253 Residents getting training for FCPS in Gastroenterology at 31 Centers under 44 Supervisors


 PSG’s 33rd Annual Congress Proceedings-II

253 Residents getting training for FCPS in
Gastroenterology at 31 Centers under 44 Supervisors

Training period cannot be increased from three to four years but centers
with inadequate training facilities, limited number of procedures
can be off listed- Zaigham Abbas

Three years training for Fellowship in Gastroenterology is not enough as
many centers do not have adequate facilities and do limited
number of procedures - Saad Khalid Niaz

KARACHI: At present there are thirty one training centers recognized by the College of Physicians & Surgeons of Pakistan for Fellowship in Gastroenterology with forty four accredited supervisors and two hundred fifty three postgraduates are under training. It is not possible to increase the period of training from three to four years but those centers where the workload is not much and the trainees do not get enough exposure may be off-listed after a careful review. This was hinted by Prof. Zaigham Abbas, Dean Faculty of Gastroenterology at the CPSP while speaking at the recently held 33nd annual conference of Pakistan Society of Gastroenterology and GI Endoscopy.  He was speaking at the Training and Collaboration session during the congress held on March 11, 2017, Day two of the conference. This session was jointly chaired by Prof. Ghias UN Nabi Tayyab, Prof. Zaigham Abbas, and Dr.Ali Akbari Sari from Iran and Dr. Greger Lindberg from Sweden from Sweden. Prof. Shahab Aid moderated the session.

Photographed during the Training and Collaboration session at the PSG’s 33rd Annual Conference held at Karachi
are Dr. Saad Khalid Niaz, Prof. Shahab Abid, Prof. Ghias Un Nabi Tayyab, Dr.Ali Akbari Sari,
Paul Hagan, Prof. Zaigham Abbas, Dr. Greger Lindberg and others.

Prof. Paul Hagan from UK was the first speaker who talked about Endoscopic Training in UK and how can we adapt or adopt it. He pointed out that till 1988 there was no training list. It was real passion and drive which was needed to succeed. In 1998 some areas had centers which provided good training. There was increasing specialization and case studies. Few people got together and started discussing what should be mandatory for training in gastroenterology.  It was in 2008 that we had dedicated training list, job protocols and the sign off trainees were monitored. Then we had an enlarged endoscopic training programme. We also had accredited training centers with TCT and TGT qualifications. In 2016 the dedicated training was started all over the UK and now all trainees are first registrars.  All trainees have annual review of their programme of training. There is a pre-placement meeting for all the trainees. For the endoscopy training programme there is an induction meeting, mentorship is offered to observe and training of faculty. It is mandatory that all faculty members must attend a training center atleast once a year.

He then talked about DOPS the directly observed performance scopes, the joint advisory group of GI endoscopy (JAG). He then gave details of the JAG Endoscopy Training System and Training Centers. In order to adapt or adopt any system, it takes a long time.  It reduces the risk to patients and trainees.  One needs to mix it all with adapt and education.  During the congress we had some excellent workshops. Working together offers many benefits and it was the way forward, he concluded.

Prof. Zaigham Abbas from Ziaudidn Medical University highlighted the role of College of Physicians & Surgeons Pakistan in postgraduate training in gastroenterology. The postgraduates have do FCPS-I and then two years training in internal medicine or they must have done FCPS-II in internal medicine before they are enrolled in this training programme. There is three years training in gastroenterology. One has to get registered with RTMC at CPSP. He also discussed the responsibilities of residents and supervisors. Trainees have to either write a dissertation or two original research papers the synopsis of both must be approved by the RTMC. The postgraduates are supposed to be either first or second author in these papers. They have to provide details of the procedures performed. There is compulsory workshop for the trainees. Knowledge, skill and attitudes are important part of the curriculum. Two hundred fifty three trainees are currently enrolled which are under training at thirty one centers by forty four supervisors. The supervisors get CME credit hours. He also gave details of TOACS which has replaced OSCE and DOPS.  CPSP also offers second Fellowship in Gastroenterology after one has done FCPS in Medicine. There are workshops for the Fellows on Radiation safety, endoscopic equipment while washing & sterilization of endoscopes will also be added, he remarked.

This was followed by an excellent presentation by Dr. Saad Khalid Niaz a noted gastroenterologist who is working at Civil Hospital Karachi in a surgical unit on honorary capacity. The topic of his presentation was Research and Training opportunities at Civil Hospital Karachi. Tracing the history of his affiliation with this surgical unit, Dr. Saad Niaz said that to begin with it was just to provide a service at a public hospital. It is a properly equipped and adequately staffed with training tools and we have adequate number of cases. We do all sort of GI procedures with acceptable results and complications. We have a proper record keeping, there is dedicated time for teaching and the trainees are approved and accredited for training.  This fact is recognized by the college and the Pakistan Society of Gastroenterology and GI Endoscopy.

Dr. Saad Khalid Niaz

Continuing Dr. Saad Khalid Niaz said that we have no guidelines for Evaluaiton of training progamme. It is not possible to provide adequate training in gastroenterology to the residents in three years time because many people after having spent three years in training then come to us to work and learn. Some of the accredited training centers, he opined, were not doing enough number of cases. We started this service in October 2006 at surgical unit in Civil Hospital Karachi. So far we have done 8,320 ERCPs, 13,487 OGDS, 4,519 colonoscopies, 836 EUS and 89 capsule endoscopies since 2009.  Since 2010 we have performed 55 Enteroscopies and we have also started spyglass. Over the years we have trained seven Fellows, four are doing advanced procedures regularly. Our training programme is just like the one practiced in UK. We have colonoscopy workshops. For inducting trainees we select one candidate from each province and one from the federal capital. Our teaching and training faculty comes from UK and USA besides Pakistan. So far we have had five Hands on Workshops on ERCP, nine Hands on Workshops on colonoscopy. We have regular sessions with foreign faculty on Skype. Each candidate gets five colonoscopies during the course. We just had eighth hands on course. We organize international workshops and have feedback from the trainees on regular basis. We have eighteen publications and made twenty-five presentations at various conferences at home and abroad. We are part of the Asia Pacific Spyglass Registry. Personally it has been extremely rewarding for me and I have learnt a lot and we are also providing a service. He laid emphasis on recognition by CPSP, collaborative Fellowship, starting advance Fellowship in EUS and ERCP by the CPSP. We are shortly going to start EUS course as well, Dr. Saad Khalid Niaz remarked.

Dr. Tayyab Saeed Akhtar from Holy Family Hospital Rawalpindi was the next speaker who gave details of Research and Training Facilities at HFH under the supervision of Prof. Mohammad Umar, Consultant Gastroenterologist and Principal of Rawalpindi Medical College. He pointed out that we have purpose built facility. We have dedicated facility for ERCP, EUS, conference room, library including Digital library. We have our own histopathology lab and we can provide FNA facility.  So far we have performed 1002 EUS, organized several workshops. The number of patients being treated at the center is increasing. So far we have performed more than two thousand ERCPs. We have a separate Radio Ablation room at our facility. We have organized some courses on Radio Frequency Ablation as well. We have Fibroscan which has reduced the need for liver biopsies. We have Endoscopy Skills Laboratory where the trainees are provided training before they are allowed to work on the patients. We also have a Video library for the trainees. We have MD and FCPS training programme and so far we have trained 14 FCPS and four MDs. We have conducted numerous CME courses, eight Advanced ERCP courses with the help of international faculty. All the details about the unit are available on our website www.pakistangastrohep.org he added.

Prof. Saeed Quraishy along with Prof.Aamir Ghafoor chairing one of
the scientific sessions during the PSG’s 33rd Annual Conference.

Dr. Amna Subhan describedher personal experience of training in Bangkok Thailand. She pointed out that for ERCP temperament and consistency is needed. It is a five years of Graduate Gastro training programme. Dr. Faisal Wasim described his Singapore experience. He pointed out that Fellowship training is available at various specialist centers where one can go but it is essential to get registered with Singapore Medical Association which may take ten to twelve months. They check all the details of education, training and accreditation of the training facilities. He particularly pointed out that if you can develop good rapport with technicians and nurses, they will be very helpful.

Dr. Greger Lindberg from Sweden remarked that they do have training courses in endoscopy and it is important to learn. We have GI Histology course. It was extremely important to learn how to establish good doctor patient relationship. Dr.Ali Akbar Sari from Iran speaking at the occasion said that there are two Gastroenterology Centers in Iran.  Tehran University of Medial Sciences has a training programme while Shiraz has a very big Transplant Center. We are open to collaboration and we can learn a lot from each other. We have such training programmes. Iran has five Gastroenterology Journals. We must collaborate because multicentre studies are more important, Dr.Ali Akbari Sari remarked.

Prof. Baddar Fiyaz Zuberi presenting certificate to Prof. Varocha Mahachai from Thailand and some other speakers
at the 33rd Annual Conference
of Pakistan Society of Gastroenterology and GI Endoscopy held at Karachi recently.

During the discussion Dr.Saad Khalid Niaz remarked that three years training programe in gastroenterology was not enough. Many procedures are not performed at some of the centers which are recognized for training. He further suggested that training should be at multiple centers and let the trainees rotate for some time at different centers working with different trainers. It will improve the FCPS training in gastroenterology. He also suggested starting some super specialist training. Prof.Zaigham Abbass Dean of Gastroenterology at CPSP pointed out that it was not possible to increase the training period from three to four years. Currently someone first does FCPS in Medicine and then get three years training in Gastroenterology for Fellowship which is a second fellowship.  The training period becomes seven years. If we increase the gastroenterology training to four years, it will be too hard for the postgraduates. What we can do is to identify a few centers for advanced training.

We can also have another look at the accredited training centers and those with inadequate facilities, limited number of procedures can be off listed. It was also emphasized during the discussion that we must give importance to collaborative management and the training centers should be empowered. We need to develop a system and not centers which should be accredited. It was also suggested that we can have special programmes in Diagnostic Gastroenterology, Endoscopy which is important but advanced procedures can be looked into later. Dr. Greger Lindberg from Sweden remarked that they had four years training programme at Karolinska Institutet.