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The future of gastroenterology training: the trainee's perspective
  1. Philip J Smith
  1. Correspondence to Philip J Smith, Division of Medicine, University College London, Rayne Institute, 5 University Street, London WC1E 6JJ, UK; pjsmith{at}

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‘The life so short, the craft so long to learn’ (Hippocrates, 460–370 BC) is still as appropriate now as it was over 2000 years ago. However, even the ‘founding father’ of modern medicine would probably never have imagined the advances in medical training, subspecialisation and technology that have occurred in even the past 10 years—let alone the previous millennia. Gastroenterology is no exception; on the contrary, one might argue it has seen some of the greatest evolutions as a specialty—from advanced endoscopic techniques, digital imaging and radiological intervention through to an increased focus on personalised medicine (based on genetic and molecular diagnostic advances).

The past and the present

From a trainee's perspective, the past 10 years have seen a tidal wave of changes in both gastroenterology and general medical training, driven by factors within the specialty and powerful external influences, which combined have moulded the way trainees develop into the consultants of the future. This is best demonstrated by the introduction of the European Working Time Directive, which has fundamentally altered the landscape of UK gastroenterology training—increasing the complexity of on call rotas, endoscopy list coverage and overall training provision.1,,3 Less time for trainees on the ‘shop floor’ has led to concerns over the quality of training and the development of a ‘subgrade’ of future consultants. However, electronic portfolios, such as the NHS e-portfolio and the Joint Advisory Group Endoscopy Training System e-portfolio, have been designed with the aim of facilitating and supporting training by ensuring clinical and practical competencies are recorded and assessed in a systematic manner. Essentially trainees have less exposure to patients, but better assessment of their training and progression. Closely linked to the competency-based assessments, has been the restructuring of the pathways into gastroenterology training—from foundation training, core training and then entry into specialty training. A …

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