Gastroenterology covers a wide range of disorders including those of the gastrointestinal tract in its entirety, the liver, the pancreas and the biliary tree. The diversity of organs affected and the numerous diseases afflicting these organs makes Gastroenterology a particularly attractive specialty.
Endoscopy is a central component of Gastroenterology with sub-specialty training in oesophageal therapy, endoscopic retrograde cholangiopancreatography, endoscopic ultrasound, portal hypertension, small bowel studies, as well as more conventional upper and lower gastrointestinal endoscopy. Gastroenterologists in East Anglia also contribute to general medicine and the majority of trainees to date have achieved dual accreditation. A major attraction of Gastroenterology has been the evolution of critical collaborations with radiologists, pathologists, GI surgeons, liver transplant teams, and a variety of clinical nurse specialists, nutritionists and psychologists.
Gastroenterologists in most district general hospitals cover a variety of disorders including inflammatory bowel disease, oesophageal disease, hepatology, small bowel disorders and perform most routine endoscopies. Within the region, sub-speciality interests have evolved including hepatology, liver transplantation, inflammatory bowel disease, intestinal failure small bowel transplantation. New government initiatives have stressed the value of rapid throughput for patients with potential malignancy, which forms a critical component of the speciality.
Training Programme
The deneary tends to be geographically split into East (Norwich based) and West (Cambridge) but with the option to move according to preference and to remain for several years within a sub-region – the programme director being as accommodating as possible in this regard. Bedford, Huntingdon, Ipswich, Great Yarmouth, King's Lynn, Bury St Edmunds, Basildon, Colchester, Stevenage, Watford, Chelmsford, Peterborough and Luton & Dunstable hospitals are smaller units with between three and six lead gastroenterologists. Each of these offers an excellent mix of Gastroenterology and general medicine as well as variable specific training including ERCP, oesophageal manometry, capsule endoscopy, balloon enteroscopy and EMR. The units at Norwich and Cambridge are larger and allow sub-specialty exposure in Hepatology, Nutrition, Inflammatory Bowel Disease and advanced endoscopy (EUS and ERCP), which can be either as part of the rotation or a dedicated Advanced Training Programme (ATP).
The opportunities for research are outstanding and range from basic science to translational medicine and clinical trials. The majority of research opportunities within East Anglia are on offer in Cambridge and Norwich medical schools. There are currently several ACFs and NIHR/University Clinical Lecturers in place at the two centres as well as many opportunities for out of programme research. Cambridge has a Chair of Gastroenterology and has several established academics with internationally acclaimed research pedigree. The main research areas are in inflammatory bowel disease, Barrett’s oesophagus and oesophageal cancer as well as in various aspects of hepatology. Cambridge is a Biomedical Research Centre and CRUK Experimental Medicine Centre with particular strengths in metabolic and inflammatory diseases as well as cancer. Norwich Medical School has a vibrant research programme in Gastroenterology with a number of Chairs and Academics. Out of programme experience for research is encouraged provided that advance notice is provided to Health Education England, Working across the East of England - Information can be found here.
- Completion of a core medical training programme or equivalent.
- Documented evidence of achievement of level 1 competencies in general internal medicine (acute) and generic curricula.
- Full MRCP with PACES is now essential for progression to ST3.
All trainees are appointed to the whole region and not to specific posts or rotations.
The rotation is complex because of the varying needs (educational and personal) of the trainees, the service needs of the units, and fluctuation in numbers caused by trainees leaving the programme for out of programme experience.
In general, there are 49 posts currently in the region. Trainees generally spend their 1st year in one of the smaller DGHs with exposure to general gastroenterology including diagnostic endoscopy as well as GIM. The second year is often in a larger DGH with some subspecialty experience. Most of the 3rd and 4th years will be spent in the Teaching Hospitals and the final year usually involves a DGH placement.
Trainees based in Norwich can expect to spend two years in the teaching unit. Due to the distribution of posts based around Cambridge, trainees on these programmes will spend an average of 18 months (some will spend 1 year and some 2 years) in the teaching hospital, whereas 24 months is more likely for those based around Norwich. The second teaching hospital year will be most likely an ATP as specified in the 2010 curriculum.
Whilst there is an obvious degree of geographical separation between trusts, this is not fixed and some posts will receive trainees from both ends of the rotation. The TPD will take personal travel arrangements into account for placements and will try not to make the huge rotational moves
The standard date for rotation to new posts is the 1st Monday in September. Where new appointees join the region at another date (usually the August recruitment) they will usually spend 13 months in a unit before the next rotation, however their initial placement will be determined by the vacancy situation.
Gastroenterology is a hugely rewarding specialty to embark upon with a wide variety of sub-specialties that can be chosen from. The Eastern Deanery allows a real balance of training with both teaching hospitals in the region renowned for research as well as providing excellent Gastroenterology training.
There are several axes within the region – Cambridge, Norwich, M1 corridor and Essex. You will get at least 1 year in one of the two teaching hospitals. Geographical constraints will be accommodated but you should be positively seeking out specific training opportunities.
Useful contacts
| Role | Name | |
| Training Programme Director | Arun Shankar | arun.shankar@nnuh.nhs.uk |
| Trainee Representatives |
Hemant Laxaman (Ipswich) |
hemant.laxaman@ipswichhospital.nhs.uk |
| Specialty Administrator | Rachel Plumb | rachel.plumb@nnuh.nhs.uk |
Curriculum
Detailed guidance on the Gastroenterology assessment blueprint and curriculum is available from the JRCPTB website -
Endoscopy Training:
- Unless you are doing a very specialist attachment you should have access to a minimum of 1 training list per week with the option of additional adhoc list based on other clinical commitments.
- For new starters you should be reasonably up the learning curve for OGD before doing colonoscopy (say at least 50 OGDs) and can start flexi sigs early on.
- Basic OGD and Colon courses are mandatory but discounted if done at Norwich. Your lists should be tailored to your needs.
- Before attempting ERCP you should be JAG accredited in OGD and have reasonable therapeutic OGD experience.
- You should have an endoscopy trainer and log all procedures via JETS.
- Please note 10 DOPs per year needed for anything you are not yet accredited in.
- 2 DOPs per year to show you have maintained your skill level if accredited.
- JAG accreditation is required for CCT in diagnostic upper GI endoscopy and colonoscopy for non Hepatologists. Therapeutic OGD, ERCP and EUS are not yet JAG accredited but may well be in the near future
GIM
- If you are doing GIM (which most are) then your CCT will tie in with the Gastro one. You will have separate PYAs and ARCP outcomes. GIM contacts and training days can be found here.
Academic
- Training for academics (NTNA, typically a CL post) is competency based although there is a minimum training period of 48 months – 24 months gastro if an academic Hepatologist. In order to complete in a timely manner your training layout needs discussion well in advance. Dropping GIM is an option but the decision needs to be made early.
ATPs
- If you look at the 2010 Gastro curriculum there is a diagram showing that year 4 is meant to be a specialist year. Hepatology and Nutrition are run nationally (recruit November – NHS jobs) but there are IBD and endoscopy ATPs established now in both Norwich and Cambridge which are recruited to around Febuary/March time ahead of the ST3 round. They can be done in ST5-ST7 – latter if no other outstanding training requirements apart from a few GIM on calls
Eportfolio
- For each post you need an Educational Supervisor assigned. He/she needs to do an induction, mid-point and end appraisal.
- In addition, a supervisor report needs completing at the end of each post and prior to any ARCP be it interim, absentia or a formal one face to face. This needs to be done for both GIM and Gastro (i.e. 2 reports per year) if you are dual accrediting.
- If you have any problems with educational supervision please email the TPD.
- There is some new guidance (JRCPTB website) so common competencies won’t necessarily need signing off but most of them do bar the advanced curriculae which are only for those doing the relevant ATP.
- Look at the latest decision aid to see how much needs signing per ST year and note there is now a limit to how much you can spread a piece of evidence.
- Competencies need both trainee and supervisor ratings (red and blue icons).
- You should have the latest GIM and Gastro curriculae uploaded
- ESEGH – European wide specialty exam (previously called SCE) held annually and a pass is mandatory for CCT. Usually attempted in ST4 or ST5. There are training courses held in Nottingham and St Marks.
- Audits - You need to do an annual audit in gastro/hep and 3 GIM audits over your lifetime as an SpR. Try and enhance the various aspects of your CV as you go along – teaching, leadership, management (course essential but leave until final years), courses/meetings, presentations/publications
- CCT - There is now a CCT calculator which you are meant to use. This will be checked at ARCP and you can get a copy from your deanery contact. If you are new and trying to count previous LATs then this needs sorting within a few months of your NTN. Note that you can’t count 3 months for mat leave anymore and all time counted from OOP needs prospective approval by the JRCPTB and GMC. The 6 months grace period is currently subject to review and may end up being abolished.
Reading list
Join the BSG and BASL (if interested in hepatology) or BAPEN (if interested in Nutrition)
Training Days:
- These are mandatory but also include the East Anglian Gut Club (an afternoon twice a year) and the Cambridge Liver Symposium (end Sept).
- A register needs to be signed to confirm attendance and if you cannot make it, the Trainee Reps should be emailed in advance.
- The list of training days is circulated well in advance so no excuse not to cancel routine commitments although on call is understood. If you don’t know when the days are, the Trainee Reps should be the first port of call.
AOB
- Check out our Facebook Page; EoE Gastro SpRs
This information was compiled by Trainee Representatives Dr Richard Warburton and Dr Kiran Bundhoo
For a full list of upcoming training events and study courses aimed at all medical specialties within the region - Please visit the following links:
- The Upcoming Events Page, where you can find information on a range of upcoming courses
- The School of Medicine Calendar, where you can see events and courses by month