Post written by Katarzyna M. Pawlak, MD, PhD, Aline Charabaty, MD, AGAF, and Catharine M. Walsh, MD, MEd, PhD, from the Hospital of the Ministry of Interior and Administration, Szczecin, Poland, the Division of Gastroenterology, Johns Hopkins School of Medicine, Johns Hopkins-Sibley Memorial Hospital, Washington, DC, USA, and the Division of Gastroenterology, Hepatology and Nutrition and the Research and Learning Institutes, Hospital for Sick Children, Department of Paediatrics and the Wilson Centre, University of Toronto, Toronto, Ontario, Canada.

The drastic impact the COVID-19 pandemic has had on endoscopy services worldwide has been well documented; however, the impact of the pandemic on endoscopy trainees has not previously been evaluated. We aimed to assess the impact of the COVID-19 pandemic on trainees’ procedural volumes, barriers to training and well-being in different parts of the world.

Recent studies have mainly focused on the new realities of case selections and protective equipment that endoscopy centers have had to face because of COVID-19. However, issues pertaining to endoscopy training, including changes in case volumes, barriers to hands-on training opportunities, trainees’ concerns, and the overall impact of the pandemic on trainees’ physical and emotional well-being have not been evaluated.

93.8% of the 770 trainees surveyed across 63 countries reported that the COVID-19 pandemic has had a profound negative effect on their program’s endoscopy volumes, with a corresponding reduction in training opportunities. Subsequently, trainees had concerns about their competency development and about the potential need to prolong their training in order to achieve endoscopy proficiency. These concerns were associated with high rates of anxiety (52.4%) and burnout (18.8%) among trainees.

These results emphasize the need for institutions, training programs, and GI societies to be particularly creative in their support of trainees during these unprecedented times. Strategies to optimize endoscopy training, include the use of validated assessment tools to define skills deficiencies and develop individualized learning plans, the use of simulation-based technical and non-technical skills training, and finally the use of educational resources to develop cognitive skills acquisition. The virtual education platforms offered by major gastrointestinal societies worldwide, and the innovative social media collaborative learning initiatives, such as @ScopingSundays, @MondayNightIBD, and @GI_Journal on Twitter, have become valuable open access resources for didactic and endoscopy-related education for trainees around the globe at a time where conferences and hands-on training symposia are on hold. Finally, effective mentorship during training and beyond for fellows graduating during the pandemic, is now more crucial than ever, to promote continued endoscopic skills and knowledge development.

In addition to supporting trainees in acquiring and enhancing endoscopic competencies beyond the traditional pathways, training programs need to implement strategies aimed at fostering trainees’ well-being and a sense of supportive community.  Some of these strategies include scheduling appropriate breaks and time off, organizing virtual social gatherings for trainees and faculty, providing a safe space to discuss emotional state and confidential mental health resources, and implementing formalized stress management and resiliency training. These measures can all have a positive impact on the trainees’ well-being and subsequently on their overall training satisfaction.

Figure 1. Comparison of trainee-reported number of supervised procedures (A), independent procedures (B), and total procedures (C) in the 30-day period before (PRE) and during COVID-19 (COVID). Symbols and error bars represent the median and interquartile ranges. ∗.0001 < P < .05, ∗∗P < .0001. Colon, Colonoscopy; UGIB, upper GI bleeding hemostasis.

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