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.
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.
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 any part 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 your procedure 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 note in 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.
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).
You must record in your logbook the details of all procedures undertaken after you commence logging irrespective of the clinical outcome so that the reviewer has sufficient information to review your performance over time.
Reviewers are members of the Committee or are senior colonoscopists appointed by the Committee.
What images will be considered sufficient evidence of completion of a procedure?
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.
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.
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.
Does 'SSA' include Sessile Serrated Polyps as well as Sessile Serrated Adenomata?
Yes. For the purposes of Recertification both should be included.
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).
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.
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.
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.
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.
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.
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.
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.
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.
What are the fees?
Funding provided by the Federal Department of Health through the National Bowel Cancer Screening Program will cease on 31 December 2018. The use of the online logbook system is free until 31 January 2019. From 1 February 2019 a fee will be introduced and payable upon the triennial (three yearly) submission of logbooks.
This fee will be a 'cost recovery' fee with all proceeds feeding back into the administration and maintenance of the Recertification Program. All logbooks submitted by 31 January 2019 will not be subject to a submission fee.
logbook submission - $840 including GST
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.
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.