The main purpose of getting old is to be grumpy, live in the past, and above all complain about everything. I seem to be settling into the role quite well. It gives one the permanently satisfying inner glow, of living with inevitable disappointment. “They said it couldn’t get any worse and behold, – it did!”
With that, naturally, goes being cynical about the next generation. The past was always better. No doubt aging Tyrannosaurs were complaining about the next generation of Velociraptors just as the meteor struck. It is not a view that I adhere to. The past was not uniformly better by any stretch of the imagination. The young people coming into medical school at the moment, are as bright, motivated, and caring as I was. I remain as passionate about being a doctor as I was on the first day I stepped into the Medical Quad at Edinburgh University. Perhaps now more confident and a little less frightened than I was then. And with a marginally better hair cut.
The past is always comfortable. It is a film we have seen before. We know how it ends, we cannot change it, so the past holds no fears. Nor, contrary to popular belief, is the future necessarily scary. It has not happened yet. There is always the opportunity to change the future. It could be bad, but it might be better. The scariest time to live in is always the present.
At the moment, our trainees are facing real difficulties. As we enter a second, and possibly a third wave of COVID, our trainees, the future of our specialty, have been diverted away from training. Perhaps the NHS as a service, has no choice, particularly in areas entering Level 3 restrictions. Inevitably training will reduce or pause, but as we come out of each wave, it is important that training resumes quickly and that the service demand for “volume at all costs”, doesn’t halt all training lists and clinics, because without them we will stoke up a whole heap of trouble for the future.
It is possible that diagnostic and treatment centres and endoscopy academies, with immersive, intensive training may be the way of the future, but they are in the future and depend on the goodwill of managers and planners, and also money. To help our current trainees, we also need to remain firmly rooted in the scary present.
This means protecting training time as the service resumes, if necessary by extending the working day and maximising our existing space. Mentoring and assisting new colleagues, who may not always be confident in their skills, has always been important, but will be even more so in the days ahead.
Fellowships, and other ways of enhancing training, not just in endoscopy but in hepatology and nutrition, will be important and they need to be funded. We need to persuade the Departments of Health in all Four Nations that fellowships provide not only immediate enhanced training, but also an immediate return on investment for the service. We also need to remember that training in gastroenterology is not just about endoscopy, but also outpatients and ward work as well. The outpatient service, in particular, has been transformed or devastated, depending on your viewpoint, by the COVID pandemic.
A few weeks ago I had the privilege of sitting in on the trainee’s weekend. It was relevant, well-organised, and inspiring. As the Twitter feeds and chatlines confirmed, our trainees really care about their training, but equally about their patients and also what the service they will provide will look like in the next ten years, and how we will ensure quality.
In a few weeks, we have our Introduction Day and the Taster Weekend, when we have to lay out our stall and persuade the next generation that gastroenterology and hepatology are the specialties they really want to go into.
Cynicism and despair kill specialties, particularly in the minds of younger colleagues. If we send out a message that our training is rotten, that it cannot be completed within four years, that less than full-time training is inferior and that, even if you make it to the dizzy heights of being a consultant, you won’t enjoy it, or have any time to research or see your family again, we will die as a specialty. Exactly the same arguments apply to being a nurse, or a GI physiologist, or a dietitian.
So we need to turn our thinking on its head. To the next generation of velociraptors I would say:
This is a great specialty to be in: we have plenty of work and opportunity.
The learning in Gastroenterology and Hepatology is lifelong. It always was, still is and always will be. You will not get bored.
I needed help and encouragement early in my career. I was lucky to work with people who provided it and passionately believed in gastroenterology. I remember a senior colleague looking at an SHO, with an increasing sense of despair, when he was told that he planned to take up a career in cardiology. “But why would you want to do that,” he said, “it’s just a pump, some pipes and one hormone, when you could have the whole complexity of the digestive tract on which to build a career. We still have poorly understood conditions, chronic diseases and most of the major malignancies to discover and research. We have shown that we can master peptic ulcer, Hepatitis C and countless other conditions. Why would you not want to join us?”
As endoscopists, we have some of the ultimate hands-on skill sets, which thanks to the renaissance in endoscopy training, we can help you master. Endoscopy is difficult and needs practice and most of us still constantly try to improve our technique. I have scoped for 34 years, but a few years ago, after listening to Siwan Thomas-Gibson talking about water immersion techniques, I changed again. In Gastroenterology the required talents do not depend on gender, background or belief. The joy of gastroenterology is that you can have a great career, whatever your background, because the essential knowledge and skills can be taught.
So in spite of the trials of COVID, we should be saying to young people, “Why wouldn’t you want to join us?”
Let’s hear it for the Velociraptors.