Training Matters Opinion – Published in Frontline Gastroenterology
Dr Michael FitzPatrick, Dr Jennifer Clough, Dr Philip Harvey, Dr Elizabeth Ratcliffe
Gastroenterology training is understandably arduous. The UK Gastroenterology curriculum spans diseases of the liver, luminal gastrointestinal (GI) tract and pancreatobiliary system. Trainees must complete periods of specialty nutrition and hepatology alongside the general internal medicine (GIM) curriculum. Certification in gastroscopy is mandatory, and colonoscopy certification is expected for most prior to certificate of completion of training (CCT). Gastroenterology trainees have among the highest rates of burnout within medical specialties, with training negatively affecting relationships and morale, and high levels of reported presenteeism. Gastroenterology previously enjoyed high competition ratios; these are now falling.
Trainees often struggle to acquire colonoscopy skills. A 2018 survey demonstrated half lacked certification as they approached CCT, and decreasing procedure numbers. Endoscopy training for upper GI bleeding (UGIB) represents a further challenge, as out-of-hours (OOH) services are frequently consultant-delivered. These factors drive a need for post-CCT supervision at a time of widespread consultant vacancies.
As sub-specialty areas of gastroenterology become increasingly complex, trainees must invest more time to gain competence. Developing sub-specialty expertise now informally mandates out of programme training.
Time committed to GIM is increasing, which deleteriously affects specialty training time. GIM rota gaps are common, exacerbating pressure on trainees. The European Working Time Directive and 2016 junior doctors’ contract contributed both to reduced specialty training time and continuity. Imminent reforms following the Shape of Training report will reduce Gastroenterology training from five to 4 years, further compounding these problems.
Our increasingly complex craft specialty and reduced training time would inevitably have mandated change. The need to mitigate the impact of the COVID-19 pandemic must now catalyse that change.