Severn Gastroenterology Registrar Induction Book
Congratulations on your appointment to a Gastroenterology training post in the Severn Deanery. Speciality training at registrar level is ever-changing with new assessments, competencies and a multitude of organisations and websites. After you have celebrated obtaining your Gastro/GIM NTN, there are a number of steps that should be undertaken, some mandatory, some advisable. This document has been compiled to try to explain these steps so that you can get a head start with your training. We look forward to working with you and learning from each other. We hope that your time with us is an educationally rewarding one.
Severn Gastroenterology Specialist Training Committee
Dr Richard Makins Consultant Gastroenterologist, Cheltenham & TPD
Dr Julia Maltby Consultant Gastroenterologist, RUH, Bath
Dr Andrew Bell Consultant Gastroenterologist, Weston General Hospital
Dr Amanda Beale Consultant Gastroenterologist, UHB
Dr Manish Hegde Consultant Gastroenterologist, Swindon
Dr Katie Smith Consultant Gastroenterologist, Yeovil
Dr Leonard Griffiths Consultant Gastroenterologist NBT, Bristol
Dr Emma Wesley Consultant Gastroenterologist, Taunton
This manual is a composite of many peoples work; we acknowledge the original by Dr M Lockett and Dr M Khan . This version extensively revised and updated in 2019 by Dr Gio Sheiybani and Dr Richard Makins.
The information was correct at the time of writing to the best of our knowledge but could change at any time. Please check the relevant websites mentioned for the most up to date information. If you spot any inaccuracies please inform Dr Makins so that this document can be kept as up to date as possible.
Before you start or as soon as possible after starting in your job
Health Education England – South West
The Deanery deals with recruitment, curricula and assessments. You should have already been registered and issued with a National Training Number. For queries regarding this, please contact:
Joanne Pickstone - Education Programme Manager Medicine
Joint Royal College of Physicians Training Board (JRCPTB)
This is where you will find all your forms for mandatory assessments, as in core medical training. The important thing to note is that for ARCP, you will need two separate educational supervisor reports for GIM and for gastroenterology. These can be found on the eportfolio.
Trainee Self Administration
You can now add and amend posts on your ePortfolio and from 1 August 2018 you will be responsible for adding your own placement information to include dates, grade, and supervisors.
The Severn programme team will no longer routinely add placement information to ePortfolio.
The JRCPTB have produced a guide and video on how to administer posts as a trainee, click here for details.
Changes to CCT Date
Local deanery teams no longer have the access to amend programme membership dates on ePortfolio. Therefore, if your CCT date changes, you must ensure that you notify the JRCPTB of this by emailing firstname.lastname@example.org and attaching a completed CCT date calculator.
You will not be able to add a post which goes beyond your programme end date.
There is a summary of functionality and permissions on the attached document.
Support from the Medicine Programme Team
We are, as always, happy to help and if you have any ePortfolio queries which you cannot resolve, please contact Faye Price in the first instance.
Telephone: 01454 252 637
For any technical issues where the functionality isn’t working properly you should contact the JRCPTB support team.
The Joint Advisory Group on Gastrointestinal Endoscopy (JAG) assumes an active and broad role in the quality assurance of endoscopy training and services across the UK. All endoscopy trainees must register with JETS, the eportfolio system used to log all endoscopic procedures. Registration for this can be done online. In addition, some Trusts may be signed up to the National Endoscopy Database (NED) which allows automatic upload of all procedures between your local reporting system and the eportfolio, to prevent having to input them twice. Please contact the endoscopy lead at your Trust who can tell you if their Trust is doing this.
It is worth becoming a BSG trainee member straight away. If you were a BSG Taster Member as a Core Trainee, please contact Janet Bassett who will facilitate upgrade of your membership. Once you have joined (£110 per year or £97.50 if paying by direct debit), you will receive Europe’s highest impact factor scientific journal, GUT every month. Once you are a BSG member, there are discounted rates for attending the annual BSG conference as well. The BSG publishes a number of useful national guidelines which can be downloaded from the website (you do not have to be a member to get access to these). The trainees section runs an annual management skills workshop with a significant discount for BSG members and travel expenses cover as well as annual education days.
The Royal College of Physicians have a vast number of roles and many of you may be collegiate members after having passed the MRCP. As an StR, membership is voluntary but the JRCPTB enrolment fee can be incorporated. There are a number of benefits including the Journal of Clinical Medicine and free access to the Continuing Professional Development (CPD) scheme, useful around the time of your Penultimate Year Assessment (PYA).
You should have been informed by Joanne Pickstone at the Deanery via email which hospital you will be starting at and on what date. Everyone rotates annually on the 1st Monday in September, which is agreed nationally. You should also know your finish date at that Trust. If you are unsure please contact the Gastroenterology training programme director (TPD) as a matter of urgency:
Please contact your new consultants as soon as possible to arrange any pre-booked leave to avoid clinics/lists being cancelled at short notice and to discuss your post and training needs. Most Trusts require eight weeks notice to cancel fixed commitments. If you are not sure who you will be working for, I suggest contacting the training lead for that Trust (listed on the Welcome and contacts pages of this book) who should be able to let you know.
When you start in your first post, in addition to a general trust induction, you should have a departmental as well as an endoscopy unit induction. You should be allocated to an educational supervisor who will be one of the Consultant Gastroenterologists in the department. It is necessary to arrange a meeting with this consultant during your first two weeks or prior to starting at which you should discuss your educational needs, both in general medicine and gastroenterology. If a ARCP has been conducted previously, the recommendations should be brought to this meeting. A Personal Development Plan should be derived by you prior to the meeting if possible and this will be discussed and developed further with your Educational Supervisor.
Subsequent meetings should be planned throughout the placement as well as an end of placement/ pre-ARCP appraisal. These should occur with each educational supervisor in each placement/ hospital throughout your training.
The post content and timetable
Ideally, each post in your rotation should consist of:
|Outpatients:||2-3 per week|
|ST3-4||Direct consultant supervision (i.e. clinic should be cancelled if the consultant is away)|
|ST5+||Indirect consultant supervision (you should have the opportunity to discuss patients with the consultant within 5 working days of the clinic if the consultant is away and there should be a nominated consultant in the hospital on the day of the clinic)|
You should be allocated 30 minutes to see a new patient and 15 minutes for a follow up patient. It is your responsibility to ensure that the clinic is cancelled when you are away or on call.
At least 20 training lists in the year
Ideally attend. 1-2 service lists
|Ward rounds||2-3 per week (at least one consultant led & one STR led per week)|
Aspire to one bleep free session per week for audit/research/private study
Multidisciplinary meetings (x-ray, histology, oncology, surgery, IBD, upper GI) when locally available
|Grand round||When locally available|
Please discuss any concerns about your timetable with your educational supervisor.
The job allocation is determined by the TPD and is determined according to your seniority & preferences. You will be asked to indicate your preferences in the spring of each year and the rotation will be approved by the training committee in May and then sent out via e-mail.
Both curricula can be found on the JRCPTB website:
The training days and ESEGH are based on the Gastroenterology curricula.
General (Internal) Medicine 2009 (revised 2012)
Core Nutrition training
During the core nutrition module, which will typically take place over a 6 month period in an accredited unit, specialty registrars will have the opportunity to develop training and expertise in the core principles of nutritional support and management of intestinal failure.
Please see appendix A for the new Core Nutrition checklist that will form the basis of the competency assessment for this.
Severn Trusts accredited in core nutrition:
- Royal United Hospital, Bath
- UH Bristol
- Gloucester and Cheltenham
Core Hepatology training
There is currently a variety of models of service and training in hepatology prevailing in the UK. To fulfil the requirements of Core Hepatology training, you should be placed in a level 2 Hepatology centre, which is defined by the following minimum requirements:
- At least 2 WTE ‘Hepatologist’
- Specialist nurse team including alcohol liaison
- Dedicated hepatology clinics and pathways
- HCV ODN treatment centre
- 24 hour emergency endoscopy including treatment of varices
- Transjugular intrahepatic portosystemic shunt placement
- Work up and shared care arrangements for liver transplantation
- HPB MDT
- Interventional radiological treatment of HCC
- Liver Histopathology review
Appendix B is the Hepatology checklist for when you are obtaining the competencies in hepatology. You can access the full version by double-clicking the image icon in appendix B.
Level 2 Hepatology centres in Severn:
UHB - Hepatology post
NBT – Hepatology post
There is an opportunity to gain advanced training in both hepatology and nutrition. They are out of the deanery but can count towards your training. They are competitive national applications which occur once a year and most trainees tend to apply after ST5. For more information, see the below link:
There are six Gastroenterology training days per year, organised jointly with the South West Peninsula Deanery. They are free to trainees but the time involved must be taken from your annual study leave allowance of 30 days or as two of your bleep free sessions. They are usually held at the Mount Somerset Hotel in Taunton. They are jointly co-ordinated by Dr Richard Makins (TPD for Severn) and Dr Louisa Vine (TPD for Peninsula). (Study Leave Policy)
The dates are arranged well in advance giving you plenty of time to cancel fixed commitments, swap on calls and avoid taking annual leave. The programmes will be sent out by e-mail a couple of weeks before the day. You are expected to attend >70%. The topics are repeated on 2.5 year cycle so you have more than one chance during your five years of training to attend a specific topic.
General medicine training days are organised separately.
The following websites all have free registration and have lots of Gastro and GIM modules that can be used for continuing medical education. These could be used to make up some of your external training if for example you found you were unable to attend the required number of training days (GIM is particularly difficult to swap if you are on call or on nights for example).
- Doctors.net.uk electronic Continuing Medical Education (eCME)
- Medscape Education
- BMJ Learning
- If you are a member of the London RCP, you can access their online CME which is released in their quarterly edition of “Clinical Medicine”. It will give you 2 external CPD credits
- Evening medical updates: Many trusts run remote Evening Medical Updates once a month. This would count towards your GIM hours. Please contact your Trust to find out more information on this.
There are many courses which will be of interest and quite a lot which are or may become compulsory (as follows). Some of these, such as the management and ‘train the trainers’ courses, are best left to the final 2 years but please try to spread the remainder throughout your training. All endoscopy courses can be found & booked via the JETS website.
The National Endoscopy Training Programme
Basic skills in UGI endoscopy
Pre-ST3 or first 6 months of ST3 year
Basic skills in colonoscopy
Mandatory if training in colonoscopy
Basic skills in Therapeutic GI endoscopy
Basic skills in ERCP
Recommended if training in ERCP
Teaching the teachers/Train the trainers in endoscopy
ALS updates every four years
Mandatory for all
Mandatory for all
There is a study leave budget available for mandatory courses. Once you have attended the course, the postgraduate education department will contact your Educational Supervisor to ensure the course is one that is required for CCT. This will allow you to claim course and reasonable travel expenses.
Professional and Generic Skills Programme
For all core and senior medical trainees
Information about the Professional and Generic Skills Programme
The Professional and Generic Skills programme is a collaborative venture provided by Health Education England - working across the South West, and delivered jointly by Plymouth University Schools of Medicine and Dentistry (PU PSMD) and the University of Bristol Faculty of Medicine and Dentistry.
The programme is designed to provide a unique combination of practice skills, knowledge and thinking to develop your career path as a clinical leader within an evolving NHS.
You will need to commit seven days to attend six CPD modules - choosing your modules from any of the six locations across the south west: Truro, Plymouth, Exeter, Taunton, Bristol and Cheltenham/ Gloucester as below:
Module 1: Patient safety, quality systems and personal responsibilities
Module 2: Communications, partnership and teamwork: teaching and learning
Module 3: Communications, partnership and teamwork: communications
Module 4: Maintaining trust: medical ethics, and medicine and the law
Module 5: Management and leadership: NHS structures and funding
Module 6: Management and leadership: personal skills
How do I book onto the programme?
Professional & Generic Skills Administration team:
Annual conference held in June each year at different venues throughout the UK. A good meeting to submit abstracts to, attend lectures on the latest research and for networking. There is a one day postgraduate course prior to the meeting which is of a high standard. All StRs are encouraged to attend & present research or audits. The deadline for abstract submissions is often several months before the meeting so check the website early for the latest information.
British Association of Parenteral and Enteral Nutrition (BAPEN)
Annual nutrition conference held in November
British Association for the study of the Liver (BASL)
Annual liver meeting held in September
Digestive Disease Week (DDW)
Annual American general gastroenterology meeting held in May
United European Gastroenterology Week (UEGW)
Annual European general gastroenterology meeting held in October throughout Europe.
European Colitis and Crohn’s Organisation (ECCO) meeting
Annual IBD meeting held in February throughout Europe.
Annual Review of Competence Progression (ARCP)
This is an annual review of training undertaken by the Severn Gastroenterology Training Committee plus a representative from the GIM training committee. Your first assessment will be approximately 1 year after starting in the ST3 grade. Assessments are held in September. Both Gastroenterology and GIM are assessed together in ST4 and ST6, otherwise they are held separately. You will be emailed the dates of these by the postgraduate school separately. At the first few years’ assessments, the competency assessment tools (DOPS, mini-CEX, MSF) will be reviewed on e-portfolio together with endoscopy and GIM patient portfolios, training day attendance, course attendance, a summary of the post(s) under assessment, completed Gastroenterology and GIM educational supervisor’s reports, up to date CV and a summary of extra activities achieved. More detailed information can be found on the Gastroenterology assessment page of the Deanery website. Please note that a separate educational supervisor’s report for GIM and gastroenterology should be completed. These will be reviewed and a decision made based on the process outlined in the JRCPTB handbook.
Decision aids for GIM and gastroenterology can be found here on the JRCPTB website.
Penultimate Year Assessment (PYA)
This is held 12-18 months prior to your CCT date. This is similar to an ARCP but involves assessment of your entire training from ST3 onwards & is carried out by an external Gastroenterology TPD. Its purpose is to review and establish satisfactory training to date, identify your training needs for the final post, and to agree a final binding CCT date. There is a separate PYA for general medicine and gastroenterology.
The panel consists of STC Chairman/TPD/External Advisor, a second Consultant Physician, SAC representative (external), and Deanery administrator. For Gastroenterology you will have to provide a CV, a summary of all your specialty experience (i.e. posts), all your WPBAs/eportfolio for your entire training, a summary of your endoscopy portfolio, your training requirements for your remaining time and a summary of your achievements. You will be expected to do a short (10 min) presentation to the panel on power point. More detailed information can be found on the Gastroenterology assessment page of the Deanery website.
This is the same eportfolio used to record assessments during core medical training. All your WBPAs for both GIM and gastroenterology should be recorded here. All your posts will need to be added by yourself rather than the postgraduate department so try and do this as soon as you start.
JAG has developed an endoscopy E-Portfolio for all trainees in endoscopy. This is a web-based system that can be accessed both at work and at home via the JAG Endoscopy Training System (JETS) website.
The E-Portfolio will support the trainee JAG certification process.
The E-Portfolio provides an electronic means of logging your endoscopic procedures. The system produces meaningful performance data outputs so that you can monitor the number of procedures that you are performing and your performance data quarter-by-quarter or year-by-year. You will be able to print these summary screens in preparation for your ARCPs etc. The E-portfolio provides an electronic format for JAG-approved DOPS forms to be completed. It also enables you to give anonymous feedback on training received (i.e. your trainers) and to populate a personal development plan.
The E-portfolio can be accessed through the JETS website. If you currently have a JETS account, then your logon details will be unchanged. At the initial logon you will be asked to grant the trust access to your E-portfolio. If you have never used the JETS website, you will receive an e-mail with your logon details and an e-mail requesting that you grant the trust access to your portfolio.
If you have forgotten your logon details or have any IT queries then e-mail askJETS@rcplondon.ac.uk.
Some Trusts may be used NED (National Endoscopy Database). This means that all procedures that you do that are reported may upload to JETs automatically. Please check with your individual Trusts to see if they are using this. You will still need to ensure whatever is uploaded onto JETs is accurate but should reduce the work of uploading all your procedures.
Acute GIM portfolio
Evidence of direct care – which means personal management i.e. clerking, examining and investigating – of an indicative number of 300 patients per year admitted on the general medical “take” (i.e. approximately 1000 patients during the 3- year training programme (or over 5 years if dual accrediting)). This will need to be recorded (perhaps as a print out of the hospital admission data), discussed with the Educational Supervisor and recorded in general terms in a log book signed off by the Educational Supervisor and countersigned by the relevant Deanery STC Chair and/or TPD. There is a calculator that will allow you to work out how many patients you are seeing on an on-call shift. It is important that your ES signs this to verify that this is correct prior to your ARCP.
Inpatient GIM portfolio
Evidence of inpatient experience must be recorded. This should include at least three years of experience undertaking in-patient ward rounds that must include patients with multi-system disease based in a variety of different specialities and which allow competences to be obtained in the management of the “Top 20” and “Other Presentations” as detailed in the GIM curriculum. There must be consultant supervision of these ward rounds at least twice a week. The ward rounds may be undertaken on specialist wards.
Outpatient GIM portfolio
Experience of the management of outpatients can be obtained in specialist clinics, direct access clinics or ambulatory care clinics. To satisfy the regulations for award of a CCT in GIM there must be experience of at least one clinic a week for an indicative 3 years during which the trainee will build up experience and competence in managing the “Top 20” and ”Other Presentations”. During training at least 186 clinics or equivalent should be performed. This must be ratified by the Educational Supervisor and countersigned by the relevant Deanery STC Chair and/or TPD.
European Specialty Examination in Gastroenterology and Hepatology (ESEGH) (formerly known as the Specialty Certificate Exam in Gastroenertology)
From January 2018 the Specialty Certificate Examination (SCE) in Gastroenterology and the European Section and Board of Gastroenterology and Hepatology Examination (ESBGHE), will become a single examination which will be referred to as the European Specialty Examination in Gastroenterology and Hepatology (ESEGH).
In the UK, the examination continues to be the General Medical Council (GMC), approved mandatory summative assessment of knowledge for trainees in Gastroenterology and Hepatology.
More information can be found at:
It is a computer-based two-paper test (2 x 3 hour papers, with 100 ‘best of five’ questions in each paper). It can only be taken once a year and can be done at any time after reaching ST3 level. It is thought that most candidates will complete it during ST5-7. It must have been attempted at least once prior to the PYA and passed before CCT.
The examination is made up of questions covering the Gastroenterology curriculum selected by a predetermined blueprint. This blueprint can be found in the below link:
31 example questions can be found on the MRCPUK website:
Best of Five MCQs for the Gastroenterology SCE (Oxford Higher Specialty Training Higher Revision) is a revision guide written by former Severn trainees and available from online booksellers
All candidates who pass the ESEGH will be given the post-nominal Cert. RCP (UK) (Gastroenterology). Upon successful completion of the CCT, trainees who have MRCP (UK) will be eligible to apply to the Royal College of Physicians for MRCP (Gastroenterology).
There is a nominated training lead for each trust (see welcome page). We all meet twice a year to discuss issues relevant to training, ratify rotations etc. There is one junior (ST3 to ST5) and one senior trainee (ST6+) elected to attend these meetings to represent your views.
The current trainee reps are:
Dr James Hawken
Dr Dushen Murugiah
Please contact them if there are any issues that you would like to raise.
All trainees are allocated a set amount of leave and funding to support the delivery of curriculum targets during training. There are 30 days leave. Your GIM and Gastroenterology training days must be taken out of this time allocation. Exam fees can not be claimed.
The administration for study leave is now within the remit of the individual Trust’s postgraduate department. Further detail are available here on the Severn PGME website.
Out of Programme (OOP)
Time can be requested for experience ‘out of programme’ at the discretion of the TPD, the most common being research (OOPR). Other reasons include clinical experience at home (e.g. acting up as a consultant for 3 months, endoscopy fellow post) or abroad (OOPE), career break (OOPC), or other training in a post approved by the GMC (OOPT). For more information on these, please see the Out of Programme page.
If the post you are going to be working in is not a recognised training post and you want it to count towards your CCT then GMC approval must be applied for at least 8 weeks in advance. Posts cannot be approved retrospectively. Please contact both Jo Pickstone at the Deanery and the TPD (Dr Richard Makins) if you are considering planning an OOP, at least 6 months prior to the start date.
If you believe that you have “well-founded personal reasons” you may meet the eligibility criteria for flexible training and then be able to apply for future funding to continue your training on a less than full time. Details about the application process can be found on the Deanery website If you have further enquiries, please contact Joanne Pickstone at the Deanery.
During your StR training, it may become necessary to have to consider the possibility of requesting an Inter-Deanery Transfer (IDT). This may come about because of well founded personal reasons (e.g. the relocation of a partner) or on educational grounds, (e.g. to gain further experience or undertake a particular training module).
A trainer who is selected and appropriately trained to be responsible for the overall supervision and management of a specified trainee’s educational progress during a training placement or series of placements. The Educational Supervisor is responsible for the trainee’s Educational Agreement.
Usually, a Consultant Gastroenterologist at your current placement hospital.
Training programme director (TPD)
Responsible for managing specialty training programmes including StR/Fixed Term Specialty Training Appointments. Organises placements, training days, annual assessments (ARCP), helps the postgraduate dean in managing trainees in difficulties.
Specialist Advisory Committee (SAC)
Part of the Royal College / JRCPTB setup, there is a SAC for each speciality. Roles include advice on speciality training, writing and reviewing speciality curricula, provides external assessors for PYAs, and recommends CCTs.
Joint Royal College of Physician’s Training Board (JRCPTB) (replaced JCHMT & JCBMT)
Through all 3 UK Royal College of Physicians, develop curricula and assessments for the medical specialities. You must enrol in order to be registered as an ST3 on e-portfolio.
Regional unit responsible for implementing specialty training in accordance with GMC approved specialty curricula. Postgraduate Deans work with Royal Colleges/Faculties and local healthcare providers to quality manage the delivery of postgraduate medical training to GMC standards.
Joint Advisory Group on GI Endoscopy (JAG)
Funded by the Royal Colleges, it sets endoscopy standards, accredits endoscopy units, processes individual endoscopist accreditation, maintains training and nursing standards
Gloucestershire Hospitals NHS Foundation Trust
Dr Richard Makins
Great Western Hospitals NHS Foundation Trust, Swindon
Dr Manish Hegde
Musgrove Park Hospital, Taunton
Dr Emma Wesley
01823 333 444
North Bristol NHS Trust, Bristol
Dr Leonard Griffiths
Royal United Hospital Bath NHS Trust, Bath
Dr Julia Maltby
University Hospitals Bristol NHS Foundation Trust, Bristol
Dr Amanda Beale
0117 923 0000
Weston General Hospital, Weston-Super-Mare
Dr Andrew Bell
01934 63 63 63
Yeovil District Hospital NHS Foundation Trust, Yeovil
Dr Katie Smith
01935 475 122
Dr Richard Makins
Dr Sarah Gillett
Trainee representatives on the training committee
Dr James Hawken
Dr Dushen Murugiah
Health Education England – South West
Severn Postgraduate School of Medicine Manager
Ms Joanne Pickstone
Education Programme Co-ordinator for Medicine
American Association for the Study of Liver Diseases
American Gastroenterological Association (AGA)
American Society for Gastrointestinal Endoscopy (ASGE)
The British Association for Parenteral & Enteral Nutrition (BAPEN)
British Association for Study of the Liver (BASL)
European Association for the study of the Liver (EASL)
United European Gastroenterology Federation (UEGF)
e-Endoscopy – evolving online endoscopy training programme developed by the JAG and e-Learning for Healthcare (e-LfH) providing core knowledge and educational support modern endoscopic practice.
British Soceity of Gastroenterology
St Marks Online Colonoscopy course
Wolfson Endoscopy Unit, St Marks Hospital
Courses to help prepare one for the CRC screening exam but also useful for StRs perfecting colonoscopy
The American Gastroenterological Association’s comprehensive, self-directed reference for gastroenterologists to assess their knowledge, earn CME credit, prepare for the GI board/MOC exam or simply keep current on new developments in the field. Useful to help prepare for the SCE exam.
An educational site with training resources for gastroenterology professionals. Highly recommended by the trainees!