To the Editor:
Diagnostic and therapeutic procedures are among the core aspects of gastroenterology. We acknowledge that during the COVID-19 pandemic there have been diminished procedural volumes, as highlighted by the American Society for Gastrointestinal Endoscopy. 1 As trainees in gastroenterology we would like to advocate for our training by proposing solutions to this challenge.
First, hands-on procedures can be supplemented by the use of simulation endoscopy-based systems. Simulators are widely available and are often not used to their full potential. Simulation offers multiple advantages during times when traditional training cannot take place in the endoscopy unit. It is a tool for objective evaluation of competency,2 which is of paramount importance for trainees who will be starting independent practice soon. It also allows for tailoring and continued proficiency for diagnostic and therapeutic purposes.
During the COVID-19 pandemic, telemedicine has been extensively used for ambulatory practice. In light of its potential benefits, incorporation of tele-endoscopy should be considered to account for reduced endoscopy volumes. Tele-endoscopy would involve real-time display of procedures as they are being performed by attendings, during which trainees observe these cases. Examples could include hemostasis for GI bleeding and complex endoscopic resection of lesions. Tele-endoscopy could also allow for real-time–based discussions, so trainees gain continued competence in decision making. From the patients’ perspective, tele-endoscopy allows for a “second look” to take place to ensure that no lesions have been missed and hence provides further reassurance that the endoscopic examination has been done optimally.
COVID-19 has posed a significant challenge to endoscopic training. However, where there is a challenge there is also an opportunity. We hope that recognizing the training limitations we currently see will provide an impetus for alternative and improved training solutions.
Disclosure
All authors disclosed no financial relationships.
References
- 1.American Society for Gastrointestinal Endoscopy American Society for Gastrointestinal Endoscopy: guidance for trainees during the COVID-19 pandemic. Gastrointest Endosc. 2020;92:748–753. doi: 10.1016/j.gie.2020.05.032. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Walsh C.M., Cohen J., Woods K.L. ASGE EndoVators Summit: simulators and the future of endoscopic training. Gastrointest Endosc. 2019;90:13–26. doi: 10.1016/j.gie.2018.10.031. [DOI] [PubMed] [Google Scholar]