Upper gastrointestinal endoscopy training: impact of the COVID pandemic on general surgery trainees

Abstract

Background: Upper gastrointestinal endoscopy (UGE) is a vital skill for general surgeons, yet the adequacy of training in low-resource settings like South Africa remains unclear. This study assesses endoscopy training for general surgery registrars at Groote Schuur Hospital, with a focus on the impact of the COVID-19 pandemic.

Methods: A retrospective analysis of the Upper Gastrointestinal Surgery Registry was conducted from 1 April 2018 to 30 September 2024. Data on diagnostic and interventional UGEs were reviewed across three periods: pre-COVID-19, during COVID-19, and post-COVID-19. Registrar exposure was evaluated based on the number of procedures performed during a standard three-month rotation. Descriptive and comparative statistical methods were applied (p < 0.05).

Results: Of 12 455 UGEs, 6 901 (55.3%) were performed by registrars. Diagnostic procedures accounted for 66.9% of all UGEs, with registrars performing 64.1%, while interventional procedures made up 33.1%, with 37.8% performed by registrars. Training during the COVID-19 period was significantly reduced, with only two registrars completing full rotations, compared to the usual 12–18. Although procedural volume increased post-COVID – 21.8% for diagnostic and 60.2% for interventional UGEs – median registrar exposure per rotation dropped from 131 pre-COVID to 112 post-COVID. This indicates that despite increased service delivery, registrar training opportunities did not return to pre-pandemic levels.

Conclusion: General surgery registrars at Groote Schuur Hospital receive substantial endoscopy exposure; however, the COVID-19 pandemic disrupted training significantly. Enhancing simulation-based learning and optimising rotations are crucial to ensure adequate competency in UGE.