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Changing trends in the UK management of upper GI bleeding: is there evidence of reduced UK training experience?
  1. H A Penny1,
  2. M Kurien1,
  3. E Wong1,
  4. R Ahmed1,
  5. E Ejenavi1,
  6. M Lau1,
  7. C Romaya2,
  8. F Gohar1,
  9. K L Dear3,
  10. K Kapur4,
  11. B Hoeroldt5,
  12. A J Lobo1,
  13. D S Sanders1
  1. 1Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield, UK
  2. 2British Society of Gastroenterology, London, UK
  3. 3Department of Gastroenterology, Chesterfield Hospital, Chesterfield, UK
  4. 4Department of Gastroenterology, Barnsley Hospital, Barnsley, UK
  5. 5Department of Gastroenterology, Rotherham Hospital, Rotherham, UK
  1. Correspondence to Dr Hugo Penny, Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield S10 2JF, UK; h.penny{at}


Objective The aim of this study was to evaluate UK trainee experience in endoscopy for acute upper gastrointestinal bleeding (AUGIB).

Methods Data was prospectively collected from all patients presenting to South Yorkshire Hospitals with AUGIB from September 2011 to December 2011 and compared with data from 1996. Concurrently, all gastroenterology trainees registered with the British Society of Gastroenterology were invited to respond to a web-based questionnaire regarding their experience in AUGIB management.

Results 77% (589/766) of the patient cohort underwent endoscopy for AUGIB; 15% (90/589) were performed by trainees. 7.2% (9/125) of the out of hours endoscopy case load was performed by trainees; all were low-risk or medium-risk cases (pre-endoscopy Rockall score ≤4). During the study period, dual therapy was delivered by a trainee on only four occasions. Comparison with the 1996 cohort demonstrated a marked reduction in the number of trainee performed endoscopies (76% vs 15%; p<0.001). Questionnaires were returned by 51% (245/478) of British Society of Gastroenterology trainees. 81% (198/245) thought that <10% of the gastroscopies they had performed involved therapeutic intervention. 23% (57/245) felt they would not be competent in AUGIB endoscopy by completion of specialty training.

Conclusions This study demonstrates the decline over time in trainee experience in AUGIB endoscopy. It also highlights a lack of trainee exposure to more challenging cases, out of hours endoscopy and therapeutic procedures. Furthermore, trainees are concerned that a level of competency may not be attained during specialty training. We advocate reviewing UK endoscopic training provision for AUGIB to ensure that experienced endoscopists are produced to meet future service needs.


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