Professor Benedict Devereaux
Endoscopy trainees have suffered a 95% reduction in monthly procedural volume due to COVID-19, leading to fears this will prolong their training.
An international survey of 777 endoscopy trainees from 63 countries including Australia, found their case numbers dropped during COVID-19 due to hospital policies, lack of cases, PPE shortages, redeployment and other personal reasons.
Notably, about half of the respondents were from three hardest-hit countries of the US, UK and Spain at the time the survey was conducted in April 2020.
The survey found reduced endoscopy exposure was reported almost universally – 95% in Australia/New Zealand, 98% in North America, 93.5% in Europe, 95.6% in Asia, 82.8% in South America and 100% in Africa.
The level of PPE used within the endoscopy unit was felt to be adequate in 68% of cases, and about half of respondents (47%) believed that a lack of PPE was contributory to reductions in institutional endoscopy case volume.
The survey showed 72% of respondents were concerned about the need to prolong specialty training in order to reach the required level of competency.
And a similar proportion (69%) believed that existing national/international guidelines should be modified to better support endoscopy training during the COVID-19 pandemic.
More than half of trainees reported some level of anxiety and up to 19% met the criteria for burnout.
“The effects of COVID-19 are projected to persist until at least 2022. As such, an urgent review of endoscopy training is warranted to adapt accordingly and provide direction,” the study investigators said.
“Training programs should openly recognize that minimum procedural numbers may not be achievable in some countries and adopt mitigation strategies.”
“Additionally, it will be important for institutions and private practices to ensure that new faculty are closely mentored to promote continued skills development.”
Australian impact
GESA vice-president Professor Benedict Devereaux, who led their COVID-19 advice regarding endoscopy, told the limbic that Australian trainees were relatively fortunate.
“There has been an impact on their training in that they have had less exposure during the height of the pandemic to endoscopic procedures,” he said.
“And that was in fact guided by GESA in its triage guide because we felt from a safety point of view for the trainee and also for the conservation of PPE that we had to exclude them from the procedure room at the height of our first phase of the pandemic.”
However, due to the relatively short period of tight restrictions in Australia, the impact on local trainees will be relatively mild and certainly less than what was anticipated.
“We would consider that it would not be a widespread significant problem for our trainees.”
Professor Devereaux said the level of anxiety amongst trainees was quite valid.
“I think all of us have experienced anxiety through the pandemic – the trainees, the teachers, all clinicians, and of course the general population. There is no doubt about it.”
“As was mentioned in the survey that related to their personal risk of contracting the disease, the impact it may have on their family as well as the impact that it might have on their training program and their future.”
However trainees could take some positive learnings from the COVID experience that might benefit them throughout their careers.
“Perhaps there have been less procedures but I think the trainees have gained a greater understanding of infection control in endoscopy and on the appropriate use of the different standards in PPE. That’s been a really important addition to their training.”
Professor Devereaux added that the cognitive aspects of endoscopic training – knowing when to do a procedure, how to do it, what the expected pathology is, and how that will be managed – should not have been affected by COVID-19.
“So we always emphasise the cognitive aspects of endoscopic training and through the pandemic there has been plenty of time for trainees to focus on that. Endoscopic training is not all about procedural skills,” he said.