Impact of COVID-19 on gastroenterology fellowship training: a multicenter analysis of endoscopy volumes

Abstract

Background and study aims The COVID-19 pandemic has had a profound impact on gastroenterology training programs. We aimed to objectively evaluate procedural training volume and impact of COVID-19 on gastroenterology fellowship programs in the United States. Methods This was a retrospective, multicenter study. Procedure volume data on upper and lower endoscopies performed by gastroenterology fellows was abstracted directly from the electronic medical record. The study period was stratified into 2 time periods: Study Period 1, SP1 (03/15/2020 to 06/30/2020) and Study Period 2, SP2 (07/01/2020 to 12/15/2020). Procedure volumes during SP1 and SP2 were compared to Historic Period 1 (HP1) (03/15/2019 to 06/30/2019) and Historic Period 2 (HP2) (07/01/2019 to 12/15/2019) as historical reference. Results Data from 23 gastroenterology fellowship programs (total procedures = 127,958) with a median of 284 fellows (range 273–289; representing 17.8 % of all trainees in the United States) were collected. Compared to HP1, fellows performed 53.6 % less procedures in SP1 (total volume: 28,808 vs 13,378; mean 105.52 ± 71.94 vs 47.61 ± 41.43 per fellow; P < 0.0001). This reduction was significant across all three training years and for both lower and upper endoscopies (P < 0.0001). However, the reduction in volume was more pronounced for lower endoscopy compared to upper endoscopy [59.03 % (95 % CI: 58.2–59.86) vs 48.75 % (95 % CI: 47.96–49.54); P < 0.0001]. The procedure volume in SP2 returned to near baseline of HP2 (total volume: 42,497 vs 43,275; mean 147.05 ± 96.36 vs 150.78 ± 99.67; P = 0.65). Conclusions Although there was a significant reduction in fellows’ endoscopy volume in the initial stages of the pandemic, adaptive mechanisms have resulted in a return of procedure volume to near baseline without ongoing impact on endoscopy training.

Prolonged Impact of COVID-19 on Job Prospects and Training for Pediatric Gastroenterology Fellows in North America

“… 3 - 7 A significant reduction in endoscopic procedures performed by gastroenterology trainees has been reported. 5 , 6 …”

“…[3][4][5][6][7] A significant reduction in endoscopic procedures performed by gastroenterology trainees has been reported. 5,6 The American College of Graduate Medical Education has set forth minimal required competency-based assessments that training programs could use during the COVID-19 pandemic to ensure that trainees are meeting core competencies. 10 While graduating fellows must meet these standards, the true impact of training in the COVID-19 pandemic will be best evaluated as fellows begin their first job.…”

“…However, at that time of the previous survey, the COVID‐19 pandemic was just beginning, and training programs were figuring out how best to support trainees 1. Since then, there have been several studies evaluating the impact of the COVID‐19 pandemic on medical training 3‐7. A significant reduction in endoscopic procedures performed by gastroenterology trainees has been reported 5,6…”

Simulator-based training method in gastrointestinal endoscopy training and currently available simulators

“…20,33 Furthermore, as a result of the coronavirus disease 2019 pandemic, the number of examinations at endoscopy centers, where GI endoscopy education is mostly delivered, was reduced by up to 99%, resulting in a sudden and severe decrease in the availability of endoscopic education for apprentices. 1,[34][35][36][37][38][39][40][41][42][43][44] In the last two years, endoscopists who lacked adequate education have entered the medical field, and there has been a significant additional load on monitoring and education.…”

Endoscopy After the COVID-19 Pandemic—What Will Be Different?

“…[ 52 ] It is also encouraging to note that with adaptive mechanisms, procedure volumes for trainees and/or fellows have returned near to baseline without an ongoing impact on endoscopy training. [ 53 ] Time will tell whether these new educational and training models are on par with traditional methods that are mainly based on procedure numbers.…”