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In response to the COVID-19 pandemic, the British Society of Gastroenterology (BSG) and Joint Advisory Group (JAG) swiftly recommended suspension of all non-essential endoscopic activity with a view to protecting patients and staff.1 This included a restriction on the number of individuals working in procedure rooms which included trainees.1 The suspension of training was considered to be justified by several concerns. These concerns included limiting the spread of COVID-19, being mindful of the supply of endoscopic consumables (including personal protective equipment (PPE)) and the need to redeploy trainees to other areas within the hospital during the peak of the crisis. As we approach the fourth month, where very little or no endoscopy training has taken place, there is growing concern over satisfactory progress within the specified training programme period. This is likely to impact on trainee confidence, which will be further exacerbated by the stress of regular adjustments to guidelines and policies and other personal considerations during the pandemic.2
In the pre-COVID-19 BSG national trainee survey from 2016, 12.5% of trainees had no access to a regular training list, and 53% of final-year trainees had not achieved full certification in colonoscopy.3 Thus, it is likely that an already pressured area of the curriculum will have suffered heavily. A further publication highlights this baseline deficiency in endoscopic training among colorectal trainees, with only 19% achieving 300 colonoscopies for full certification in 2017.4
As many units are well under way in planning their return to endoscopy service delivery, it is unlikely that training will resume in the same capacity as it did beforehand. How long this is likely to be the case as yet remains unknown. Pressure on services has shifted attention away from training and onto pre-screening patients, ensuring sufficient supply of standard and enhanced PPE, creating more time for more stringent infection control and cleaning procedures, and the workforce challenges created by increased sickness, shielding and re-deployment of endoscopy staff.5 Alongside this will come the inevitable pressure to tackle the backlog of elective patients
The future may entail sending trainees to COVID-19 minimised units or hospitals to perform endoscopy; regardless, there will have been a significant disruption to their training. Over the past few years, the Academy of Medical Royal Colleges (AoMRC) has redeveloped its recommendations to guide doctors returning to practice after a period of absence, which includes an individualised return to practice action plan incumbent on the trainee and supervisor to complete.6 Even if trainees are not considered to fall within the recommendations laid out by the AoMRC, perhaps we should be considering an individualised return to practice plan. This would take into consideration the potential practical impact on training but would also recognise the emotional impact the pandemic may have had. Serious consideration does need to be given to whether extending training, especially for those in their final year who are yet to achieve full endoscopic competence, should be recommended and even mandated. Equally for any trainee whose confidence has been significantly impacted by the pandemic and the period of absence from practical procedures, perhaps they also ought to be offered the opportunity for extension.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
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