Introduction: Repetitive movements, poor posture, and insufficient education on endoscopic ergonomics can lead to endoscopic related injuries (ERI). More women are entering gastroenterology (GI), and may encounter increased ergonomic challenges due to smaller average hand size and stature. This study assesses whether sex and gender-related characteristics impact ERI, ergonomic training, and knowledge among current GI fellows. Methods: A 56-item anonymous survey was sent to general and advanced GI fellows via email between May and June 2022 to 73 academic centers across the United States. Basic demographic information was obtained including: age, sex, gender, training level, height, glove size, types of endoscopy teachers, and whether ERI was sustained. Questions related to endoscopy suite environment, ergonomic instruction, techniques, equipment availability/use and basic ergonomic knowledge were also included. Univariate and multivariate analyses were utilized in order to compare responses of male and female GI fellows. Results: The questionnaire was emailed to 667 participants; 203 surveys were initiated with response rate of 31%; 200 surveys were completed and included in analyses. Of the 200 respondents, 99 (49.5%) reported female sex at birth and 101 (50.5%) reported male sex at birth. Female fellows were noted to have average smaller hand size and stature (Figure). More female fellows reported that equipment was not ergonomically optimized for their use (47.5% vs 28.7%, p = .006) (Table). Additionally, more females reported that their female teachers had trained them with consideration of physical size (22.4% v 9%, p = .068), and voiced increased desire for access to dial extenders (55.6% vs 20.2%, p = .001). There was a higher incidence of neck and shoulder pain following endoscopy sessions among female fellows (55.6% vs 28.7%, p=.001). Despite no sex differences, overall poor ergonomic understanding was noted, with an average score of 60% on 5-point knowledge-based test. Conclusion: Sex differences exist in ergonomic and endoscopic training of current GI fellows. This study highlights the urgent need for formal ergonomic training with consideration sex of the trainee and physical stature, in order to enhance safety, comfort, efficiency, and equity in training and practice of endoscopy.Figure 1.: Physical stature of male and female gastroenterology fellows Table 1. - Comparison of ergonomic, endoscopy experience between male and female trainees Overall Females Males P-value Preference for same gender teacher 11 (5.5%) 11 (11.1%) 0 (0%) 0.001 Transient neck/shoulder pain 84 (42.0%) 55 (55.6%) 29 (28.7%) 0.001 Equipment not ergonomically optimized 76 (38.0%) 47 (47.5%) 29 (28.7%) 0.006 Glove size not available 18 (9.0%) `15 (15.2%) 3 (3.0%) 0.003 Dial extenders not available 68 (34.0%) 43 (43.4%) 25 (24.8%) 0.001 Teachers train with consideration of stature 103 (52.0%) 43 (43.9%) 60 (60.0%) 0.033 Female teachers train with consideration of stature 31 (15.7%) 22 (22.5%) 9 (9.0%) 0.068 Desire for dial extenders 75 (37.9%) 55 (55.6%) 20 (20.2%) 0.001 Desire for well-fitting aprons 78 (38.6%) 45 (45.9%) 33 (33.3%) 0.030 Desire for formal ergonomic training 194 (98.0%) 98 (99.0%) 96 (97.0%) 0.625