Comment

298 www. thelancet. com/gastrohep Vol 8 April 2023 same, some higher specialty training programmes will reduce from 5 years to 4 years (appendix). The emphasis on producing doctors capable of delivering holistic care is welcome, as is the new curriculum focusing on high level capabilities with a simplified assessment structure. However, concerns have been raised within the gastroenterology and hepatology community that widespread structural and cultural change is needed to continue to train highly skilled doctors capable of delivering excellent specialist care. 2 The clinical and training environment envisioned in the Shape of Training report is profoundly different to the current situation, in which clinical services are severely stretched for a chronically understaffed workforce, with increased rates of physician burnout repeatedly highlighted. 2-4 We describe some of the barriers and often-unspoken rules of medical training within the UK that must be addressed to deliver the new curriculum.

Gastroenterologists provide the majority of endoscopy services. An ambitious component of the new gastroenterology and hepatology training curriculum is that mastery of this skill is now mandated. Learning to perform high quality endoscopy requires large amounts of dedicated teaching time with only around half (51%) of trainees achieving this in the previous 5-year training programme in the UK. 2 Although a consultant on their first day is expected to control a life-threatening upper gastrointestinal bleed, just one in five (21%) were part of an upper gastrointestinal bleeds rota during their training. 2, 5 How do we bridge this gap between completion of training and becoming a consultant, and what challenges must we overcome? One of the current problematic practices in gastroenterology training is a pressure to learn endoscopy in non-working hours, for example during rostered days off. This unspoken rule discriminates against those who have other commitments, notably female endoscopists, carers, and those working less than full time. In the UK, a study compiling official gastroenterology training data for select years between 2011 and 2021 found that female trainees had lower rates of achieving colonoscopy certification during training (55% in men vs 45% in women, p= 0· 005). 6 In the aftermath of the COVID-19 pandemic, nearly a quarter of all trainees (22%) reported feeling burnt out. 7 Expecting these doctors to rely on training in their own time is unacceptable and leaders should be promoting