Gastroenterology Trainees Research Articles

Approach to the Do-Not-Resuscitate patient in the periendoscopic period – survey about the current Portuguese reality

Background and Aims: Cardiopulmonary arrest is a rare but possible complication of endoscopic procedures, particularly when performed under sedation and/or analgesia. Hospitalized patients, and probably those with a Do Not Resuscitate (DNR) order, present a higher risk of severe cardiopulmonary complications during endoscopy. The request for endoscopic examination, particularly urgent procedures, is becoming increasingly more frequent in patients with Do-Not-Resuscitate orders. This study aimed to assess current practices, concepts and guideline awareness of nationally surveyed Portuguese gastroenterologists regarding the approach to code status for DNR patients in the periendoscopic period. Methods: Online anonymous and self-administered survey was adapted to the Portuguese reality and was conducted to assess gastroenterologists and gastroenterology trainees’ basic demographics data and details about current practice, personal opinions and knowledge of existing guidelines concerning the reversal of periprocedural DNR orders. Results: One hundred and forty five gastroenterologists, including 26 trainees (17.9%), responded to the survey. In patients with a DNR order, code status is rarely discussed (<25% of cases) with the patient/legal representative (66.9%, n=97) or hospitalist (58.6%, n=85) and the DNR order is also rarely reversed (reversal in all (100% of cases) or most cases (75-99% of cases) in 8.3% n=12). Most respondents were unaware of the procedures necessary for DNR prescription in Portugal (81.3%, n=118), as well as existing guidelines on DNR reversal (96.5%, n=140). Regarding personal beliefs, the majority considered that in these patients, the DNR order should be reversed to an intermediate option that includes limited resuscitation maneuvers (62.1%, n=90) and that the urgency of a procedure should not influence the decision to reverse DNR (n=89, 61.4%). There was consensus on the need for recommendations on this topic for gastroenterologists (97.9%, n=142). Conclusion: Portuguese gastroenterologists usually do not revisit the DNR order before endoscopic procedures as a matter of course and consequently do not reverse it. Furthermore, we found significant variation in practices and beliefs among Portuguese gastroenterologists in their approach to the patient w

Impact of Artificial Intelligence on Gastroenterology Trainee Education

Impact of Artificial Intelligence on Gastroenterology Trainee Education

A Roadmap to a Successful Job Search for Gastroenterology Trainees

A Roadmap to a Successful Job Search for Gastroenterology Trainees

Ensuring the Future Pool of Gastroenterologists in the United Kingdom Is Imperative

ABSTRACTThis perspective article explores the importance of fostering interest in gastroenterology among medical students and addressing the barriers that deter them from pursuing careers in this specialty. The paper highlights the critical role of early exposure to research, specialized electives, and mentorship in encouraging students to consider gastroenterology as a career choice. Current challenges include limited access to specialized electives and research opportunities within UK medical schools, inadequate hands‐on experience, and a perceived lack of stability and control over future training pathways. Additionally, suboptimal working conditions in the National Health Service (NHS) and uncertainty in the allocation of foundation jobs further discourage students from specializing in gastroenterology. To address these issues, the paper proposes several strategies: expanding gastroenterology electives, increasing research opportunities through grassroots initiatives and developing targeted mentorship programs to guide and inspire students. Furthermore, enhancing diversity and representation within the specialty by removing barriers for female medical students is crucial for creating a more inclusive environment. This article combines insights from existing literature, personal experiences, and innovative educational initiatives to provide a comprehensive overview of the current state of gastroenterology training for medical students. The recommendations aim to inspire new approaches to medical education and training that will cultivate a well‐prepared, diverse, and motivated workforce ready to advance the field of gastroenterology.

Anatomical Benchmarks in the Training of Gastroenterologists.

Anatomy is one of the oldest medical disciplines and offered over the centuries the morphological explanation for the structure, function and pathology of the body. Learning anatomy was one of the first steps in the accumulation of medical knowledge. Practicing gastroenterology means the approach of pathology presenting with morphological changes. Diagnosis and therapeutical interventions require also precise anatomical knowledge. This is a review of the most important anatomical benchmarks necessary to trainees in gastroenterology. Two teachers of anatomy and one resident of gastroenterology performed a literature survey. They checked the curricula of gastroenterology of continental and national societies of gastroenterology and hepatology. They also checked on Pubmed and Google Scholar pertinent journal papers. They selected and analyzed papers presenting important anatomical benchmarks considered very important for the appropriation of practical skills. A list of recommendations was the outcome of this initiative. These are largely overlapping on the available curricula. The relevant anatomical benchmarks should be used in the training programs of residents in gastroenterology. Good anatomy training enables practitioners to diagnose correctly digestive pathology, to interpret the results of the imaging or endoscopic investigations, to recommend or undertake therapeutic interventions. Although ancient, anatomy is very useful in the training of future gastroenterologists. The trainees should emphasis the learning of the most important anatomical benchmarks.

Perceptions regarding the impact of gender on training and career advancement among gastroenterologists in India and other South Asian countries.

There are limited studies on the impact of gender on training and career advancement in gastroenterology. The aim was to study this impact and understand the perceptions of work-life balance and beliefs regarding gender dynamics among gastroenterologists in India and other South Asian countries. A web-based survey was conducted among trainees and attending physicians in South Asia from November 15, 2021, to March 30, 2022. The survey instrument had four components: demographic features, training, career advancement and work-life balance. As many as 622 gastroenterologists completed the survey, of which 467 responses were from India (mean age: 41.1years; females: 11.5%). A higher proportion of female respondents from India believed that gender bias in recruiting and training had negatively impacted their careers (40.7% females vs. 1.5% males). Radiation hazard for fertility (11.1% females vs. 1.9% males, p < 0.001) and as a health concern (14.8% females vs. 5.1% males, p = 0.005) were significant career deterrents for females. A higher proportion of female participants from India faced a career interruption (59.3% females vs. 30.3% males, p ≤ 0.001). Common reasons were pregnancy (37%) and childcare provision (25.9%). More females believed that women were more productive than men (40.8% females vs. 16.9% males, p < 0.001) and that a salary gap existed (44.7% females vs. 29.1% males, p < 0.001). The incidence of self-perceived burnout was 63% among females and 51.6% among males (p = 0.115). Gender-related factors impact the training and career of female gastroenterologists.

Primary and Specialty Care Trainees' Perceptions About Proton Pump Inhibitor Use.

Proton pump inhibitors (PPIs) are widely prescribed with proven efficacy in many indications, yet longstanding controversy about potential adverse events persists. We aimed to acquire knowledge about perceptions of outpatient PPI long-term prescribing (≥8 wk) among primary and specialty care trainees at 2 Canadian Universities. Family medicine, internal medicine, and gastroenterology trainees completed a web-based survey that included 20 clinical scenarios assessing trainee knowledge about PPI efficacy. Contextual PPI prescribing decisions were also elicited, balancing possible PPI indications versus side effects. Management strategies were compared between junior and senior trainees, as well as across training programs. Over a 4-month period,163 trainees (age <26 y: 12%; age 26 to 45: 88%; 59% females) participated in the survey (family medicine: 51%, internal medicine: 44%, and gastroenterology: 5%); 83% were considered junior residents. Only 42% had received formal education on prescribing PPI long-term. Overall, 93% believed they would benefit from such teaching, with 98% stating they would follow related guidelines. No between-group differences were noted in knowledge of appropriate PPI indications nor possible side effects when comparing juniors to seniors, or among different specialties. Across different management scenarios, inappropriate PPI discontinuation was chosen by 14.3% to 67.2%, whereas inappropriate PPI continuation was reported in up to 57%. Trainee seniority and specialty did not differ in appropriate deprescribing rates. Training level and primary versus specialty care settings are associated with frequent inappropriate PPI prescribing and deprescribing. These findings highlight the need for and may inform future educational programs on PPI usage.

A106 COLONOSCOPY TEACHING: A SURVEY OF CANADIAN GASTROENTEROLOGY RESIDENTS

Abstract Background With the advancement in equipment and techniques, colonoscopy training continues to evolve. Programs such as the Skills Enhancement for Endoscopy (SEE) curriculum developed by the Canadian Association of Gastroenterology teach techniques such as loop reduction, patient turning, and water immersion aimed at improving adenoma detection, cecal intubation, and patient comfort. While there is vast literature focused on assessing learners’ endoscopic competencies, there is limited data pertaining to the training of specific colonoscopy techniques. Aims To assess various colonoscopy techniques used to train gastroenterology residents in Canada. Methods A survey of gastroenterology trainees was developed to assess specific aspects of their experience with colonoscopy education. This included questions on the frequency of position changes, use of pediatrics colonoscopes, water immersion, loops reduction, and SEE program initiatives. The survey was advertised at the 2023 Gastroenterology Residents-In-Training Course with a link to the survey e-mailed to all attendees. This survey has been re-distributed to the current gastroenterology resident cohort and therefore this abstract’s results are interim data pending further survey responses. Results At the time of survey administration, there were 69 gastroenterology residents registered in Canada. Responses were received from 21(30%) residents; 5 in post graduate year (PGY) 4 and 16 in PGY5. One quarter (24%) of residents reported that colonoscopy teaching methods were uniform amongst faculty members and one third (33%) reported that more than half of their preceptors mentioned SEE program initiatives. Thirty-eight percent of residents reported that more than half of their preceptors suggested position change on insertion when the scope is advancing well on insertion. Majority of residents (90%) reported that water immersion during colonoscope insertion was recommended by most preceptors. Most residents (76%) reported that position change to help with loop reduction was suggested by more than half of their preceptors. Fifty-seven percent of residents reported that more than half of their preceptors commented on type of loop formation and reduction techniques. Once the cecum is reached, a minority of residents (29%) reported that more than half of preceptors recommended position change specifically to improve cecal visualization. Conclusions Certain colonoscopy techniques such as turning patients, water immersion, and loop reduction can assist with adenoma detection rates and patient comfort. However, there exists considerable variability in colonoscopy techniques taught to Canadian gastroenterology residents. Increased standardization among colonoscopy technique education may benefit gastroenterology trainees. Funding Agencies None

A83 GENDER-RELATED BARRIERS TO ADVANCEMENT ALONG THE GASTROENTEROLOGY CAREER PATHWAY: AN INTERNAL MEDICINE RESIDENT PERSPECTIVE

Abstract Background Women comprise approximately 31% of the Canadian and 19% of the American gastroenterology population. This gender disparity widens throughout training, with relative gender parity in medical school, slightly less female representation in internal medicine, then with the widest gender disparity in gastroenterology training and practice. Aims Our aim was to understand the gender-related barriers to advancement along the gastroenterology training pathway specifically among internal medicine residents. Methods A 72-question online survey was distributed by email to internal medicine residents from post-graduate years (PGY) 1, 2, and 3 at the University of Toronto. The initial email was followed by two reminder emails over 1 month. Questions pertained to demographic characteristics, social situation, career aspirations, academic pursuits, and career challenges. Data analysis was performed using SAS software. Continuous variables were compared using Wilcoxon (Mann Whitney U test) and categorical variables with chi-squared and Fisher’s exact test. Results 40 residents completed the survey. 62.5% were female and most were PGY1 or 2 (n=18, 45% for each; PGY3 was n=4, 10%). Women were more likely to be single (44% vs. 27%, p = 0.0423). In terms of scholarly involvement, women more frequently had additional academic pursuits than their male counterparts (92% vs. 60%, p = 0.0195). For training-related challenges, women more often reported different expectations were put on them due to their due to their background, specifically related to gender (70% vs. 33%, p = 0.0356). Women described more challenges with support staff compared to their colleagues (36% vs. 0%, p = 0.0105), and stated that gender was the reason. Women were also more likely to report that their clinical competence was challenged compared to their peers (32% vs. 7%, p = 0.0384). Outside of work, women more often felt a work-life misbalance due to coordinating childcare (64% vs. 27%, p = 0.0085). Regarding career aspirations, men more often endorsed wanting a hospital leadership role (67% vs. 32%, p = 0.0201). They also rated renumeration as a driving motivation for applying to a subspecialty more often (47% vs. 12%, p = 0.0085) and rated their desired future personal income to over $70,000 more than women (p = 0.0402). Conclusions This study is the first to examine gender-related barriers to advancement in gastroenterology at the crucial internal medicine resident level. Women more often reported training-related challenges with others’ expectations and judgments of their clinical competence, as well as personal challenges with coordinating childcare. A deeper understanding of these differences may shape support interventions to help women meet their career goals. Funding Agencies None

The synergistic role of virtual coaching with simulation-based mastery learning for upper endoscopy.

Our simulation-based mastery learning (SBML) curriculum, delivered in person, has been shown to successfully train novices in structured esophagogastroduodenoscopy (EGD). SBML with virtual coaching (VC) has the potential to improve the effectiveness and efficiency of endoscopy training and expand access to trainees from around the world. We share our observations conducting an EGD training course using SBML with VC. We conducted a 1-week virtual SBML course for novice trainees across seven academic centers in the USA and Asia. The cognitive component was delivered using an online learning platform. For technical skills, a virtual coach supervised hands-on training and local coaches provided assistance when needed. At the end of training, an independent rater assessed simulation-based performance using a validated assessment tool. We assessed the clinical performance of 30 EGDs using the ASGE Assessment of Competency in Endoscopy tool. We compared the trainees' scores to our cohort trained using in-person SBML training using non-inferiority t-tests. We enrolled 21 novice trainees (mean age: 30.8 ± 3.6 years; female: 52%). For tip deflection, the trainees reached the minimum passing standard after 31 ± 29 runs and mastery after 52 ± 37 runs. For structured EGD, the average score for the overall exam was 4.6 ± 0.6, similar to the in-person cohort (4.7 ± 0.5, p = 0.49). The knowledge-based assessment was also comparable (virtual coaching: 81.9 ± 0.1; direct coaching: 78.3 ± 0.1; p = 0.385). Over time, our novice trainees reached clinical competence at a similar rate to our historical in-person control. VC appears feasible and effective for training novice gastroenterology trainees. VC allowed us to scale our SBML course, expand access to experts, and administer SBML simultaneously across different sites at the highest standards.

Gastroenterology trainee experience, confidence and satisfaction in nutrition training: a cross-sectional survey in the UK

IntroductionNutrition is an essential part of gastroenterology specialist training. There is limited evidence of trainee experience in this area. The shorter training programme introduced in 2022 may lead to reduced...

Lack of standardization and faculty development in pediatric colonoscopy: A qualitative study.

A standard curriculum for pediatric colonoscopy training has neither been required nor universally implemented in North American fellowship programs. This qualitative study assessed the needs of colonoscopy training in pediatric gastroenterology to determine the standardized components of procedural teaching. Focus groups with pediatric gastroenterology attendings, fellows, procedural nurses, and interviews with advanced endoscopists, all practicing at a single institution, were conducted between March and June 2018. Data were analyzed using thematic analysis principles. Four themes emerged: (1) lack of standardization of colonoscopy performance, (2) lack of professional development of procedure teaching skills, (3) need for teaching behaviors that promote learner's performance, and (4) barriers to effective teaching and learning. A conceptual framework was created for developing a standardized "train-the-trainer" curriculum. Our needs assessment supports expansion of efforts to make this comprehensive training available to all pediatric gastroenterologists involved in procedure teaching.

Exploring Endoscopic Competence in Gastroenterology Training: A Simulation-Based Comparative Analysis of GAGES, DOPS, and ACE Assessment Tools.

Accurate and convenient evaluation tools are essential to document endoscopic competence in Gastroenterology training programs. The Direct Observation of Procedural Skills (DOPS), Global Assessment of Gastrointestinal Endoscopic Skills (GAGES), and Assessment of Endoscopic Competency (ACE) are widely used validated competency assessment tools for gastrointestinal endoscopy. However, studies comparing these 3 tools are lacking, leading to lack of standardization in this assessment. Through simulation, this study seeks to determine the most reliable, comprehensive, and user-friendly tool for standardizing endoscopy competency assessment. A mixed-methods quantitative-qualitative approach was utilized with sequential deductive design. All nine trainees in a gastroenterology training program were assessed on endoscopic procedural competence using the Simbionix Gi-bronch-mentor high-fidelity simulator, with 2 faculty raters independently completing the 3 assessment forms of DOPS, GAGES, and ACE. Psychometric analysis was used to evaluate the tools' reliability. Additionally, faculty trainers participated in a focused group discussion (FGD) to investigate their experience in using the tools. For upper GI endoscopy, Cronbach's alpha values for internal consistency were 0.53, 0.8, and 0.87 for ACE, DOPS, and GAGES, respectively. Inter-rater reliability (IRR) scores were 0.79 (0.43-0.92) for ACE, 0.75 (-0.13-0.82) for DOPS, and 0.59 (-0.90-0.84) for GAGES. For colonoscopy, Cronbach's alpha values for internal consistency were 0.53, 0.82, and 0.85 for ACE, DOPS, and GAGES, respectively. IRR scores were 0.72 (0.39-0.96) for ACE, 0.78 (-0.12-0.86) for DOPS, and 0.53 (-0.91-0.78) for GAGES. The FGD yielded three key themes: the ideal tool should be scientifically sound, comprehensive, and user-friendly. The DOPS tool performed favourably in both the qualitative assessment and psychometric evaluation to be considered the most balanced amongst the three assessment tools. We propose that the DOPS tool be used for endoscopic skill assessment in gastroenterology training programs. However, gastroenterology training programs need to match their learning outcomes with the available assessment tools to determine the most appropriate one in their context.

A Novel Dry Simulator Model for Learning Comprehensive Endoscopic Retrograde Cholangiopancreatography/Endoscopic Sphincterotomy Procedures while Minimizing Adverse Bleeding Events (with Video).

Endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (EST) are essential skills for performing endoscopic cholangiopancreatic procedures. However, these procedures have a high incidence of adverse events, and current training predominantly relies on patient-based approaches. Herein, we aimed to develop an ERCP/EST simulator model to address the need for safer training alternatives, especially for learners with limited ERCP experience. The model was designed to facilitate the use of actual endoscopic devices, supporting learning objectives that align with the components of the validated Bethesda ERCP Skill Assessment Tool (BESAT). BESAT focuses on skills, such as papillary alignment, maintenance of duodenoscope position, gentle and efficient cannulation, controlled sphincterotomy in the correct trajectory, and guidewire manipulation. Thirty gastroenterology trainees used the simulator between May 2022 and March 2023, and their satisfaction was assessed using a visual analog scale (VAS) and pre- and post-training questionnaires. The novel simulator model comprised a disposable duodenal papillary section, suitable for incision with an electrosurgical knife, alongside washable upper gastrointestinal tract and bile duct sections for repeated use. The duodenal papillary section enabled reproduction of a realistic endoscope position and the adverse bleeding events due to improper incisions. The bile duct section allowed for the reproduction of fluoroscopic-like images, enabling learners to practice guidewire guidance and insertion of other devices. Following training, the median VAS score reflecting the expectation for model learning significantly increased from 69.5 (interquartile range [IQR]: 55.5-76.5) to 85.5 (IQR: 78.0-92.0) (p &lt; 0.01). All participants expressed a desire for repeated simulator training sessions. This innovative simulator could serve as a practical educational tool, particularly beneficial for novices in ERCP. It could facilitate hands-on practice with actual devices, enhancing procedural fluency and understanding of precise incisions to minimize the risk of bleeding complications during EST.

Current Pediatric Endoscopy Training Situation in the Asia-Pacific Region: A Collaborative Survey by the Asian Pan-Pacific Society for Pediatric Gastroenterology, Hepatology and Nutrition Endoscopy Scientific Subcommittee.

To date, there is no region-specific guideline for pediatric endoscopy training. This study aimed to illustrate the current status of pediatric endoscopy training in Asia-Pacific region and identify opportunities for improvement. A cross-sectional survey, using a standardized electronic questionnaire, was conducted among medical schools in the Asia-Pacific region in January 2024. A total of 57 medical centers in 12 countries offering formal Pediatric Gastroenterology training programs participated in this regional survey. More than 75% of the centers had an average case load of <10 cases per week for both diagnostic and therapeutic endoscopies. Only 36% of the study programs employed competency-based outcomes for program development, whereas nearly half (48%) used volume-based curricula. Foreign body retrieval, polypectomy, percutaneous endoscopic gastrostomy, and esophageal variceal hemostasis, that is, sclerotherapy or band ligation (endoscopic variceal sclerotherapy and endoscopic variceal ligation), comprised the top four priorities that the trainees should acquire in the autonomous stage (unconscious) of competence. Regarding the learning environment, only 31.5% provided formal hands-on workshops/simulation training. The direct observation of procedural skills was the most commonly used assessment method. The application of a quality assurance (QA) system in both educational and patient care (Pediatric Endoscopy Quality Improvement Network) aspects was present in only 28% and 17% of the centers, respectively. Compared with Western academic societies, the limited availability of cases remains a major concern. To close this gap, simulation and adult endoscopy training are essential. The implementation of reliable and valid assessment tools and QA systems can lead to significant development in future programs.

Gastroenterology training in Africa: an assessment of curriculum and perception

Gastroenterology training in Africa: an assessment of curriculum and perception

UK-wide survey of gastroenterology and hepatology trainees in 2022: endoscopy, workforce planning and the Shape of things to come

ObjectiveShape of Training has shortened the gastroenterology curriculum in the UK from a 5 to 4-year programme. There are ongoing concerns that this will negatively impact training and the attainment...

S1712 Racial and Ethnicity-Related Barriers to Internal Medicine Residents Pursuing Fellowship Training in Gastroenterology

S1712 Racial and Ethnicity-Related Barriers to Internal Medicine Residents Pursuing Fellowship Training in Gastroenterology

S758 Impact of Artificial Intelligence on Gastroenterology Training and Education: A Survey of Fellows' Perspectives

S758 Impact of Artificial Intelligence on Gastroenterology Training and Education: A Survey of Fellows' Perspectives

S709 Learning From Error – Improving Constructive Conversations Around Adverse Events in Gastroenterology Training

S709 Learning From Error – Improving Constructive Conversations Around Adverse Events in Gastroenterology Training