Improving trainees exposure to acute upper gastrointestinal bleeding: registrar of the week model.

We read with interest the recent paper by Raju et al that highlighted the impact of the COVID-19 pandemic on gastroenterology training in the UK.1 This national survey of gastroenterology trainees showed a significant reduction in all aspects of training experiences including endoscopy, clinics, referrals and specialty ward cover. Furthermore, only 21% of the trainees were part of an acute upper gastrointestinal bleeding (AUGIB) rota, a concerning figure that has not improved since the previous trainees survey in 2010.2 Although initiatives such as immersive 6-week blocks of tailored training and ad hoc endoscopy lists have been shown to increase trainees’ exposure to managing AUGIB without jeopardising patient safety,3 the wide implementation of this model is hindered by the increasing acute general medical commitments and rota gaps.

We would like to share our local model, ‘Registrar of the week’. In our teaching hospital, the allocated registrar of the week performs all urgent inpatient endoscopies within working hours under direct supervision from the on-call consultant. Also, the registrar carries the AUGIB referrals phone and provides gastroenterology advice to other specialities across three hospital sites throughout the week (figure 1). Each registrar undertakes this role for 7–8 weeks every year. On average, the registrar of the week performs 30 urgent procedures per week, the majority of which are for AUGIB. This model provides the trainees with protected specialty time and therapeutic endoscopy experience even in the early years of training. Moreover, it is easy to incorporate within the rota alongside the general medical commitments. The trainees’ feedback has been excellent despite the high burden of phone and email referrals which could exceed 20 referrals per day.

Figure 1

Registrar of the week responsibilities.

Finally, we agree with Raju et al that innovative solutions are needed to ensure adequate training and to mitigate the challenges of the pandemic and the forthcoming shorter specialty training. The limited trainees exposure to AUGIB is a major concern that, if not addressed, will hinder the ability of trainees to achieve independence as consultants which will have significant negative implications on the standard of care provided to our patients in the near future. Therefore, more local initiatives like ‘Registrar of the week’ are needed.