Shape of Training Review: an impact assessment for UK gastroenterology trainees

Abstract

Background: Physician training in the UK is undergoing considerable change due to the implementation of recommendations made in the Shape of Training Review. In particular, higher specialty training (HST), including gastroenterology, will be shortened from 5 to 4 years. This will also incorporate general internal medicine (GIM) training. There is concern among gastroenterologists regarding how high-quality gastroenterology training will be delivered in 4 years.

Methods: The 2018 British Society of Gastroenterology (BSG) trainees' survey results were used to examine the potential impact of a 4-year HST period on achieving key competencies in gastroenterology.

Results: 291 (49.4%) gastroenterology trainees responded. Satisfaction with gastroenterology training was high (79.6% respondents), and self-reported confidence in hepatology training was also high (84% senior respondents). However, only half (51.1%) of the respondents achieved complete colonoscopy certification by their final year of training. Comparison with the 2014 BSG trainees' survey demonstrated that the number of endoscopy procedures achieved by trainees has reduced in sigmoidoscopy (p=0.006) and colonoscopy (p<0.001). The proportion of time spent in GIM training has increased since the last survey, with 81.8% of the respondents spending more than 25% of their time in GIM. GIM training was reported to be a key barrier to adequate gastroenterology and endoscopy training.

Conclusion: These data indicate significant barriers to delivering gastroenterology and endoscopy training within the current 5-year programme. Novel strategies will be required to improve the rate of progression in endoscopy training, in particular if high-quality gastroenterology HST training is to be delivered in 4 years.

Keywords: colonoscopy; endoscopy; nutrition.

Figure 1

Number of endoscopic procedures for respondents by stage of training. The number of procedures performed by respondents from the 2018 survey, categorised by stage of training, for (A) OGD, (B) flexible sigmoidoscopy and (C) colonoscopy is shown. Both box and whiskers plots (median, IQR, range) and scatter plots are displayed. For OGD (A) and colonoscopy (C), the dotted line indicates 200 and 300 procedures, respectively, the minimum requirement for JAG accreditation. (D) The proportion of respondents who have achieved JAG accreditation for OGD and colonoscopy at each stage of training. JAG, Joint Advisory Group; OGD, oesophagogastroduodenoscopy; ST, specialty training.

Figure 2

Comparison of the number of endoscopic procedures for respondents by stage of training between the 2014 and 2018 surveys. The number of procedures performed by respondents from the 2014 (blue) and 2018 (red) surveys, categorised by stage of training, for (A) OGD, (B) flexible sigmoidoscopy and (C) colonoscopy is shown. Scatter plots with median and IQR are displayed. The dotted lines indicate the minimum requirement for complete JAG accreditation (200 for OGD and sigmoidoscopy, 300 for colonoscopy). **P<0.01 (Mann-Whitney test). (D) The proportion of respondents completing the minimum required numbers of procedures for OGD (200, solid line), flexible sigmoidoscopy (200, dotted line) and colonoscopy (300, dashed line) is shown for the 2014 survey (blue) and 2018 survey (red). P value statistics from two-way analysis of variance with Sidak’s multiple comparisons test. JAG, Joint Advisory Group; OGD, oesophagogastroduodenoscopy; ST, specialty training.

Figure 3

Respondents (%) reporting differing proportions of time spent on general internal medicine (GIM) training in the 2014 and 2018 surveys. The proportion of respondents who reported spending greater than 25% of their time on GIM training is also shown.