First, gastro training is hard

It’s a big curriculum:
https://abs.twimg.com/emoji/v2/... draggable="false" alt="✅" title="Fettes weißes Häkchen" aria-label="Emoji: Fettes weißes Häkchen">Luminal
https://abs.twimg.com/emoji/v2/... draggable="false" alt="✅" title="Fettes weißes Häkchen" aria-label="Emoji: Fettes weißes Häkchen">IBD
https://abs.twimg.com/emoji/v2/... draggable="false" alt="✅" title="Fettes weißes Häkchen" aria-label="Emoji: Fettes weißes Häkchen">Nutrition
https://abs.twimg.com/emoji/v2/... draggable="false" alt="✅" title="Fettes weißes Häkchen" aria-label="Emoji: Fettes weißes Häkchen">Hepatology
https://abs.twimg.com/emoji/v2/... draggable="false" alt="✅" title="Fettes weißes Häkchen" aria-label="Emoji: Fettes weißes Häkchen">Pancreato-biliary
https://abs.twimg.com/emoji/v2/... draggable="false" alt="✅" title="Fettes weißes Häkchen" aria-label="Emoji: Fettes weißes Häkchen">Cancer

Plus, procedures:
https://abs.twimg.com/emoji/v2/... draggable="false" alt="✅" title="Fettes weißes Häkchen" aria-label="Emoji: Fettes weißes Häkchen">OGD
https://abs.twimg.com/emoji/v2/... draggable="false" alt="✅" title="Fettes weißes Häkchen" aria-label="Emoji: Fettes weißes Häkchen">Colonoscopy
https://abs.twimg.com/emoji/v2/... draggable="false" alt="✅" title="Fettes weißes Häkchen" aria-label="Emoji: Fettes weißes Häkchen">Emergency GI bleeding

The triple-whammy is internal medicine training, with lots of on-call non-gastro work
2/x
Second, trainees struggle to achieve this in the 5-year programme.

Previous work from @BSGTrainees shows that trainees struggle to complete colonoscopy training, with half of final year trainees not signed off.

3/x https://twitter.com/DoctorFitz/status/1103241918769778688?s=20">https://twitter.com/DoctorFit...
These pressures lead to gastro trainees having some of the highest rates of burnout of higher medical trainees.

It has become the norm to take time out of training to gain sub-specialty experience, as many trainees do not feel ready for consultant roles without it.

4/x
So things aren’t great.

But they& #39;re about to get a whole lot harder, as Shape of Training means that gastro training will reduce to 4 years. This will really add on the pressure.

So even before COVID, gastro training was facing a wicked series of challenges.

And then…

5/x
...COVID appeared.

Endoscopy & clinics cancelled. Trainees seconded to COVID rotas. Exams & teaching cancelled. Shielding trainees could not do patient-facing work. The impacts on endscopy have been highlighted nicely ( @RashidLui @drkeithsiau & co)
6/x

https://doi.org/10.1016/j.gie.2020.06.010">https://doi.org/10.1016/j...
So how do we address the COVID problems, AND make a better training environment to address the existing challenges of gastro training, and the shorter training time from Shape of Training?

Here are our thoughts:

7/x
https://abs.twimg.com/emoji/v2/... draggable="false" alt="🚨" title="Polizeiautos mit drehendem Licht" aria-label="Emoji: Polizeiautos mit drehendem Licht">Endoscopy

https://abs.twimg.com/emoji/v2/... draggable="false" alt="✅" title="Fettes weißes Häkchen" aria-label="Emoji: Fettes weißes Häkchen">High-volume endoscopy blocks early in training
https://abs.twimg.com/emoji/v2/... draggable="false" alt="✅" title="Fettes weißes Häkchen" aria-label="Emoji: Fettes weißes Häkchen">Embed endoscopy simulation in all regions
https://abs.twimg.com/emoji/v2/... draggable="false" alt="✅" title="Fettes weißes Häkchen" aria-label="Emoji: Fettes weißes Häkchen">Research how best to use endo simulation
https://abs.twimg.com/emoji/v2/... draggable="false" alt="✅" title="Fettes weißes Häkchen" aria-label="Emoji: Fettes weißes Häkchen">Develop alternative methods of delivery of non-technical skills training
https://abs.twimg.com/emoji/v2/... draggable="false" alt="✅" title="Fettes weißes Häkchen" aria-label="Emoji: Fettes weißes Häkchen">Mandate 1 year on UGI bleeding endoscopy rota

8/x
https://abs.twimg.com/emoji/v2/... draggable="false" alt="🚨" title="Polizeiautos mit drehendem Licht" aria-label="Emoji: Polizeiautos mit drehendem Licht">Clinics and sub-specialty experience

https://abs.twimg.com/emoji/v2/... draggable="false" alt="✅" title="Fettes weißes Häkchen" aria-label="Emoji: Fettes weißes Häkchen">Remote consultation software with multiple clinicians to facilitate training and assessment
https://abs.twimg.com/emoji/v2/... draggable="false" alt="✅" title="Fettes weißes Häkchen" aria-label="Emoji: Fettes weißes Häkchen">Early trainees may prefer FTF
https://abs.twimg.com/emoji/v2/... draggable="false" alt="✅" title="Fettes weißes Häkchen" aria-label="Emoji: Fettes weißes Häkchen">Specialist service meetings to offer virtual access to regional trainees
https://abs.twimg.com/emoji/v2/... draggable="false" alt="✅" title="Fettes weißes Häkchen" aria-label="Emoji: Fettes weißes Häkchen">Virtual specialist ward rounds

9/x
https://abs.twimg.com/emoji/v2/... draggable="false" alt="🚨" title="Polizeiautos mit drehendem Licht" aria-label="Emoji: Polizeiautos mit drehendem Licht">Teaching

https://abs.twimg.com/emoji/v2/... draggable="false" alt="✅" title="Fettes weißes Häkchen" aria-label="Emoji: Fettes weißes Häkchen">Curriculum-mapped training, delivered online and FTF
https://abs.twimg.com/emoji/v2/... draggable="false" alt="✅" title="Fettes weißes Häkchen" aria-label="Emoji: Fettes weißes Häkchen">Regional collaboration to help standardise content
https://abs.twimg.com/emoji/v2/... draggable="false" alt="✅" title="Fettes weißes Häkchen" aria-label="Emoji: Fettes weißes Häkchen">Sub-specialist meetings could be recorded and used for online learning materials

10/X
Gastro-IM:
https://abs.twimg.com/emoji/v2/... draggable="false" alt="✅" title="Fettes weißes Häkchen" aria-label="Emoji: Fettes weißes Häkchen">IM and Gastro are, to some extent, in conflict with one another in a zero-sum game
https://abs.twimg.com/emoji/v2/... draggable="false" alt="✅" title="Fettes weißes Häkchen" aria-label="Emoji: Fettes weißes Häkchen">Training time needs to be balanced between them if the programmes are to produce excellent dual-accredited specialists that patients deserve

11/x
https://abs.twimg.com/emoji/v2/... draggable="false" alt="✅" title="Fettes weißes Häkchen" aria-label="Emoji: Fettes weißes Häkchen">Gastro training needs to be ring-fenced to allow a total of 3 years equiv FT (as in EU & AUS)
https://abs.twimg.com/emoji/v2/... draggable="false" alt="✅" title="Fettes weißes Häkchen" aria-label="Emoji: Fettes weißes Häkchen">May work best with blocks of IM rather than constant on-call
https://abs.twimg.com/emoji/v2/... draggable="false" alt="✅" title="Fettes weißes Häkchen" aria-label="Emoji: Fettes weißes Häkchen">Will allow more gastro on-call, helping UGIB rotas, in-reach, & direct admissions, reducing pressure on medicine

12/x
Some of this will be easy. Other aspects are really tricky, & will need time, investment, and change in mindset to achieve.

However, if we grab this opportunity, we can hugely improve Gastro training in the UK, to the benefit of patients, doctors, and gastro services.

13/x
We really want to hear what the UK gastro community think about the challenges in training. We hope this piece helps start that discussion.

Finally, thanks to the reviewers and the great team @FrontGastro_BMJ - @RMBeattie50 @Jonathansegal85 @DrPhilipJSmith and colleagues.

FIN
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