Article Text

Download PDFPDF
How can gastroenterology training thrive in a post-COVID world?
  1. Michael FitzPatrick1,
  2. Jennifer Clough2,
  3. Philip Harvey3,
  4. Elizabeth Ratcliffe4
  1. 1 Translational Gastroenterology Unit, Oxford University, Oxford, Oxfordshire, UK
  2. 2 Gastroenterology, Guy’s and St Thomas’ NHS Trust, London, UK
  3. 3 Gastroenterology, Royal Stoke University Hospital, Stoke-on-Trent, Staffordshire, UK
  4. 4 Gastroenterology, Salford Royal NHS Foundation Trust, Salford, UK
  1. Correspondence to Dr Michael FitzPatrick, Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford University, Oxford, OX3 9DU, UK; michael.fitzpatrick{at}

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Gastroenterology training landscape pre-COVID

Gastroenterology training is understandably arduous. The UK Gastroenterology curriculum spans diseases of the liver, luminal gastrointestinal (GI) tract and pancreatobiliary system. Trainees must complete periods of specialty nutrition and hepatology alongside the general internal medicine (GIM) curriculum. Certification in gastroscopy is mandatory, and colonoscopy certification is expected for most prior to certificate of completion of training (CCT).1 Gastroenterology trainees have among the highest rates of burnout within medical specialties, with training negatively affecting relationships and morale, and high levels of reported presenteeism.2 Gastroenterology previously enjoyed high competition ratios; these are now falling.

Trainees often struggle to acquire colonoscopy skills. A 2018 survey demonstrated half lacked certification as they approached CCT,3 and decreasing procedure numbers.4 Endoscopy training for upper GI bleeding (UGIB) represents a further challenge, as out-of-hours (OOH) services are frequently consultant-delivered. These factors drive a need for post-CCT supervision at a time of widespread consultant vacancies.2

As sub-specialty areas of gastroenterology become increasingly complex, trainees must invest more time to gain competence. Developing sub-specialty expertise now informally mandates out of programme training.

Time committed to GIM is increasing, which deleteriously affects specialty training time.3 GIM rota gaps are common,2 exacerbating pressure on trainees. The European Working Time Directive and 2016 junior doctors’ contract contributed both to reduced specialty training time and continuity. Imminent reforms following the Shape of Training report will reduce Gastroenterology training from five to 4 years,5 further compounding these problems.

Our increasingly complex craft specialty and reduced training time would inevitably have mandated change. The need to mitigate the impact of the COVID-19 pandemic must now catalyse that change.

Training issues arising during the COVID-19 era

The COVID-19 pandemic has necessitated dramatic restructuring of the workforce, with gastroenterology trainees widely redeployed and elective activity reduced. The impact on specialty training is substantial, with key examples summarised …

View Full Text


  • Twitter @Doctorfitz, @jennie_clough, @Phil_Harvey1

  • MF, JC, PH and ER contributed equally.

  • Contributors MF conceived the article concept. MF, JC, PH and ER contributed equally in the development and the writing of the article.

  • 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.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Linked Articles

  • UpFront
    R Mark Beattie