GI Fellowship Program Directors Research Articles

A 12-Year North American Longitudinal Study of Gender Equity and Equality in Gastroenterology

A 12-Year North American Longitudinal Study of Gender Equity and Equality in Gastroenterology

Gastroenterology Fellowship Applicants’ Perspectives on GI Program Preferences

Gastroenterology fellowship continues to be highly competitive among internal medicine subspecialties. Recruiting excellent applicants is also important for GI fellowship program directors. We aim to examine factors that influence GI fellowship applicants' perspectives about a fellowship program. The authors conducted an anonymous online survey of applicants focusing on program characteristics including location, faculty, research/clinical opportunities, website, and interview day experience. Anonymous survey responses were recorded regarding program characteristics, and subsequent candidate preferences were evaluated for factors influencing their decision. Candidates were also asked to evaluate their interview experience and share other comments about the program. Though GI fellowship applicants have varying preferences regarding the ideal training program, some opinions converged. The study of these trends can inform program directors regarding areas for improvement that in turn can help attract the best applicants.

S1273 Are There Differences in the Academic Productivity Between Female and Male GI Fellowship Program Directors?

INTRODUCTION: The gastroenterology (GI) fellowship program directors (PDs) play a pivotal role in running the fellowship program. The purpose of this study was to analyze the demographic characteristics, academic background and scholarly activities of GI fellowship director workforce in the United States (US). METHODS: A list of all Accreditation Council for Graduate Medical Education (ACGME) accredited adult GI fellowship programs was obtained. PDs of all programs were included in the study. Publicly available sources were used to gather information about each PD, including the individual program websites, HealthGrades and Doximity websites, Scopus database. The variables collected included age, sex, educational background, fellowships of GI societies (AGAF, FASGE, FACG, FAASLD) and scholarly metrics. Non-parametric statistics including Mann-Whitney U and Kruskal Wallis tests were applied to compare the groups. RESULTS: A total of 207 GI PDs from 207 adult GI fellowship programs were included, of which 159 (76.8%) were males. Female PDs were significantly younger than male PDs (median age 45.5 vs 53 years, P < 0.001). The mean age at appointment of PDs was 45.5 years and the mean duration served as PD was 6.4 years. Majority of PDs graduated from North American medical schools (81%). General gastroenterologists comprised 79% of PDs, while the rest had specialized in hepatology (12%), advanced endoscopy (6%), IBD (2%), and gastric motility (1.0%). Majority of PDs (63.2%) were fellows of a professional GI society. The mean publications, citations and h-index were 37.324 ± 66.51, 1512.57 ± 3820.82 and 12.03 ± 18.27, respectively. No difference was observed in scholarly activities when stratified by sex. Academic rank was available for 113 individuals, amongst which 37 were assistant professors, 43 associate professors and 33 were professors. There was statistically significant increase in scholarly metrics with higher academic rank. Advanced endoscopists and hepatologists had significantly higher scholarly metrics compared to general gastroenterologists. CONCLUSION: While there is no difference in scholarly metrics between current male and female PDs and APDs, gender disparities exist in leadership roles in GI fellowship programs. Efforts should be made to bridge this gap.Figure 1.: Demographics of PDs – by gender (a) and by age* (b).

Exploring Use of Endoscopy Simulation in North American Pediatric Gastroenterology Fellowship Training Programs.

Increasing evidence supports simulation-based training; however, limited data exist regarding its use in pediatric gastroenterology (GI). We explored the use of simulation-based endoscopy training in pediatric GI fellowship programs across North America. GI fellowship program directors (PDs) from the United States and Canada were surveyed between August to November 2018. The pretested, electronic survey comprised 3 sections: program demographics; details of current simulation-based training; and PDs' perceptions of endoscopy simulation. Responses were analyzed using descriptive statistics. Forty-three of 71 (61%) PDs responded (6 Canadian, 37 US). Programs were predominantly academic (95%) and enrolled 1.87 ± 1.01 fellows/yr. Twenty-four programs (56%) reported using simulation for endoscopy training, whereas 8 (19%) used simulation for nonprocedural education. Only 2 programs (5%) used endoscopy simulation for assessment. Of those using simulation (n = 24), upper endoscopy and colonoscopy were trained most frequently, and mechanical simulators were used most commonly. Eight programs (33%) required simulation training prior to clinical performance. Although 10 programs (42%) provided protected training time, only 2 (8%) tracked hours. Three programs (13%) reported having an organized curriculum and 6 (25%) train their endoscopic trainers. Cost, time constraints, and lack of a standardized curriculum were perceived as key barriers to integration. Most PDs reported a need for endoscopy simulation to train both technical and nontechnical skills; however, they felt simulation cannot replace clinical experience. PDs recognize the potential importance of endoscopy simulation, particularly for novices; however, only 56% report using it. Perceived barriers indicate the need for inexpensive portable simulators and a validated pediatric simulation curriculum to promote uptake.

Best Practices in Teaching Endoscopy Based on a Delphi Survey of Gastroenterology Program Directors and Experts in Endoscopy Education

Teaching endoscopy is a key objective of gastroenterology (GI) fellowship programs but the best approach is not known. We sought to characterize which teaching competencies experts considered most critical for endoscopy education. We developed and refined 18 endoscopy teaching competencies based on literature review, personal experience, and interviews with experts. We invited GI fellowship program directors and endoscopy education experts to participate in a Delphi process to rate each proposed competency as essential, important but not essential, or not important using a 70% agreement threshold for consensus. Thirty-four GI fellowship program directors and 2 experts in endoscopy education participated (n= 36). Most survey participants were male (61.8%), associate professors (55.9%), and had performed at least a quarter of procedures with fellows (80.6%). Survey response rates were 94% (34 of 36) for round 1 and 91% (31 of 34) for round 2 (overall 31 of 36; 86.1%). After 2 rounds we achieved the predefined consensus level for most competencies. Fourteen of 18 competencies (77.8%) reached consensus after round 2: 10 (55.6%) were deemed essential and 4 (22.2%) were deemed important but not essential. Essential competencies included the following: discusses patient history and plans for procedure with trainee (100%), assumes control of procedure when trainee is unable to progress or if patient safety concerns arise (100%), maintains attention throughout the case (96.8%), and discusses the next steps in management for the patient (96.8%). In a national Delphi survey of endoscopy education experts, we identified 10 essential endoscopy teaching competencies. These can be used to frame faculty development and standardize GI fellowship programs to promote high-quality endoscopy education.

Promoting Leadership by Women in Gastroenterology—Lessons Learned and Future Directions

Promoting Leadership by Women in Gastroenterology—Lessons Learned and Future Directions

Musculoskeletal Injuries Are Commonly Reported Among Gastroenterology Trainees: Results of a National Survey.

Endoscopy-related musculoskeletal injuries are increasingly recognized among gastroenterologists. While injury rates and risk factors have been studied among practicing gastroenterologists, little is known about rates among trainees during fellowship. This study analyzes the prevalence of endoscopy-related overuse injuries and risk factors for injuries among a national sample of gastroenterology (GI) fellows. We also surveyed GI fellowship program directors and fellows about perceptions of overuse injuries during GI training. We distributed a 29-item electronic survey to GI fellows at accredited programs in the USA in April 2016. Survey items included demographic information, questions pertaining to injuries, and level of agreement on the importance of ergonomics training in GI fellowship. Additionally, we distributed a 7-item electronic survey to fellowship program directors evaluating perception of overuse injuries and prevention during fellowship training. Fisher's exact test determined factors associated with sustaining an injury. An estimated 1509 fellows received the survey. Eleven percent (n = 165) of gastroenterology fellows completed the survey. Twenty percent reported having a musculoskeletal injury. Female gender was the only factor associated with a higher rate of reported injury (p < 0.01). The most common injuries reported were thumb and other hand-related pain (n = 28 [64%]). Musculoskeletal injuries may affect up to 20% of GI fellows. Female fellows more frequently report injuries and may be at particularly high risk which has not been found in previously reported surveys of practicing gastroenterologists. Standardized curricula on ergonomic considerations and injury prevention are needed to enhance GI fellowship training and reduce injury rates.

A Deeper Look at the Small Bowel: Training Pathways in Video Capsule Endoscopy and Device-Assisted Enteroscopy.

Although there are guidelines for video capsule endoscopy (VCE) and device-assisted enteroscopy (DAE), little is known about fellowship training in these technologies. The aims were to better characterize current small bowel endoscopy training in 3-year GI fellowship programs and 4th-year advanced endoscopy programs in the U.S. We developed an online multiple-choice survey to assess current GI fellowship program training in small bowel endoscopy. The survey was distributed via email to GI fellowship program directors in the U.S. Of the 168 program directors contacted, 59 responded (response rate = 35.1%). There was no statistically significant difference in the availability of VCE or DAE between respondents and non-respondents. VCE training was universally available in 3-year training programs, with 84.8% (50/59) requiring it for fellows. The majority of 3-year GI fellows graduated with independence in VCE: 83.1% (49/59) of programs reported "most" or "all" graduates were able to read independently. DAE techniques were available in 86.4% of training programs (51/59). Training in DAE was more limited and shared between 3-year and 4th-year programs: 12.1% (7/58) of 3-year programs required training in DAE and 22.9% (8/35) of 4th-year programs required training in DAE . Training in VCE is widely available in U.S. GI fellowship programs, although programs have different ways of incorporating this training into the curriculum and of measuring competency. While DAE technology was available in the majority of programs, training was less frequently available, and training is shared between 3-year fellowship programs and 4th-year advanced endoscopy programs .

Sa1136 - Social Media in GI Training Programs: Preliminary Results of a National Survey of GI Fellowship Program Directors

Sa1136 - Social Media in GI Training Programs: Preliminary Results of a National Survey of GI Fellowship Program Directors

Su1091 State of Trainee Inflammatory Bowel Disease Education in the United States: A National Survey

Introduction: The incidence of Inflammatory Bowel Disease (IBD) and the complexity of its management are increasing. Identifying shortcomings and defining the core content of IBD education in gastroenterology (GI) fellowship training in the United States (US) are critical to preparing trainees for this challenge. The aim of this study was to perform a needs assessment survey of US GI fellowship program directors (PD) and trainees to understand the current state of IBD training in the US. Methods: A 15-question PD survey and 19question trainee survey was performed using Survey Monkey. Survey content was developed and reviewed together with nationally recognized IBD experts and optimized in a pilot trial with recently graduated GI trainees. Final questionaires were sent to all US PDs with the request to forward the trainee survey to their respective program trainees. Data were analyzed using excel and SAS v9.3. Results: Surveys were completed by 43/161 (27%) PDs and 116 trainees. The majority of PDs (39/43) worked at university or university-affiliated hospitals. IBD specific inpatient and/or outpatient rotations were offered by 63% of PD institutions. All trainee years were equally represented. While most trainees were or with their inpatient and outpatient IBD training, a significant subgroup was unsure or felt their inpatient (33%) or outpatient (43%) training was inadequate. Only 28% of trainees were satisfied with their current level of IBD exposure during training. Monthly IBD didactics was the only variable independently associated with satisfaction with current level of training (OR 4.6, 95% CI 1.8-11.8). Most trainees (62%) were not interested in pursuing an IBD career, but 10% were considering applying for an advanced IBD fellowship. Strikingly, 57% would consider an IBD focus, if offered, in the context of a 3 year GI fellowship. We examined trainee comfort by different competencies in IBD management (Figure 1). Trainees reported the most confidence or comfort in the management of inpatient CD or UC. In contrast, fewer than half the trainees reported comfort in the management of pouch or stoma issues or the pregnant IBD patient. The proportion of PDs viewing a competency as essential training strongly correlated with trainee comfort in that area (correlation co-efficient 0.75, p < 0.001; Figure 2). Conclusions: Over one-third of participating US GI trainees did not feel confident or mostly comfortable with their level of IBD training. More than half would consider choosing an IBD focus during GI fellowship, if offered. There is a wide spectrum of comfort regarding different competencies in IBD management suggesting that specific areas may require additional focus during training. These findings can provide the basis for the development of an IBD core competency curriculum for US GI fellowship programs.

What Drives US Gastroenterology Fellows to Pursue Academic vs. Non-Academic Careers? Results of a National Survey

We conducted a nationwide survey of US gastroenterology fellows to identify key demographic and job-related factors relevant to the decision between an academic and a non-academic career. A survey was e-mailed to all US GI fellowship program directors and distributed at fellows' endoscopy courses. Data were evaluated via univariate and multivariate analysis. One hundred eighty-four fellows completed surveys. Univariate analysis identified one factor that predisposed fellows to pursue non-academic practice: the perception that a non-academic salary would meet their financial needs. Four factors were identified that predisposed fellows to pursue academic practice: age>35 years, prior attainment of a master's or a PhD degree, and advanced fellowship. All factors were significant on multivariate analysis. If salaries were equal, 60% of respondents would choose academic over non-academic practice. Fellows selecting academic practice were motivated to publish and conduct research. Level of debt and a positive relationship with a mentor were not significant factors. Fellows desiring more money strongly favor non-academic practice. Fellows choosing academic practice tend to be older, plan to pursue advanced training, desire fewer work hours per week, and have a higher rate of prior graduate study. If salaries were equal in academic medicine and non-academic practice, the majority of fellows would choose academic medicine.

Choosing Academic versus Private Practice Careers for US GI Fellows: Cash Is King

Purpose: Choosing between an academic career and a private practice career is a difficult and critical decision for GI fellows. Many complex factors come into play when making this career choice. We conducted a nationwide survey of US GI fellows to identify key demographics and job-related factors to analyze this decision making process. Methods: A survey was emailed to all US GI Fellowship program directors and distributed at several fellows' endoscopy courses. Fellows filled out surveys via one of these two routes only. The survey queried respondents on their personal, educational, professional, and financial backgrounds and goals, and included a free response area where other factors could be addressed. No remuneration was offered for participants. Data was compiled and evaluated via univariate and multivariate analysis. Results: 184/404 (46%) US GI fellows submitted completed surveys. Univariate analysis identified one factor that predisposed fellows to pursue private practice: the perception that an academic salary would not meet their financial needs (p=0.04). Univariate analysis identified 4 factors that predisposed fellows to pursue academic practice: Age >35 years (p=0.003), prior attainment of a Master's degree (p=0.01), advanced fellowship training (p=0.0001), and a perception that academicians worked fewer hours (<60 per week) than private practice physicians (p=0.008). All of these factors except the perception regarding work hours were also statistically significant on the multivariate analysis. If salaries were equal, 108/131 (82%) fellows who answered the question would choose academic practice over private practice (p<0.0001). Fellows selecting academic practice were strongly motivated to publish and conduct research. The desire to teach was not a strong motivator for either group. Surprisingly, existing level of debt, the presence of a positive relationship with a mentor, and research experience were not significant factors in the decision. Conclusion: Salary plays a key role in the decision to pursue academic versus private practice, with those desiring more money strongly favoring private practice. Fellows choosing academic practice tended to be older, plan to pursue advanced training, desire fewer work hours per week, and appear to have a stronger preexisting academic background as evidenced by a high rate of prior graduate study. If salaries were equal in both academic medicine and private practice, the overwhelming majority (82%) of fellows would choose academic medicine.

Can U.S. GI fellowship programs meet American Society for Gastrointestinal Endoscopy recommendations for training in EUS? A survey of U.S. GI fellowship program directors

American Society for Gastrointestinal Endoscopy (ASGE) EUS training and credentialing guidelines exist, but the capability of U.S. GI fellowships to meet these guidelines has not been assessed. To ascertain the capability of U.S. GI fellowship programs to meet ASGE guidelines for EUS training in the context of 3-year and advanced GI fellowships. U.S. GI fellowship programs were surveyed for the presence or the absence, type, and extent of EUS training. Demographics regarding the programs and the program directors were obtained. Data on the annual total EUS volume and data on EUS performed by 3-year and/or advanced-year fellows were collected and analyzed. Ninety-one of 142 contactable GI programs responded (64%); 72% of programs performed >200 EUS/y and thus could train >or=1 EUS trainee/y. For 3-year GI fellows, 55% received less than 3 months of training, with 43% not receiving actual "hands-on" EUS experience, and 61% not learning EUS-guided FNA. The median EUS performed by 3-year fellows was 50 (0-350). Programs that offer advanced endoscopy fellowship had a median advanced-trainee EUS volume of 200 procedures (range, 50-1100 procedures). Of advanced fellows, 20% failed to receive "hands-on" training and 52% performed <200 procedures. We observed a significant difference in the median EUS volume performed by 3-year versus advanced-year fellows (P<.001). Program director variables did not correlate with training EUS volumes. The majority of U.S. GI fellowship programs have established the EUS volume to train at least 1 EUS fellow, per ASGE guidelines; however, most 3-year and many advanced fellows are currently receiving insufficient EUS training.

What Will Be Needed for the New Gastroenterology Fellowship Match to Succeed?

What Will Be Needed for the New Gastroenterology Fellowship Match to Succeed?

Formal and Adequate EUS Training Remains Difficult to Obtain in US GI Three-Year Fellowships Despite Strong Demand for Instruction: Results of a Nationwide Survey of GI Fellowship Program Directors

Formal and Adequate EUS Training Remains Difficult to Obtain in US GI Three-Year Fellowships Despite Strong Demand for Instruction: Results of a Nationwide Survey of GI Fellowship Program Directors