Endoscopy trainingDramatic 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.
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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
‘Sprint’ courses
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
Upper GI bleed on-call experience
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Planned educational opportunitiesLocal/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.
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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.
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Outpatient clinicsTelephone 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.
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Subspecialty exposureRedeployment 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.
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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.
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