LAUSR

The COVID-19 pandemic has affected essentially all aspects of our lives. Doctors in training are especially vulnerable from it as we are one of the many frontliners in this time. We will always be remembered as the COVID-19 pandemic batch. We were caught off guard with the coming of the pandemic early this year, and it came like a deluge that swept everything it reached, including our personal and professional lives. Definitely, one will not consider this as the perfect time to undergo fellowship training. However, given this unique setting, we face it positively with various opportunities to move forward. It is not a matter of being left with no choice but, rather, choosing what is the best for everyone. Herein, we share some thoughts and perspectives regarding the impact of the pandemic on our training as gastroenterologists, and how we cope and adapt with it. As gastrointestinal (GI) practice is shifting gears and adopting new strategies to overcome the challenges, we provide an outline of the different measures we GI fellows can observe as we continue in our training (Table 1). In our country, the Philippines, GI inpatient, outpatient and endoscopy cases were immediately on a downward trend at the beginning of the outbreak. We felt the impact starting to trickle early this year. As time went by, the trickles turned into waves, and so are the patients who came in positive for the coronavirus infection. As many healthcare workers become infected as well, hospital manpower became marginal. Within the next few days, our responsibilities broadened. We assumed internist duties, such as manning the frontline, and took our gastroenterology posts on a skeletal force. We put down our endoscopes and we relearned to operate our mechanical ventilators and interpret arterial blood gases. As the pandemic hit the world with great magnitude, this scenario became a common picture among healthcare workers and different medical specialties. With the growing pressure, we moved forward, adopting best practices, adhering to the ever-changing guidelines, and devising ways to limit exposure while maximizing the use of our depleting resources. From the perspective of gastroenterology, the pandemic had specific impacts regarding staff and patient safety resulting in postponement of non-urgent clinical and endoscopic services. As GI endoscopy is considered to be a risk for viral transmission, elective endoscopic procedures were postponed. A higher threshold for performing endoscopic procedures was adopted. Furthermore, endoscopy performed by GI fellows was suspended in most institutions. Trainees were discouraged from performing or assisting in endoscopic procedures in order to shorten procedure time, limit exposure, and preserve personal protective equipment (PPE) resources. This declining number of endoscopic procedures performed by fellows had a great impact on our training. In our country, the overall reduction in endoscopic procedures has been the primary concern of all 59 fellows. Supplementary programs, such as simulation-based learning and virtual endoscopy mentoring, could be arranged so that fellows could achieve sufficient competency. A study in Australia showed that 45% of GI trainees were in favour of additional ‘catch-up’ endoscopy training, while 36% favoured an extended training duration due to the limited access to endoscopy. Given the disruption of the usual learning activities of GI fellows, an issue that could emerge with this kind of set-up is burnout. Compounding concerns on