This time of year has always been an uneasy one. At school and university, it signified the end of frivolities and return to the classroom. In our professional career, it has usually signified the time for a change in workplace. Change is something that I, like many others, always struggle to adapt to. I enjoy the routine of knowing what I am going to do, where I am going to do it and who I am going to do it with. This year, many junior doctors may have greater anxiety as, finally, the almost mythical beast of ‘Shape of Training’ accompanies them to their next stage of training.
The Shape of Training has a number of critical implications to Gastroenterology training. Firstly, training has shifted from a 5 year to a 4 year model. The opportunity to ‘drop’ General Medicine has now gone and there is now a requirement to undertake a certain number of non-Gastroenterology clinics (5/year). The Hepatology pathway has become more formalised with trainees either going down the Luminal or Liver path from ST6. Only in the Luminal training program will colonoscopy be mandatory. However, the Hepatology path will require trainees to undertake one of the conventional ATPs which, whilst access has improved in recent years, remain geographically inequitable.
Naturally trainees are concerned about this, particularly given how training was compromised during the initial phases of the pandemic. The recent BSG Trainee survey demonstrated how concerned trainees are about the impact of reduced training time within the new curriculum given where they are in their training currently (1). Endoscopy specifically has suffered with reduced numbers of trainees achieving accreditation than the pre-pandemic era. This is of concern considering that the 2019 BSG trainees survey found only 51.1% of respondents had completed colonoscopy certification by their final year of training (2) which is likely to be compounded for future trainees by the new JAG accreditation requirements for increased gastroscopy and colonoscopy numbers (3). The impact of reduced colonoscopists despite an increasing endoscopy waiting list and pressures from bowel cancer screening remains to be seen.
Whilst we are still adjusting to this new normal and improving non-COVID service provision, 84.2% of trainees felt that they would not be ready to become a consultant after only 4 years of training. The #FGDebate on Gastroenterology Training from earlier this year highlighted significant concerns trainees have regarding to picking Hepatology and Luminal tracts so early in their careers and the impact of not getting their desired track.
It is of course natural to be anxious about change and particularly change which impacts how and what we do in our working lives. I would encourage all of you who did not attend the recent BSG webinar on the new curriculum to watch it on the BSG website (Gastroenterology Curriculum 2022 Education Evening Webinar – The British Society of Gastroenterology (bsg.org.uk)). Drs Cowan, Alstead, Gee and Griffiths give a frank but clear overview of what’s to come, where the unknowns are and how the unknowns will be addressed. Personally, I think the new curriculum may be easier to navigate and less cumbersome from an administration perspective. It feels like there is a focus on protecting Gastroenterology training time which was not as strong historically. And, we should not be limited by our training program. If you want to be a Liver Transplant consultant and do not get the Hepatology track, it does not mean that you cannot take OOP and post-CCT opportunities to get the experiences you need to do this (you will probably need them even if you do the Hepatology track). Finally, one of the few things I am certain about is that our trainers want us to be well trained and do well. With 50% of consultant Gastroenterologist jobs unfilled, we need the workforce coming through to be motivated and competent. Ultimately they are invested in us which means that we will find a way to make this work, just as we have done with other changes in training over the years. So whilst September may feel like we are heading into unchartered territories, it may in fact be more of the same…
- Raju S, Harris R, Cook C, et al. UK-wide study of the opinions of gastroenterology trainees: COVID-19, Shape of Training and the future workforce. Frontline Gastroenterology. Published online first 20/12/2021. DOI: 1136/flgastro-2021-101965
- Clough J, FitzPatrick M, Harvey P BSG Trainees section et al. Shape of Training Review: an impact assessment for UK gastroenterology trainees. Frontline Gastroenterology. 2019; 10: 356-363.
- Siau K, Beales IL, Haycock A et al et al. JAG consensus statements for training and certification in oesophagogastroduodenoscopy. Frontline Gastroenterology. 2022; 13: 193-205