CAGS-CAG Joint Endoscopy Meeting
Minutes
Sept. 10th, 2016
Library Room, Fairmont Royal York Hotel – Toronto, ON
Present:
Chair: Dr. Mark Walsh
Dr. David Armstrong
Dr. Sean Cleary
Dr. Chris de Gara
Dr. Tony Gomes
Dr. Steve Heitman
Dr. Lawrence Hookey
Dr. Jim Ellsmere
Ms. Jasmin Lidington
Dr. Adam Meneghetti
Dr. Michael Ott
Dr. David Pace
Mr. Paul Sinclair
Dr. Chris Vinden
Dr. Cliff Yaffe
- Welcome
Dr. Walsh welcomed those present and called the meeting to order at 10:05 AM.
- Approval of Agenda
Dr. Walsh asked for any additions to the agenda. There were no additions to the agenda.
- Business Arising
a)Joint CAG-CAGS Endoscopy Task Force: Structure, mandate and governance
Dr. Walsh introduced the concept of a joint endoscopy task force that would be shared between CAGS and CAG. In light of the fact that both Gastroenterologists and General Surgeons provide endoscopic services, a joint task force made good sense and both boards were very supportive of its creation. Dr. Ellsmere referenced to the meeting held at the Canadian Digestive Disease Week (CDDW) last February where it was suggested that the joint task force would host two meetings annually (one at the Canadian Surgery Forum and one at the CDDW),and formalize membership of the joint task force that would be co-chaired between the two organizations. The members present from CAG said that the CAG Chair would logically be Dr. Steve Heitman. Dr. Walsh said that CAGS would name a co-chair and other members to sit on the joint task force after consultation with those interested. Dr. Stephen Kelly requested that there also be representation from the Canadian Society of Colon and Rectal Surgeons on the task force and all agreed. The optimal number of people to sit on the task force would be between six and ten.
One purpose of the Joint CAG-CAGS Endoscopy Task Force would be to promote quality of endoscopic services in Canada that focused on two levels of quality: 1) Competency, and; 2) Maintenance of competence, and that these two levels were not tied to the Competence by Design model of the Royal College. Another purpose would be to develop national statements and guidelines around endoscopic services. Dr. Armstrong said that CAG used a rigorous statement development process supported by their quality assurance committee that was widely respected and based on consensus. The last statement produced was seven or eight years old and there was a need to draft a more current one and this would be an excellent first undertaking for the Joint CAG-CAGS Endoscopy Task Force.
The model in the UK (JAG) which the SEE Program is based on, provides a training and oversight mechanism for the evaluation and assessment of new technologies and interventions that come into society. This provided a wonderful opportunity to demonstrate collaboration and would be a good exercise to vet mutual statements of interest and to create clinical practice guidelines. With the continuing rollout of colorectal screening programs across the country, these capabilities and activities were important and much needed.
b) SEE Program
Dr. Walsh said that he had read the SEE Program Memorandum of Understanding (MOU) document and suggested there may be an issue with the point of 1/3 Surgeons and 2/3 Gastroenterologists enrolment clause, since there were potentially so many more General Surgeons who would enroll for the course. He asked if training General Surgeons to become faculty created any kind of issue for CAG and Mr. Paul Sinclair said that there was no issue with Surgeons becoming faculty but there was an issue getting enough people prepared due to the resources required to run the program. Becoming faculty of the program took six to eight courses and that could be done in 12 – 18 months. Dr. Walsh asked Mr. Sinclair for a list of Surgeons who were waiting for the course and Mr. Sinclair said he would provide that to Ms. Lidington. This could be done on an ongoing basis to understand if the Program is working effectively for CAGS Members. Mr. Sinclair added that theresources that are needed to run the course have been a challenge in the past and some courses have been cancelled because they haven’t had an external faculty member available to evaluate. Dr. Walsh said that the MOU had been drafted as a two year agreement and that provided a decent term to pilot the collaboration.
c)Non-Specialists Performing Endoscopy
Discussion on the issue of non-specialists performing endoscopy related to the idea that these individuals were potentially fulfilling some kind of societal need and the concern was strictly about safety and quality. Dr. Armstrong said that it wasn’t the responsibility of CAG to declare who can and who cannot perform endoscopic services. The focus needed to be about expectations for anyone performing endoscopic services and part of the rationale for the creation of guidelines was to demonstrate what was expected from all Endoscopists. He added that any procedure done without a report was a waste of time and the worst cases were ones that were done unnecessarily.
d) Ratification of Position Statement
Dr. Armstrong asked where this draft statement from CAGS was going and Dr. Chris de Gara said that both federal and provincial governments needed it to be taken seriously when asking for wider implementation and support for the SEE Program or when trying to demonstrate the level of commitment to quality in endoscopic services in Canada. Dr. Walsh suggested that this would be a good starting point for the Joint CAG-CAGS Endoscopy Task Force. All agreed that would be a good place to start.
4) Next Steps:
1)Ms. Jasmin Lidington and Mr. Paul Sinclair would draft terms of reference in the next month for the Joint CAG-CAGS Endoscopy Task Force.
2)CAGS Leadership would determine individuals who will represent on the Joint CAG-CAGS Endoscopy Task Force
3)The Joint CAG-CAGS Endoscopy Task Force would draft a position statement on endoscopy as a first order of business.
4)Ms. Lidington would send Mr. Sinclair the MOU with the recommendations from the CAGS legal counsel for signing.
5)The SEE Program MOU would be evaluated over the next two year period to assess if it was effectively serving the needs of Surgeons
6)Mr. Sinclair would send Ms. Lidington the numbers of Surgeons who were waiting to take the SEE courses.
7)The next meeting would be coordinated between Mr. Sinclair and Ms. Lidington
b)Adjournment
Dr. Walsh adjourned the meeting at 10:50 AM EST.