Welcome to Gastroenterology at Severn Postgraduate Medical Education (PGME).
This excellent training programme consists of a five year ST3-ST7 training programme in gastroenterology and general (internal) medicine based in the North part of the South West of England. Severn PGME covers Bath, Bristol, North Bristol, Cheltenham, Gloucester, Swindon, Taunton, Western-Super-Mare and Yeovil. It is a great place to live, train and work.
The hospitals in the region offer a large breadth of training in general gastroenterology, hepatology, endoscopy and nutrition. There is supervised exposure to general outpatient, inpatient gastroenterology, endoscopy and emergency endoscopy, in addition to training in acute and general medicine.
There are also excellent opportunities for further sub-specialist training.
Please read through the questions below and for any further information you can also consult the Gastroenterology Induction Book.
What is Gastroenterology?
Gastroenterology needs very little introduction. It is one the major medical specialities, is extensively taught in pre-clinical and clinical undergraduate years, and is a core component of the MRCP. Every reputable medical school has an established Gastroenterology Division, often with flourishing research programs. Every DGH in the UK has a gastroenterology consultant/s with an endoscopy unit.
What makes Gastroenterology an attractive option?
Gastroenterology must be one of the most desirable and fascinating specialities a doctor can choose. It is near unique in combining a requirement for continued basic history taking and examination skills together with many and varied, highly-skilled, practical procedures. The requirement for the brains of a physician with the practical skills of a surgeon makes gastroenterology a very attractive speciality. For those of you who are thinking of general practice because you want to provide holistic care to your patients life-long, Gastroenterology can offer that too. Inflammatory bowel disease patients are diagnosed in their twenties and usually stay under regular Gastroenterology clinic review throughout their life. You can choose to sub-specialise within Gastroenterology to concentrate on one particular area. Again there is something to suit everyone: endoscopy, inflammatory bowel disease, GI bleeding, hepatology, pancreatobiliary, nutrition, GI physiology to name but a few. However, most people think the variety that being a general Gastroenterologist provides is another major plus of the specialty.
Gastroenterologists love to endoscope. It is both challenging and rewarding, especially if you can save someones life by stopping a bleeding ulcer.
Most importantly, Gastroenterologists are a friendly bunch of people who are great fun to work with. I think this comes of really enjoying what we do.
What are the Entry Criteria for Gastroenterology?
Each trainee will be expected to have achieved foundation programme competencies, or the equivalent. The first two years of specialty training (ST1, ST2) will be in a core training programme (core medical training (CMT) or acute care common stem training (medicine) (ACCS(M)). This is equivalent to the old medical SHO training. During core training physicians will be expected to have achieved level 1 acute medicine competencies for which MRCP part 1 or an equivalent exam is the knowledge based assessment. Overseas qualifications currently recognised as being equivalent to the MRCP (UK) are FRACP Part 1, FRCP Canada, MD Columbo, MHKPS Hong Kong, M.Med Malaysia, FCPS Pakistan, M.Med Singapore, FCP South Africa, US Boards of Internal Medicine.
What challenges face those hoping to specialise in Gastroenterology?
As a popular specialty, there is likely to be competitive Gastroenterology allocation in the future. Each ST3 post is oversubscribed with extremely well qualified doctors. Passing MRCP and expressing a latent interest in gastroenterology is certainly not enough to ensure you will be offered a place. Most successful applicants will have planned their entry early in their SHO career, and have acquired additional attributes to put themselves ahead of the pack. Examples would be GI audits attachments to the nutritional teams, exposure (but not training) in endoscopy, case reports and attendance at GI courses.
What is expected of those training in Gastroenterology?
Final MRCP (UK) Diploma must be achieved by the end of the ST3 year. If failed, the ST3 year must be repeated. MRCP must be passed by the end of the repeat ST3 in order to progress. The specialist Gastroenterology exam must be passed before the Penultimate Year assessment (PYA). Five mini-CEX assessments per year to cover 4 major domains and a case based discussion must be performed each year. A multisource feedback (MSF) must be submitted at the end of years 1 & 3 or more often if needed. More frequent DOPS for procedures such as liver biopsy and endoscopy are required.
The length of training for Gastroenterology is 4 years (ST3 to ST6) or five years if combined with GIM (ST3 to ST7).
What does a Specialist Registrar Say?
Having enjoyed all the medical jobs I did as an SHO, and also surgery and A&E I found if difficult to decide what speciality to pursue; I had opted for a medical SHO rotation so that I could do A&E or medicine. When choosing I think it is important to look at the Consultant’s job and what it involves. I was keen to continue to manage acutely sick patients, I wanted to do lots of practical procedures, and I was keen to continue as a physician and to continue to be involved in the medical take. This narrowed down the choices to respiratory, cardiology and gastroenterology.
I chose gastroenterology because of the procedures. So far as a year three registrar I am competent at diagnostic and therapeutic gastroscopy including banding, injection of ulcers, use of the silver probe, APC, dilatations and PEG insertion. I have trained in flexible sigmoidoscopy, and colonoscopy and also perform therapeutics in these such as snare polypectomy and hot biopsy. I am hoping to learn ERCP shortly, and may perhaps train in endoscopic ultrasound. I have also begun training in push enteroscopy and double balloon enteroscopy. On the wards I perform liver biopsies, ascitic drains and rigid sigmoidoscopy; as well as continuing the general medical procedures.
Gastroenterology is a wide-ranging speciality. We are broadly divided into luminal, hepatology and nutrition and I appreciate the variety. I enjoy the challenge of alcoholic and drug addicted inpatients, acute bleeders, refeeding anorexics, diagnosis and management of GI malignancies and the management of acute IBD. Gastroenterologists work closely with their surgical colleagues, and often provide combined care. A lot of gastroenterology is outpatient conditions and as a result hospital trainees may not have encountered much of our workload; a gastroenterology registrar can have a useful role in education and teaching. Endoscopy is the highlight of my week. Overall I have never regretted my choice, and would recommend gastroenterology to everyone.
What does the future hold for Gastroenterology?
The United Kingdom has an enviable reputation in gastroenterology, having contributed enormously to seminal areas of Gastroenterology research and practice. The United Kingdom record of innovative research in gastroenterology appears to be under threat, with the possible removal of research experience as a desirable attribute in a Gastroenterologist, coupled with a push to minimise the training period to meet service demands. There is a need to encourage Gastroenterology trainees to recognise that research periods are critical to the development of the speciality, and that such out of programme experiences don’t have to be exclusively orientated in basic science. Worthwhile experiences can include large audits, different approaches to service provision, educational initiatives, primary care initiatives and so on.
Most Gastroenterologists also have a committment to general internal medicine. The future may see a clash between the ever burgeoning internal medicine demands and heavy sessional committments to Gastroenterology plus the need for out of hours GI bleed rotas. This may result in some of the non-GI medical load being devolved to specialists in acute general medicine. There is already an increasing use of nurse/non-medical endoscopists in straightforward diagnostic endoscopy, with the more complex therapeutic procedures performed by the specialists. Threats to hospital endoscopy include sophisticated imaging and independent treatment centres. The impotance of the expert endoscopist will remain pre-eminent owing to the need for increasingly complex therapeutic procedures and the need to obtain histology.
Outpatient nursing/dietetic roles will also expand with guideline run clinics (e.g. rectal bleeding) and follow up specialist clinics (e.g. IBD or coeliac clinics). Unlike some other medical specialties however, the number of referrals to Gastroenterology continues to rise so this just means that we have more time to see the complex cases.