Really pleased to see our @FrontGastro_BMJ paper examining the challenges of Gastroenterology training in the UK, written with the awesome @jennie_clough, @Phil_Harvey1, and Lil Ratcliffe. Here's a thread - interested to see what people think! 1/x https://fg.bmj.com/content/early/2020/08/20/flgastro-2020-101601

First, gastro training is hard

It’s a big curriculum:
Luminal
IBD
Nutrition
Hepatology
Pancreato-biliary
Cancer

Plus, procedures:
OGD
Colonoscopy
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

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'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

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

Endoscopy

High-volume endoscopy blocks early in training
Embed endoscopy simulation in all regions
Research how best to use endo simulation
Develop alternative methods of delivery of non-technical skills training
Mandate 1 year on UGI bleeding endoscopy rota

8/x

Clinics and sub-specialty experience

Remote consultation software with multiple clinicians to facilitate training and assessment
Early trainees may prefer FTF
Specialist service meetings to offer virtual access to regional trainees
Virtual specialist ward rounds

9/x

Teaching

Curriculum-mapped training, delivered online and FTF
Regional collaboration to help standardise content
Sub-specialist meetings could be recorded and used for online learning materials

10/X

Gastro-IM:
IM and Gastro are, to some extent, in conflict with one another in a zero-sum game
Training time needs to be balanced between them if the programmes are to produce excellent dual-accredited specialists that patients deserve

11/x

Gastro training needs to be ring-fenced to allow a total of 3 years equiv FT (as in EU & AUS)
May work best with blocks of IM rather than constant on-call
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