This webinar was recorded on 6th July 2022 and formed an introduction to the new Gastroenterology and Hepatology Training Curriculum.
Learning objectives
- Introduce new assessment process, namely Competence in Practice framework and Entrustable Decisions
- Respond to questions regarding new curriculum
Q&A
| Question | Answer |
| What happens to trainees who do not get appointed into the hepatology arm but it’s what they wish to pursue? (due to limited spaces) | Can either stop clock with OOP and reapply or follow luminal pathway and then specialise as consultant |
| Who is taking ownership of HPB Medicine _ Hepatology or Luminal gastroenterology? | Could be either but in practice, hepatology is tending to be more solid organ so may sit better with luminal, especially if advanced endoscopy (i.e. ERCP/EUS) is involved |
| Practically speaking, our ARCP is usually in October. So ARCP for this year would be based on old or new curriculum? | Next ARCP will be based on old curriculum but include transition |
| Can we decline to attend AEC but arrange something more relevant to gastro like rheum clinic (IBD) etc? | Yes, can do any GIM clinic that you feel useful |
| What’s level 2 / 3 hepatology ? | Level 2 liver units include dedicated hepatologists with access to HCC treatment and TIPSS, level 3 is the same but with transplant. |
| Would ITU experience include level 2/HDU e.g. respiratory HDU or CCU? | Potentially. The important fact is whether you are able to manage the acutely deteriorating patient |
| Will there be more prescriptive guidance about the GAP analysis as guidance is quite vague at the moment and I assume all ES’s will be educated/informed? | Yes, there is formal guidance and the BSG will be publishing a simple guide on its website |
| Does the gap analysis take place only after September once we’ve transitioned? Or should we have had one already? | Next year |
| Where does ERCP and EUS training fit into the new curriculum? | Neither is included in the curriculum as this describes the skills that all gastroenterologists/hepatologists need. As is currently the case, expertise in advanced endoscopy is likely to need a fellowship (OOP or post-CCT) or learning as a consultant |
| Will ERCP and EUS be only if you’ve done Hepatology or luminal would be able to train in them? | Could be either but in practice, hepatology is tending to be more solid organ so may sit better with luminal, especially if advanced endoscopy (i.e. ERCP/EUS) is involved |
| I started in March 21st as an ST3, will be ST4.5 in September, will I remain same as ST4.5 and not ST5 , which makes my training 5 years and not 4? Hepatology ST6 if I have to do it will come in middle of the year and not in September. How is my case going to go forward ? | You need to discuss this with your TPD. We cannot answer individual queries, sorry. |
| Do post St7 grace periods still apply with the new curriculum? | Yes. There has been no guidance that they will change. |
| What about the ST3s who started in Feb. 22, it is stated on Ian Gee’s presentation that they should continue on the old curriculum until they hit ST4? | Strictly speaking you can only transition once ST4 (as there is no ST3 equivalent). Your TPD will be able to tell you how this will work in your region. |
| Does everyone have to do 6 months dedicated hepatology in ST5 or only those planning to do the hep sub-specialty arm? If the latter, is your TPD obliged to ensure you are placed in an appropriate centre for ST5? | Everyone has to do at least 6 months hepatology but this can be at any time. Those pursuing the hepatology arm will want to do it early to be competitive at the ATP interview. |
| What will happen with all my previously done WPBAs etc ? how can they be transitioned into the new CiPs etc ? | They will all remain. The linkage will be much easier with the new curriculum/portfolio. |
| Will there be any differentiation then between people who did complex luminal or complex hepatology to the final CCT? Or will we all be known as Gastro and Hep and it will come down to your CV as to how you pitch your job when you come to consultant jobs? | It will come down to your cv, just as it is at the moment. |
| GIM: why can we like cardiology and do only in the first year not afterwards? This will give time for trainees to pursue what they need to learn in Gastro-hepatology in the time they have. GIM on-calls take trainees away from the training in speciality. | We have tried to argue that we needed a five year training programme like cardiology, but the GMC did not accept it. |
| Would colonoscopy training be provided in ST5? Will trainees participate in GI bleed rota from ST5? Can IM clinics and ITU experience be clarified? | Yes, colonoscopy training can be done at any time depending upon your skills and local provision. Some of us believe that you should start with colons and then learn OGD. Participation on GI bleed rotas will be dependent upon competence and local rotas. As was discussed, most GI bleed therapy is now provided within hours so bleed rotas are not a mandatory part of the curriculum. Please review the GIM curriculum on the JRCPTB website for the GIM questions. |
| Does the gap analysis form on ePortfolio have areas for gastro and IM – or do we need to do two? | There is a single form covering both gastro and GIM. Transition from gastro curricula should be pretty straightforward, GIM more tricky. |
| I started as an ST3 in Aug 2021. When I will progress or choose IBD or Hepatology arm? Do I transfer at ST5 level? | You will transition next year (2022/23). You should aim to apply for the hepatology year as ST6. |
| Will people doing complex Hep be blocked from colonoscopy if they wish to continue? | They won’t be blocked but it will be difficult to dedicate enough time to learn colonoscopy as it is unlikely that there will be any significant exposure to colon training during the ST6 year. |
| So if you are starting ST6 in Sep and want to do hepatology – would that mean you would have to do an extra year on top of your ATP? | The current curriculum requires 24 months of hepatology and the new one does the same. |
| Could I attend non gastro clinics and still get these counted towards my total clinics count as an ST3 in Gastro? | They will count as GIM clinics |
| Does everyone have to do 6 months dedicated hepatology in ST5/6 or only those planning to do the hep sub-specialty arm? | Everyone has to do at least 6 months hepatology but this can be at any time. Those pursuing the hepatology arm will want to do it early to be competitive at the ATP interview. |
| I would assume you can do a post CCT fellowship in hepatology if you don’t do the ATP? | Correct |
| What is the set up for us doing these GIM clinics in terms of supervision, time per patient? I am a bit perturbed at doing a specialty clinic for something which I am not trained to do and have little knowledge of | You will need to discuss this with your local supervisors. We share your concerns. |
| When is the gap analysis expected to take place? Do we do this with ES or TPD? | It can be done with “anyone who has the knowledge and skills”. In practice, we expect that the TPDs will need to do it. |
| If you are doing hepatology ATP in ST7, would your previous experience at hepatology centres count towards hepatology pathway? | Yes |
| For those who are transitioning who have done the traditional 5 years, is the 4 years in total from ST4 or ST3 old style? | If you started a five year curriculum you will complete five years. New recruits will complete IM3 and then start as ST4. |
| Why are 50% Gastro/Hep Consultant posts unfilled? I am not sure the new curriculum is going to help the situation? | We are not training enough gastroenterologists to fill the service requirements. The new curriculum does not address this. The BSG is campaigning to increase the number of gastro training numbers. |
| With regards to gastro (as opposed to GIM), what will be the requirements of evidence things like audit, quality improvement, teaching? Are these embedded in CiPs or will the old forms like audit assessment remain? | The requirements will be broadly the same. The old forms will continue. The gastro CiPs all relate to practical ability/skills. |
| I am starting gastro ST4 after already having achieved sign off for OGDs and having done a reasonable number of colonoscopies. If I wish to go down the hep arm , will I be advised to continue with colon training or start ERCP/EUS training in the first 2 yrs? | You need to discuss this with your TPD. We cannot answer individual queries, sorry. |
| Will there be any changes with OOP maximum duration? | None are expected. |
| I have been signed off for advanced nutrition, will this transfer to the new curriculum when I transition? | No, there is no provision for advanced nutrition within the new curriculum. Your skills and knowledge will not vanish however, and this will not affect your ability to get a job using these abilities. |
| What are the realistic steps a trainee can do if doing more GIM than gastro? | You can discuss with your ES and TPD if this is affecting your training. This is the same irrespective of which curriculum you are following. |
| What counts as complex IBD placements? | This is a question for your TPD as it is a local decision. |
| Has there been any discussion or push for hands-on trainees doing less on-call? Geri / rheum for example have less to learn practically – I know it may not seem fair but on an on-call rota why can’t they do more so we can spend more time training in endoscopy? | Yes, we have made these arguments but the GMC has not agreed. |
| I couldn’t see the ARCP decision aid on the JRCPTB website – when can we expect this? | It is not yet available. It has been agreed and should be uploaded soon. |
| What power does ES and TPD have to enforce the 25%? Are management not just going to counter argue with “patient safety”? | They have a curriculum that states what the training should be. The issue of how to make up a shortfall on the GIM rota is a problem for the GIM rota writer, not the gastroenterologists. |
| Regarding the gap analysis, have ESs’ been trained to deliver this or will we need to update ourselves and then discuss this with our ES? | There will be discussion with the TPDs and guidance will be written by both the JRCPTB and the BSG. |
| The chief reg year has a fair amount of clinical and other things that can be counted in curriculum. I assume some of this would count if this can be demonstrated? | Possibly yes, it would require discussion with your TPD. |
| You are saying that if you spend too much time doing Hepatology and only 1 year doing Gastro then you aren’t really a Gastroenterologist, but aren’t we calling people who do 6 core months of Hepatology a Gastroenterologist and Hepatologist? | We are all colleagues and all experts in our own areas. Some of us choose to call ourselves gastroenterologists, some gastroenterologists with an interest in hepatology and some hepatologists. The label is not important. |
| The requirement for colonoscopy; is this for provisional or full JAG certification? | JAG are changing their certification structure and provisional certification will cease soon. |
| Most trainees in Gastro training now may not want GIM with the shortening of training program to 4 years. Would the BSG then canvas to get GIM taken off? | There is no option for training without GIM. |
Q&A
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There is no option for training without GIM.
References