Table 1

Challenges to training in the COVID era and proposed solutions

Challenges:Proposed solutions:
Endoscopy training
  • Dramatic reduction in endoscopy volume during height of pandemic with delay of all non-urgent procedures advised by national specialty groups.22

  • Large and growing waiting lists make it challenging for trusts to accommodate training lists with reduced procedure numbers.

  • Social distancing requirements and PPE provision limits the potential number of staff in the endoscopy room.

  • Endoscopy services outsourced to private providers/units may lead to exclusion of trainees.

  • Trainees and their trainers have deskilled following a lengthy period of reduced endoscopy activity.

  • Division of hospital services between ‘hot’ (COVID positive) and ‘cold’ sites will make it challenging for trainees who have inpatient responsibilities to attend training lists ad-hoc.

Individualised planning
  • Review the needs of trainees at a local or regional level to direct limited training opportunities effectively.

  • Risk assessment for high risk groups and protect LTFT trainees.

  • Protect trainee presence in endoscopy if PPE provision is rationed.


Simulation
  • Should be embedded in all training regions to allow trainees to improve technical skills without patient exposure.

  • Could facilitate early gastroscopy training as a baseline before patient training.


‘Sprint’ courses
  • Immersive high-volume training allows training to accredit over a reduced period of time.

  • Skills continue to develop through independent service lists with remote supervision.


Alternative delivery of non-technical skills training for example, decision-making
  • Expert-delivered seminar video endoscopy learning mapped to curriculum.

  • Online decision-making practice scenarios.

  • Local endoscopy MDTs for example, polyp meetings.


Joint advisory group
  • Flexibility where possible regarding pre-certification period.

  • Support access to basic skills courses and alternative modalities of training throughout the regions.


Upper GI bleed on-call experience
  • Involvement of trainees on OOH rotas nationally is variable.

  • Making this a requirement of senior trainees could facilitate acquisition of key decision-making skills.

Planned educational opportunities
  • Local/regional cancer and IBD MDTs, radiology meetings and histology meetings are limited to ‘essential’ staff in some trusts, excluding trainees who may be present for educational value.

  • Many formal local/regional teaching sessions cancelled.

  • Key national courses, including those required or desirable for progression (eg, JAG endoscopy training courses, ALS courses) cancelled.

Reinstate formal training days
  • Most curriculum-mapped training could be delivered online via videoconferencing portals.

  • Regional collaboration would permit standardised content and reduce duplication.

  • Key courses required for trainee progression should be identified to ensure adequate/extra capacity for trainees.

Outpatient clinics
  • Telephone and virtual clinics limit the possibilities for face-to-face observation, especially if work is undertaken from home.

  • Reduced supervision makes it more challenging for trainees to request workplace-based assessments required for progression.

  •  Consultants with trainees in clinic should proactively discuss arrangements for case review for example, meeting/telephone call at the end of a clinic list.

  •  Provision should be made for more direct observation of junior trainees starting in outpatient clinics.

  •  Some virtual platforms allow multiple staff members on the same call, allowing trainees and trainers to be in the same consultation. Could provide excellent supervised training opportunities, although requires service and staffing redesign, and medical education research.

Subspecialty exposure
  • Redeployment to GIM means some trainees will have missed their planned time in subspecialty training for example, level 2/3 liver centres, nutrition.

  • Many experiences deemed crucial for training have been postponed or moved to ‘virtual’ activities, making demonstration of experience more challenging.

  • Specialist services should offer virtual access to meetings, and facilitate remote access by trainees within the region.

  • Content from specialist centre meetings could be recorded, anonymised and used as online learning materials.

  • Virtual specialist ward rounds, as are being piloted for medical students in some London teaching hospitals, could facilitate remote exposure to sub-specialty inpatient medicine, for instance liver transplantation or intestinal failure.

  • ALS, Advanced Life Support; GIM, general internal medicine; IBD, inflammatory bowel disease; JAG, Joint Advisory Group on GI Endoscopy; LTFT, less than full-time; MDT, multidisciplinary team meeting; OOH, out-of-hours; PPE, personal protective equipment.