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. INTRODUCTIONAcute upper gastrointestinal bleeding (AUGIB) is a common medical emergency that has a 10% hospital mortality rate.

Acute upper gastrointestinal bleeding

“…19 Sustainability of services for UGIB also requires that those appointed to consultant posts have had adequate training and experience. 20 ■…”

Variation in exposure to endoscopic haemostasis for acute upper gastrointestinal bleeding during UK gastroenterology training

“…Training in AUGIB within the UK has been a persistently contentious issue 11. Previous data point to a reduction in trainee exposure to AUGIB cases over time,6 particularly with high-risk cases, and lack of confidence in final-year trainees with managing the condition 5. At present, there is no UK AUGIB curriculum or minimum procedural numbers recommended by JAG or the British Society of Gastroenterology (BSG) to benchmark competence in AUGIB haemostasis.…”

“…From 2021, higher specialist training will be shortened from 5 to 4 years under ‘Shape of Training’ proposals 4. This has raised concerns regarding competency acquisition in endoscopy, particularly when shortfalls have been reported during the existing 5-year training period 5–7…”

Endoscopy for upper gastrointestinal bleeding: where are we in 2017?

“…The recent NCEPOD identified that 53% of consultants contributing to an on-call UGIB rota did not feel confident in their ability to glue gastric varices 8. Gastroenterology trainees in the UK report a deficiency in their training and exposure to the management of UGIB especially in the out-of-hours period and with more difficult cases, with 21% of trainees reporting that they were not satisfied with the training they received 26. There is a clear need to develop structured therapeutic endoscopy training for UGIB in the UK.…”