As chair of the British Society of Gastroenterology (BSG) trainees’ section, I am acutely aware of the impact that COVID-19 has had on the lives of higher speciality trainees (HST). Prior to COVID-19, there were significant pressures on the HST workforce, with high levels of burnout reported by the Royal College of Physicians’ (RCP) census 2019(1). Our BSG trainee surveys over recent years have noted difficulties for trainees, including completion of certification in colonoscopy – though not mandated at certification of completion of training (CCT) is certainly expected – and concerns about achieving competencies when HST time reduces from 5 years to 4 with the Shape of Training(2).
Then the pandemic created a perfect storm of escalation rotas, massive reduction in endoscopy which decimated training opportunities, and disruption to speciality-specific work such as clinics. Add this to pressure on home life: we are frequently called as a group “trainees” which is a term that can seem reductive. “Trainees” are, in reality, highly specialised professionals who not only are 5-10 years into their work as doctors, but also parents, homeowners, researchers, artists and beyond. The term trainees can feel minimising, and this comes on top of COVID-19 minimising our world outside of work.
Many of us have been personally affected by loss associated with the pandemic and the impact of COVID-19 on our own health. Personally, we lost a dear family friend only a few weeks ago who was the “young one” in my parent’s friendship group. As I processed the news of her death, my mum informed us she had been called for the vaccine and the wave of relief carried so much weight that had built up over the last year. Not seeing family, friends, and missing our usual outlets from work has been chipping away at our resolve. Even without the pandemic our HST years are intense. My father, who spent some years of our childhood staying midweek 200 miles from home, once said how hard it was that your peak work commitments and peak home commitments often come at the same time. Work demands so much of you at exactly the time you want to be with your family. Many of us will have lost time to commuting around regions, delayed putting down roots and potentially even delayed family life due to the way training is structured.
I say all this to highlight the importance of a lesson raised by Dr Shirley Remington at our recent trainees committee webinar – self-compassion. As doctors, we have always aspired to high achievement – great exam results, the right training post, great research – so when the COVID-19 pandemic made patient care a struggle, training a struggle and home life a struggle, we automatically carried the weight of this personally. Dr Helen Fidler from the BSG council talks often of moral injury: how the discrepancy between what we want to do in terms of patient care and what we can achieve in the context of a struggling system and a global pandemic weighs on us as a personal failure.
We need to learn methods to protect ourselves and be compassionate to ourselves when this occurs. To reframe what we see as personal failure into how hard we have worked to achieve what we have, to look for good things we have done each day. I feel this particularly affects our work in general internal medicine when we do not get the opportunity to value the work we do there, the lives improved or saved as it feels like we just need to “get through” each shift sometimes – not because we cannot do it but often because years of underfilled rotas and workforce issues.
I highly recommend watching back Dr Remington’s talk on the BSG website and taking some time to be kind to yourself. As the BSG trainees committee we see you, we see the hard work you are doing and we are speaking out on your behalf to improve higher speciality training for you and future colleagues. There are positives to look to, though COVID has been a struggle for endoscopy training, money is being made available for endoscopy training academies – an intervention already needed that has been expedited by the pandemic. Virtual training opportunities are widely available, bringing international meetings to your home at more convenient times and financial affordability. The RCP is putting pressure on the government to address workforce issues for the future. The BSG, RCP, and others are working to make available resources to help those having difficulty. Please see below some contacts for you if you need anything.
From the BSG trainees committee side, I am proud to chair a committee of enthusiastic and dedicated reps who have worked hard this year despite their other commitments and will continue to in the coming years. We have elections for several rep positions coming up, so I really encourage you to apply and get involved. And lastly, please contact your local reps if we can help support you in any way over this challenging time, you are the future of gastroenterology and we need you so please let us know how best we can help.
Read the wellbeing resources from the RCP here.
- Focus on physicians: 2018–19 census (UK consultants and higher specialty trainees) | RCP London.
- Clough J, Fitzpatrick M, Harvey P, Morris L. Shape of training review: an impact assessment for UK gastroenterology trainees. Front Gastroenterol. 2019;10(4):356–63.