Endoscopy training in the UK pre-COVID–19 environment: a multidisciplinary survey of endoscopy training and the experience of reciprocal feedback

Abstract

ObjectiveTraining in gastrointestinal endoscopy in the UK occurs predominantly in a real world one-to-one trainer to trainee interaction. Previous surveys have shown surgical and gastroenterology trainees have had mixed experiences of supervision and training, and no surveys have explored specifically the role of trainee to trainer feedback. This study aimed to explore the experience of training and of providing trainer feedback for all disciplines of endoscopy trainees.Design/methodAn online survey designed in collaboration with Joint Advisory Committee training committee and trainee representatives was distributed from January 2020 but was interrupted by the COVID-19 pandemic and hence terminated early.ResultsThere were 129 responses, including trainees from all disciplines and regions, of which 86/129 (66.7%) rated the culture in their endoscopy units favourably—either good or excellent. 65/129 (50.4%) trainees reported having one or more training lists allocated per week, with 41/129 (31.8%) reporting only ad hoc lists. 100/129 (77.5%) respondents were given feedback and 97/129 (75.2%) were provided with learning points from the list. 65/129 (50.4%) respondents reported their trainer completed a direct observation of procedure or direct observation of polypectomies. 73/129 (56.6%) respondents reported that they felt able to give feedback to their trainer, with 88/129 (68.2%) feeling they could do this accurately. Barriers to trainer feedback cited included time constraints, lack of anonymity and concerns about affecting the trainer–trainee relationship.ConclusionOverall, the training environment has improved since previous surveys. There are still issues around interdisciplinary differences with some surgical trainees finding the training environment less welcoming, and trainee perceptions of hierarchical barriers and trainer responsiveness to feedback limiting the accuracy of their feedback.

Hospital compound-level endoscopy training quality performance: scoping the spectrum

“…Quality performance metric median values related to individual hospital units can be found in ▶ Table 1, and further classified by hospital according to local health boards in ▶ Table 2. Median training list allocation per trainee was 13 (10)(11)(12)(13)(14)(15)(16)(17), with only two hospital units (D17, D18) meeting the JAG standard of 20 training lists per year (P = 0.001, effect size d = -0.56). The JAG recommendation that training lists be adjusted to eight points was achieved by one hospital (D17).…”

“…Median points per list were 11 (5-18, P = 0.064, d = 0.31). Six hospitals under-utilized training opportunities (D1, 7,11,12,13,14), and 11 over-booked lists, risking inappropriate training environments (T3, D2, 4,5,6,8,9,10,15,16,18). Median annual total procedure numbers were 1395 (465-2365), amounting to 115 (39-214) procedures per trainee.…”

“…Dissatisfaction related to endoscopy training is most commonly attributed to poor access to training lists, with training progression heavily influenced by hospital placement on-call rotas and other general medical responsibilities 11 This issue amplified with respect to surgical trainees in view of competing scheduled elective surgical demands 4 12 13 , resulting in as few as 18 % of Colorectal trainees achieving the minimum number of colonoscopy procedures by the end of training 14 . The most recent UK cross-specialty survey reinforced this, highlighting again a discrepancy in training, with 38.9 % of surgical trainees accessing one training list per week, and 70 % of gastroenterology trainees having two or more scheduled endoscopy lists per week 15 . Furthermore, the UK JAG census reported a 12 % to 15 % increase in service pressures between 2017 and 2019, with a clear adverse effect on training: dedicated training list numbers falling from 76 % in 2017 to 52 % in 2019 16 .…”

UK-wide study of the opinions of gastroenterology trainees: COVID-19, Shape of Training and the future workforce

“…Furthermore, the quality of training can be improved by enhancing feedback, which is valued by trainees. 9 …”

“…Furthermore, the quality of training can be improved by enhancing feedback, which is valued by trainees. 9 Of the trainees, 10% have reported a delay to their CCT date and 32% plan to work less than full time as consultants. This will have significant ramifications to workforce planning and within a gastroenterology workforce which is already facing significant shortages.…”