Changing trends in the UK management of upper GI bleeding: is there evidence of reduced UK training experience?

Abstract

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.

Keywords: ENDOSCOPY; GASTROINTESTINAL BLEEDING.

Figure 1

(Top) Experience of endoscopy for acute upper gastrointestinal bleeding (AUGIB) based on years of specialty training. Spotted bars represent that AUGIB cases accounted for <10% of total upper GI endoscopy experience, striped bars 10–20% and white bars >20%. Seventy-nine per cent (118/150) of junior trainees (0–4 registrar training years) felt that AUGIB cases represented <10% of their total upper GI endoscopy experience compared with 61% (55/90) of senior trainees (≥5 registrar training years; p=0.001). (Bottom) Experience of therapeutic endoscopy based on years of specialty training. Spotted bars represent that therapeutic cases accounted for <10% of total upper GI endoscopy experience, striped bars 10–20% and white bars >20%. Ninety-one per cent (137/150) of junior trainees felt that therapeutic cases represented <10% of their total upper GI endoscopy experience compared with 71% (67/95) of senior trainees (p=<0.0001).