Background and Aims
Methods
Results
Conclusions
Abbreviations:
COVID-19 (coronavirus disease 2019), IQR (interquartile range), OR (odds ratio), PPE (personal protective equipment)Methods
Survey design
- 1.Demographics, including age, gender, country of training and specialization
- 2.Monthly endoscopy volumes before and during COVID-19
- 3.Training and availability of PPE
- 4.Impact on physical, mental, and emotional well-being
Outcomes
Survey distribution
Statistical analysis
Results
Baseline demographics
Total (n = 770) | North America (n = 205) | Europe (n = 323) | Australia/New Zealand (n = 40) | Asia (n = 90) | South America (n = 99) | Africa (n = 13) | P value | |
---|---|---|---|---|---|---|---|---|
Mean age, y (standard error) | 32.6 (.2) | 32.4 (.2) | 32.4 (.3) | 33.0 (.7) | 33.4 (.8) | 32.3 (.5) | 36.6 (1.5) | .11 |
Male | 417 (56.9) | 115 (59.9) | 157 (50.5) | 26 (66.7) | 67 (80.7) | 45 (46.4) | 7 (63.6) | <.001 |
Specialty | <.001 | |||||||
Adult GI | 603 (78.3) | 152 (74.2) | 274 (84.8) | 32 (80.0) | 81 (90.0) | 55 (55.6) | 9 (69.2) | |
Internal medicine | 24 (3.1) | 1 (.5) | 15 (4.6) | 1 (2.5) | 2 (2.2) | 3 (2.0) | 2 (15.4) | |
Pediatric GI | 76 (9.9) | 52 (25.4) | 6 (1.9) | 0 (.0) | 6 (6.7) | 12 (12.1) | 0 (.0) | |
Surgery | 59 (7.7) | 0 (.0) | 27 (8.4) | 7 (17.5) | 1 (1.1) | 22 (22.2) | 2 (15.4) | |
Other | 8 (1.0) | 0 (.0) | 1 (.3) | 0 (.0) | 0 (.0) | 7 (7.1) | 0 (.0) | |
Mean years of training (standard error) | 2.7 (.1) | 2.0 (.1) | 3.2 (.1) | 1.9 (.2) | 2.5 (.3) | 2.6 (.3) | 4.8 (1.5) | <.001 |
Advanced endoscopy-focused training (vs general GI) | 135 (17.5) | 9 (4.9) | 57 (17.7) | 7 (17.5) | 22 (24.4) | 35 (35.4) | 5 (38.5) | <.001 |
Impact of COVID-19 on trainee procedural volumes


Barriers to training
Total (n = 770) | North America (n = 205) | Europe (n = 323) | Australia/New Zealand (n = 40) | Asia (n = 90) | South America (n = 99) | Africa (n = 13) | P value | |
---|---|---|---|---|---|---|---|---|
Reduced endoscopy exposure | 722 (93.8) | 201 (98.1) | 302 (93.5) | 38 (95.0) | 86 (95.6) | 82 (82.8) | 13 (100.0) | <.001 |
Endoscopy opportunities available | ||||||||
None (no endoscopy) | 304 (39.5) | 80 (39.0) | 166 (51.4) | 20 (50.0) | 17 (18.9) | 18 (18.2) | 3 (23.0) | <.001 |
No restrictions | 29 (3.8) | 4 (2.0) | 14 (4.3) | 5 (12.5) | 4 (4.4) | 1 (1.0) | 1 (7.7) | .02 |
Unsupervised cases | 40 (5.2) | 3 (1.5) | 19 (5.9) | 3 (7.5) | 9 (10.0) | 4 (4.0) | 2 (15.3) | .02 |
Only low-risk/negative COVID patients | 174 (22.6) | 66 (32.2) | 34 (10.5) | 10 (25.0) | 28 (31.1) | 32 (32.3) | 4 (30.8) | <.001 |
Change in institutional endoscopy volume | <.001 | |||||||
Decreased 1%-24% | 13 (1.7) | 1 (.5) | 3 (1.0) | 1 (2.5) | 3 (3.4) | 5 (5.2) | 0 (.0) | |
Decreased 25%-49% | 61 (8.1) | 10 (4.9) | 23 (7.3) | 8 (20.0) | 13 (14.8) | 6 (6.2) | 1 (8.3) | |
Decreased 50%-74% | 211 (28.0) | 37 (18.2) | 94 (29.8) | 19 (47.5) | 31 (35.2) | 26 (26.8) | 4 (33.3) | |
Decreased 75%-99% | 327 (43.3) | 114 (56.2) | 130 (41.3) | 7 (17.5) | 35 (39.8) | 36 (37.1) | 5 (41.7) | |
Decreased 100% | 28 (3.7) | 3 (1.5) | 15 (4.8) | 0 (.0) | 1 (1.1) | 8 (8.3) | 1 (8.3) | |
Not affected | 14 (1.9) | 3 (1.5) | 5 (1.6) | 0 (.0) | 1 (1.1) | 5 (5.2) | 0 (.0) | |
Decreased (unknown) | 101 (13.4) | 35 (17.2) | 45 (14.3) | 5 (12.5) | 4 (4.6) | 11 (11.3) | 1 (8.3) | |
Mean % reduction in procedures per month during COVID-19 (standard error) | ||||||||
EGD | 85.3 (1.3) | 90.4 (1.1) | 89.6 (1.2) | 78.2 (5.3) | 81.9 (2.5) | 65.1 (9.4) | 78.6 (5.9) | <.001 |
Colonoscopy | 85.8 (2.6) | 92.1 (1.1) | 90.1 (1.4) | 76.7 (5.9) | 79.2 (2.8) | 59.8 (2.4) | 83.7 (6.2) | <.001 |
ERCP | 70.5 (4.2) | 70.0 (9.5) | 72.4 (6.9) | 63.3 (1.7) | 65.1 (9.6) | 71.8 (8.3) | 88.9 (.1) | .99 |
EUS | 78.2 (7.7) | 56.3 (2.6) | 82.6 (4.4) | 85.0 (7.2) | 94.3 (3.1) | 94.4 (3.9) | 100.0 (.0) | .60 |
All | 86.2 (1.2) | 90.1 (1.1) | 90.0 (1.2) | 78.7 (5.2) | 81.4 (2.4) | 69.4 (8.5) | 80.9 (5.6) | <.001 |
PPE adequate in endoscopy unit | 476 (67.6) | 154 (79.4) | 218 (73.9) | 27 (69.2) | 47 (61.0) | 27 (31.0) | 3 (25.0) | <.001 |
Taken off work for COVID-19–related reasons | 168 (23.9) | 24 (12.4) | 91 (30.9) | 4 (10.3) | 18 (23.7) | 24 (27.6) | 7 (58.3) | <.001 |
Personal protective equipment
Physical and mental well-being
Concerns on training
Total (n = 770) | North America (n = 205) | Europe (n = 323) | Australia/New Zealand (n = 40) | Asia (n = 90) | South America (n = 99) | Africa (n = 13) | P value | |
---|---|---|---|---|---|---|---|---|
Concerns | ||||||||
Acquiring COVID-19 | 618 (88.3) | 187 (96.4) | 228 (78.1) | 36 (92.3) | 75 (98.7) | 82 (94.3) | 10 (83.3%) | <.001 |
Competency development | 629 (90.1) | 176 (89.3) | 260 (89.3) | 34 (87.2) | 68 (90.7) | 79 (90.8) | 12 (100) | .844 |
Prolonging training | 502 (71.9) | 96 (49.5) | 230 (79) | 33 (84.6) | 55 (73.3) | 78 (89.7) | 10 (83.3) | <.001 |
Calls for changes to guidelines to support training | 472 (68.9) | 133 (69.3) | 175 (61.4) | 29 (74.4) | 56 (75.7) | 68 (81.0) | 11 (100) | .001 |
Anxiety | .164 | |||||||
None | 311 (44.7) | 86 (44.3) | 127 (44.1) | 22 (56.4) | 39 (52.0) | 32 (36.8) | 5 (41.7) | |
Mild | 231 (33.2) | 61 (31.4) | 104 (36.1) | 14 (35.9) | 21 (28.0) | 30 (34.5) | 1 (8.3) | |
Moderate | 99 (14.2) | 29 (14.9) | 39 (13.5) | 2 (5.1) | 11 (14.7) | 14 (16.1) | 4 (33.3) | |
Severe | 54 (7.8) | 18 (9.3) | 18 (6.3) | 1 (2.6) | 5 (5.3) | 11 (12.6) | 2 (16.7) | |
Burnout | 130 (18.8) | 42 (21.8) | 53 (18.4) | 1 (2.6) | 12 (16.0) | 18 (20.7) | 4 (36.4) | .058 |
Institutional support | 467 (67.4) | 175 (90.7) | 195 (67.7) | 27 (69.2) | 41 (54.7) | 25 (28.7) | 4 (36.4) | <.001 |

Physical health impact of COVID-19
Anxiety and burnout
Factor | No. of cases | Anxiety (%) | Univariable analysis | Multivariable analysis | ||
---|---|---|---|---|---|---|
Odds ratio (95% confidence interval) | P value | Odds ratio (95% confidence interval) | P value | |||
Trainee age | ||||||
Per year | N/A | 1.01 (.98-1.05) | .577 | |||
Sex | ||||||
Male | 288 | 46.8 | Reference | |||
Female | 380 | 66.0 | 2.20 (1.64-3.02) | <.001 | 2.15 (1.52-3.05) | <.001 |
Region | ||||||
North America | 194 | 55.7 | Reference | |||
Europe | 288 | 55.9 | 1.01 (.70-1.46) | .960 | ||
South America | 87 | 63.2 | 1.37 (.81-2.30) | .237 | ||
Australia | 39 | 43.6 | .62 (.31-1.23) | .170 | ||
Asia | 75 | 48.0 | .74 (.43-1.25) | .259 | ||
Africa | 12 | 58.3 | 1.12 (.34-3.64) | .857 | ||
Years in training | ||||||
Per year | N/A | .96 (.89-1.02) | .170 | |||
Specialty | ||||||
Surgery | 50 | 56.0 | Reference | |||
Adult GI | 546 | 54.0 | .92 (.52-1.66) | .789 | ||
Internal medicine | 20 | 70.0 | 1.83 (.60-5.55) | .283 | ||
Pediatric GI | 73 | 57.5 | 1.07 (.52-2.20) | .866 | ||
Other | 6 | 83.3 | 3.93 (.43-36.12) | .227 | ||
Reduced endoscopy exposure | ||||||
Yes | 654 | 55.8 | Reference | |||
No | 41 | 46.3 | .68 (.36-1.29) | .239 | ||
Redeployment | ||||||
No | 536 | 58.5 | Reference | |||
Yes | 159 | 54.3 | 1.19 (.83-1.70) | .350 | ||
Perceived adequacy of PPE | ||||||
Yes | 471 | 50.3 | Reference | |||
No | 224 | 65.6 | 1.89 (1.36-2.62) | <.001 | 1.75 (1.18-2.57) | .005 |
Training on PPE | ||||||
Yes | 513 | 54.0 | Reference | |||
No | 182 | 58.8 | 1.22 (.86-1.71) | .264 | ||
Time off work because of COVID-19 | ||||||
No | 528 | 54.5 | Reference | |||
Yes | 167 | 57.5 | .89 (.63-1.26) | .506 | ||
Concerns with developing COVID-19 | ||||||
No | 81 | 51.9 | ||||
Yes | 614 | 55.7 | 1.17 (.73-1.86) | .513 | ||
Concerns with competency acquisition | ||||||
No | 69 | 43.5 | ||||
Yes | 626 | 56.5 | 1.69 (1.03-2.79) | .040 | ||
Concerns with prolongation of training | ||||||
No | 82 | 42.1 | Reference | |||
Yes | 302 | 60.4 | 2.10 (1.50-2.94) | <.001 | 1.60 (1.10-2.32) | .013 |
Availability of institutional support for emotional / mental health | ||||||
Yes | 467 | 50.7 | Reference | |||
No | 226 | 64.2 | 1.74 (1.25-2.41) | .001 | 1.67 (1.14-2.45) | .008 |
Discussion
COVID-19 map. Johns Hopkins Coronavirus Resource Center.
- Siau K.
- Morris A.J.
- Murugananthan A.
- et al.
Supplementary data
- Appendices 1-5
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Article info
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Footnotes
DISCLOSURE: The following authors disclosed financial relationships: R. Khan: Research support from Abbvie, Ferring Pharmaceuticals, and Pendopharm. M. Żorniak: Research support from United European Gastroenterology. S. C. Grover: Research support from Abbvie, Ferring Pharmaceuticals, Pendopharm, Janssen, and Takeda; personal fees from Lupin Pharmaceuticals. All other authors disclosed no financial relationships.
See CME section, p. 960.
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Access this article on ScienceDirectLinked Article
- The impact of COVID-19 on endoscopy training needs to be considered in the context of a global pandemicGastrointestinal EndoscopyVol. 92Issue 5
- Addressing unmet needs of gastroenterologists’ training in the post–COVID-19 eraGastrointestinal EndoscopyVol. 93Issue 1
- PreviewWe read with interest the article by Pawlak et al1 about the effect of the COVID-19 pandemic on endoscopy trainees, focusing on the decreased number of endoscopic procedures, barriers to training, and the physical and emotional well-being of trainees. With the COVID-19 outbreak the endoscopic training routines was drastically interrupted, leading to a significant gap in medical education. The implementation of virtual training, with webinars held by specialist scientific societies and simulation-based training, should be promoted to meet trainees’ needs.
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