PTH-123 The Current Shape of UK ERCP Training

Abstract

Introduction ERCP training and service provision has been an area of intense interest internationally. Recent papers have highlighted discrepancies in practice and performance between individuals, units and countries. At present, there is no consensus as to how to best select and train individuals, or how to assess competency at the completion of training. This survey aimed to identify the selection processes for entry to ERCP training in use in the UK, alongside the entry characteristics of current trainees and their training and career aspirations. Methods A nationwide electronic survey of UK gastroenterology trainees. Results Responses were received from 15 of 20 deaneries, with 104 individual replies, of which 67 are currently training in ERCP. 3 deaneries have competitive selection in place comprising a combination of interview, portfolio review and endoscopic skills assessment. One deanery demands attainment of competency in both gastroscopy and colonoscopy prior to ERCP training. 91.4% are competent in OGD prior to ERCP training, whilst most intend to train in colonoscopy alongside ERCP 46.3% would like to simultaneously train in hepatology while 53.6% intend to combine with training in EUS 52.9% would expect to perform 200–500 ERCPs prior to certification of competence, but 76.5% have encountered difficulty in obtaining training-time commitments, others training or list suitability. 57.9% expect to attend less than 4 lists each month. Only 17.7% expect to be adequately trained at CCT and 79.4% intend to undertake fellowship. Conclusion Most deaneries have no formal selection process prior to beginning ERCP training. Those with competitive selection use differing criteria. There is dissatisfaction with the availability of training and acceptance that competency is unlikely to be achieved prior to CCT. The majority expect to undertake a post-CCT fellowship. Despite this, there is still interest in undertaking more subspecialty training, particularly EUS but also hepatology. The BSG working party has made suggestions regarding the structure of high quality training. This includes limiting training numbers by formalised selection to allow maximisation of training opportunity. It also makes recommendation of minimum list frequency and annual procedure numbers. These levels are not currently being achieved. Service commitment, other training needs and trainee competition are commonly cited as reasons for this. Most trainees lack confidence that ERCP competency will be attained during speciality training, in keeping with BSG working party expectation that post CCT fellowships will become standard. Current ERCP training cannot confidently produce independent endoscopists. This needs to be reflected in pre- and post-CCT training organisation and in new consultant job planning. Reference 1 With thanks to the BSG trainee committee for their assistance. Disclosure of Interest None Declared