M Lockett

Out of programme experience and training: going away to bring something back

During postgraduate gastroenterology specialty training in the UK, a number of opportunities will arise for which a trainee may want to take some time out of their specialty training programme—that is, an out of programme (OOP) activity. There are four types[1][1] of OOP activity:- This article

Sheffield Clinical Research Fellowship programme: a transferable model for UK gastroenterology

Out of programme (OOP) opportunities are to be encouraged. This article gives an insightful view of the Sheffield Clinical Research Fellowship Programme. Unique trainee feedback is provided. The take home message is clear - trainees should grab OOP experiences with both hands! For consultants the logistics described are potentially transferrable to their own regions.

Results of the British Society of Gastroenterology supporting women in gastroenterology mentoring scheme pilot

Introduction Mentorship has long been recognised as beneficial in the business world and has more recently been endorsed by medical and academic professional bodies. Recruitment of women into gastroenterology and leadership roles has traditionally been difficult. The Supporting Women in Gastroenterology network developed this pilot scheme for female gastroenterologists 5 years either side of the Completion Certificate of Specialist Training (CCST) to examine the role that mentorship could play in improving this discrepancy. Method Female gastroenterology trainees and consultant gastroenterologists within 5 years either side of CCST were invited to participate as mentees. Consultant gastroenterologists of both genders were invited to become mentors. 35 pairs of mentor:mentees were matched and completed the scheme over 1 year. Training was provided. Results The majority of the mentees found the sessions useful (82%) and enjoyable (77%), with the benefit of having time and space to discuss professional or personal challenges with a gastroenterologist who is not a colleague. In the longitudinal study of job satisfaction, work engagement, burnout, resilience, self-efficacy, self-compassion and work-life balance, burnout scale showed a small but non significant improvement over the year (probably an effect of small sample size). Personal accomplishment improved significantly. The main challenges were geography, available time to meet and pair matching. The majority of mentors surveyed found the scheme effective, satisfying, mutually beneficial (70%) and enjoyable (78%). Conclusion Mentorship is shown to be beneficial despite the challenges and is likely to improve the recruitment and retention of women into gastroenterology and leadership roles, but is likely to benefit gastroenterologists of both genders.

Gender differences in leadership, workforce and scholarly presentation within a national society: a gastroenterology perspective

In the UK, gastroenterology has been a male predominant medical speciality. Data regarding gender within workforce, academia and leadership at a national level are lacking. Data regarding scholarly presentation at the following annual conferences were collected and analysed; British Society of Gastroenterology (BSG) 2013, 2014, and Digestive Diseases Federation (DDF) in 2015. Data from the 2013–2015 BSG annual workforce reports were examined. In 2015, female higher specialty trainees (STs) made up 39% (328/848) of the trainee workforce, versus 37% and 35% in 2014 and 2013. From 2013 to 2015, less than a fifth of all consultant gastroenterologists were women. Female consultant (18%), ST (39%), associate (86%) and student attendance (47%) at DDF 2015 did not change significantly from 2013 to 2014. Female speakers (trainees and consultants) were significantly lower at DDF 2015 compared with BSG 2014; 43/331 (13%) versus 56/212 (26.4%) (p=0.0001) and BSG 2013 63/231 (27%) (p=0.0001). The number of female chairs, delivery of the named lectures and prizes awarded to women did not differ across the 3-year period. Female leadership via representation at Council and Executive at BSG was 4/30 (13%) in 2015 and did not differ in 2013/2014, with no elected council members since 2008 and one female president in 1973. The proportion of female gastroenterology trainees and consultants is increasing, but remains lower than across all medical specialties and is reflected in attendance and scholarly contributions. Action within the BSG is underway to address female under-representation in leadership roles.

Trends in UK endoscopy training in the BSG trainees’ national survey and strategic planning for the future

Background Improvements in the structure of endoscopy training programmes resulting in certification from the Joint Advisory Group in Gastrointestinal Endoscopy have been acknowledged to improve training experience and contribute to enhanced colonoscopy performance. Objectives The 2016 British Society of Gastroenterology trainees’ survey of endoscopy training explored the delivery of endoscopy training - access to lists; level of supervision and trainee’s progression through diagnostic, core therapy and subspecialty training. In addition, the barriers to endoscopy training progress and utility of training tools were examined. Methods A web-based survey (Survey Monkey) was sent to all higher specialty gastroenterology trainees. Results There were some improvements in relation to earlier surveys; 85% of trainees were satisfied with the level of supervision of their training. But there were ongoing problems; 12.5% of trainees had no access to a regular training list, and 53% of final year trainees had yet to achieve full certification in colonoscopy. 9% of final year trainees did not feel confident in endoscopic management of upper GI bleeds. Conclusions The survey findings provide a challenge to those agencies tasked with supporting endoscopy training in the UK. Acknowledging the findings of the survey, the paper provides a strategic response with reference to increased service pressures, reduced overall training time in specialty training programmes and the requirement to support general medical and surgical on-call commitments. It describes the steps required to improve training on the ground: delivering additional training tools and learning resources, and introducing certification standards for therapeutic modalities in parallel with goals for improving the quality of endoscopy in the UK.

OC-038 Making The Change: Switching to Infliximab Biosimilars for IBD at North Bristol NHS Trust

Introduction Infliximab biosimilars have been available since February 2015, however at the time there was limited guidance on how to introduce the products. The PLANETRA and PLANETAS studies demonstrate that biosimilars are equivalent in clinical efficacy when compared to Remicade®. From the 1st July 2015, the gastroenterology department at NBT introduced biosimilar infliximab making cost savings of £200,000. A 50:50 gain share agreement was negotiated with the local Clinical Commissioning Groups and these savings will be re-invested into Gastroenterology services. Here we describe how a multidisciplinary approach led to a safe transition to biosimilar infliximab. Methods An additional pharmacist was funded to implement the switch using projected savings from the gain share. Patients who were established on Remicade® were sent a letter with details of the proposed switch and given the opportunity to raise any concerns in a consultation with the specialist pharmacists in Gastroenterology. Verbal consent was obtained prior to switching to Inflectra®. Practical guidance for the prescribing and dispensing of biosimilar infliximab was circulated to clinicians and pharmacy staff. Educational sessions were provided to the Medical Day Case Unit nurses. Adverse events were reported via the Yellow card® Scheme and the Biologics Therapy Audit. From December 2015, patients were asked to complete a survey to explore their experiences leading up to and during the switch. We decided not to study clinical outcomes as the sample size is misrepresentative and the follow-up period too short to draw meaningful conclusions. Results In total, 64/65 patients consented to the switch. Following the switch, 7 patients discontinued treatment (2 post-surgery; 5 switched to alternative biologic). We received a 46% response rate to the survey. Patient feedback was largely positive. 83% of patients received the written correspondence; 93% reported that they understood the information leaflet in part (23%) or in full (70%). 96% had the opportunity to speak to pharmacist before their first infusion. Overall, 97% of patients were satisfied with the changeover process. Conclusion We have demonstrated how a multidisciplinary approach allowed the successful switch to a biosimilar within 3 months and the potential benefits to be had. The additional pharmacist post, funded by the projected gain share, will be made a substantive this year allowing for closer monitoring and optimisation of biologic treatment. This will lead to further cost savings through discontinuation of these drugs where appropriate. Since the completion of this project, the BSG has revised their statement to acknowledge that there is sufficient evidence to recommend use of biosimilar infliximab in IBD. Disclosure of Interest L. Chung: None Declared, B. Arnold: None Declared, R. Johnson: None Declared, M. Lockett Conflict with: sponsored by MSD to attend conference in 2016

PTH-120 How Can We Improve Recruitment and Support Gastroenterology Trainees in The UK? Results from The Supporting Women in Gastroenterology (SWIG) Survey

Introduction In gastroenterology, whilst numbers are increasing, women remain under-represented at both trainee and consultant grade compared with other medical specialties at 52% and 34% respectively.1 The aim of this survey was to identify the key issues around recruitment and support of trainees and consultants. Methods A comprehensive survey was designed and circulated to consultants and trainees in gastroenterology, all of whom were members of the BSG. Data regarding demographics, working patterns, professional experiences and opinions was collected and analysed. Results The survey was sent to 1900 people, 600 people opened the email and 186 responded, a response rate of 9.79%. 107 of respondents were female (62.9%), 16 respondents did not declare gender. Data was available for 183 responses. Important reasons for choosing a career in gastroenterology were practical procedures (23.3% of responses; n = 117, 59.8% female versus 39.3% male (gender not declared n = 1), a positive prior gastroenterology job (19.9%; n = 100, 66% female versus 34% male) and an inspirational local gastroenterologist (14.7%; n = 74; 63.5% female versus 35.1% male (gender not declared n = 1)).155 (94.5%) respondents would recommend a career in gastroenterology to a junior doctor (60% female versus 38.7% male (gender not declared n = 1)). Important factors in encouraging junior doctors to become gastroenterologists were reducing GIM activity (17.7% of responses; n = 91, 60.4% female versus 38.4% male (gender not declared n = 1)), role models (14.2%; n = 73, 68.5% female versus 31.5% male) and mentorship schemes (11.9%; n = 61, 60.7% female versus 37.7% male (gender not declared n = 1)). Factors thought to be helpful in supporting existing trainees were mentorship schemes (17.1% of responses; n = 78, 60.3% female versus 39.7% male), additional training and networking (14.5%; n = 66, 51.5% female versus 48.5% male) and reducing out of hours activity (13.1%; n = 60, 68.3% female versus 31.7% male). Conclusion Recruitment to gastroenterology could be improved by reducing GIM activity and developing mentorship schemes. Mentorship schemes, access to additional training and networking and reducing out of hours commitments were thought to be the most useful factors that would support existing trainees. It would be beneficial to focus on developing solutions for these key issues. Reference 1 Census of consultant physicians and higher speciality trainees in the UK, 2014-2015. Royal College of Physicians, 2016. Disclosure of Interest None Declared

PMO-251 A retrospective audit of colorectal cancer surveillance in inflammatory bowel disease in secondary care

Introduction Patients with colitis are at increased risk of colorectal cancer (CRC). Colonoscopic surveillance to detect dysplasia and early cancers has been advocated by the BSG since 2002.1 Our aims were to assess whether patients with colitis in our patient cohort are receiving appropriate colonoscopic surveillance for CRC according to these guidelines, and to assess the impact of the updated 2010 BSG guidelines2 on local endoscopy services. Methods Patients with IBD were identified from secondary care coding databases and verified by paper records. A retrospective review of case notes was performed. Data on diagnoses, duration of symptoms, extent of disease and CRC surveillance was collected and analysed. Individualised recommendations for colonoscopic screening and surveillance were made according to the 2010 BSG guidelines. Results 45 colitis patient records were reviewed; 20 CD: 25 UC, M:F 23:22. The average age was 59.4 (range 18.6–87); average duration of disease 18.6 (range 0–56). 35 (78%) had colitis extent requiring surveillance. 26 patients (58%) had symptom onset >10 years; 11 patients (42%) underwent screening colonoscopy at 8–10 years; 14 (54%) did not, one patient underwent colonoscopy but date of diagnosis was unclear. Nine patients (35%) underwent inconsistent surveillance, in six patients (23%) there was no record of a colonoscopy. Reasons for inconsistent or absent surveillance included non-attendance (2), patient declined (1) and unclear (11). 24 patients were eligible for repeat colonoscopy; 3 (13%) underwent this at the recommended interval; one patient was due in 2011; 11 (46%) underwent inconsistent surveillance; nine (38%) did not undergo any surveillance. Reasons for absent or inconsistent surveillance included non-attendance (2), lost to follow-up (1), patient declined (1), procedure unnecessary due to disease extent (1), patient undergoing surgery in the interval between colonoscopies (1) and unclear (14). Of 26 patients eligible for surveillance, 3 were excluded due to disease extent and intervening surgery. Of 23 remaining patients, the surveillance interval between colonoscopies would be increased in 12 patients (52%), unchanged in 6 (26%) and reduced in 3 (13%) with the introduction of the 2010 BSG guidelines. The impact was unclear in two patients (9%). Conclusion Patients with colitis in our patient cohort at NBT are not receiving appropriate CRC surveillance according to BSG guidelines. These results emphasise the need for a robust coordinated surveillance programme. The 2010 guidelines have had the net effect of increasing the time interval between colonoscopies, which may lead to an overall reduction in endoscopy workload from surveillance cases. Competing interests None declared. References 1. Eaden JA, Mayberry JF. Gut 2002;51(Suppl V):v10–12. 2. Cairns SR, et al. Guidelines. Gut 2010;59:666–90.

Colorectal cancer surveillance in inflammatory bowel disease: a primary care perspective

Introduction Patients with colitis are at increased risk of colorectal cancer (CRC). The British Society of Gastroenterology (BSG) has been advocating colonoscopic surveillance to detect dysplasia and early CRC since 20021. The aim is to assess whether patients with inflammatory bowel disease (IBD) in primary care have been receiving appropriate surveillance for CRC according to the BSG guidelines (2002). Methods Three GP practices were audited. Patients with IBD were identified from primary care computerised records by searching for IBD, Crohns disease, ulcerative, indeterminate and distal colitis and proctitis. Cases were verified by paper records. Data regarding diagnosis, date of symptom onset, disease extent and CRC surveillance was collected and analysed. Individualised recommendations were made according to the current BSG guidelines for CRC surveillance. A detailed report was given to the primary care practice, and patients not known to secondary care were added to the North Bristol NHS Trust IBD database. Results 166 patients were identified with IBD from 29 054 patients. 100 patients (60.2%) had colitis extent requiring surveillance. 59 patients (59%) had symptom onset >10 years; 10 patients (16.9%) had undergone colonoscopy at 8–10 years, 19 (32.2%) had not and 6 (10.2%) are due in 2010. 11 (18.6%) had an unknown extent of disease but no clear surveillance, and 13 (22%) had no record of any colonoscopy within their notes. Of 59 patients, 37 (62.7%) were eligible for repeat colonoscopy; 3 (8.1%) had undergone this, 27 (72.9%) had not and in 7 (18.9%) it was unclear from records. Conclusion Records in the practices we audited were unclear and incomplete, but it appears that patients with IBD in primary care are not receiving appropriate CRC surveillance. This emphasises the need for a reliable surveillance programme with established links with secondary care.

Colorectal cancer surveillance in IBD: a retrospective review

Introduction Patients with colitis are at increased risk of colorectal cancer (CRC) and colonoscopic surveillance to detect dysplasia and early cancers has been advocated by the British Society of Gastroenterology since 20021. Our aim is to assess whether patients with colitis who developed CRC had received appropriate colonoscopic surveillance. Methods Patients with colitis who developed CRC between 1999 and 2009 were identified from cancer Multidisciplinary Team summaries and histopathology records. A retrospective review of case notes was performed. Data on diagnoses, duration of symptoms, extent of disease, CRC surveillance and CRC diagnosis was collected and analysed. Results 16 cases of colitis and CRC were identified (M:F 12:4) from our IBD patient cohort of 1820. 10 patients had an underlying diagnosis of ulcerative colitis (4 E2, 4 E3)2, and 6 patients had been diagnosed with Crohns disease (3 L2, 3 L3)2. The mean age of diagnosis of CRC was 64.5 years (range 47–87). The average duration of underlying disease was 19.4 years (range 0.5–44). 12 patients (75%) had symptom onset of >10 years ago; 3 patients (25%) had an initial screening colonoscopy at 8–10 years. 8 patients (75%) were having surveillance, of whom only 2 (25%) had surveillance in accordance with BSG guidelines 2002, and 6 (75%) had inconsistent surveillance. Reasons for patients undergoing inconsistent surveillance included non-attendance for booked colonoscopy (1), patient unknown to or discharged from secondary care and colonoscopy not organised by GP (3), patients undergoing surveillance with barium enemas (1), patient thought to be small bowel disease only (1), patient living abroad at times (1) and patient presented at 10 years with CRC (1). 1 CRC (8.3%) was diagnosed by surveillance; the remaining 11 cases were interval cancers. The only patient diagnosed with CRC by surveillance was staged at Dukes A. 5 patients (41.7%) presented with advanced disease (Dukes C, D), and 11 patients had surgical procedures (3 panproctocolectomy + ileostomy, 3 subtotal colectomy, 5 limited resections). 3 patients (25%) have subsequently died (CRC as cause of death in all cases). Conclusion Patients with colitis have not received appropriate CRC surveillance in our trust according to the BSG guidelines (2002), and further auditing of our cohort of IBD patients is required. These results emphasise the need for a coordinated, reliable surveillance programme.