member of the Executive of the Australian Gastrointestinal Endoscopy Association and the Clinical Advisory Group for the National Bowel Cancer Screening Program. He is the lead for teaching and learning on the Royal Australasian College of Physicians Specialist Advisory Committee for gastroenterology. David’s past leadership roles have included membership of the Australian Medical Council Specialist Education Accreditation Committee, the Australian Government Medical Training Review Panel, and the Federal Council of the Australian Medical Association.