GI Training Research Articles

A310 CANADIAN GASTROENTEROLOGY RESIDENT ATTITUDES TOWARDS TREATING PATIENTS WITH DISORDERS OF GUT BRAIN INTERACTION

Abstract Background Disorders of gut brain interaction (DGBI) are common in the Canadian population. Studies show DGBI represent 30% of new referrals to gastroenterology (GI) clinics. Despite this, evidence suggests that gastroenterologists experience challenges in providing care for these patients, with a recent study from the United States indicating that this discomfort may begin early in residency training. Aims Our aim was to determine Canadian GI resident attitudes towards treating patients with DGBI, with a focus on determining underlying causes and solutions for potential negative attitudes. Methods Gastroenterology residents participating in accredited adult GI training programs in Canada were invited to participate in an online 30-item survey. This was based on similar studies in the adjacent field of chronic pain and administered using RedCap. Recruitment occurred through email invites distributed to residency program directors and QR code links presented at national GI resident meetings over one year. Results In total, 42 residents participated in the survey. Most residents reported frequent exposure to DGBI. Although most residents felt confident at diagnosing DGBI, only few felt confident in managing them. The majority reported less enjoyment and personal reward at managing DGBI than other gastrointestinal diseases, finding them frustrating to treat and expressing concern regarding the uncertainty of the diagnosis and low likelihood of successful management. Residents believed that challenges in the treatment stemmed from the following: inadequate training, uncertainty regarding the severity of symptoms that were reported, co-existing psychiatric issues, a lack of clarity on therapy and inadequate time. Residents reported that senior residents and staff both expressed negative opinions about caring for those with DGBI, and felt that displeasure for managing patients with DGBI was pervasive in the GI community. Importantly, the majority of trainees believed it was important to formally learn about the physiological underpinnings of DGBI as well as their diagnosis and management. Furthermore, understanding the impact of DGBI on a patient’s quality of life was thought to be important. Conclusions This national survey demonstrates that Canadian GI trainees are less confident and less interested in providing care for those with DGBI due to a variety of factors including inadequate training and a potential hidden curriculum. Residents believe in the importance of education in this field. The results of this study will be used to develop educational experiences to ultimately improve the care of those with DGBI. Funding Agencies None

Senior trainee as endoscopy teacher: impact on trainee learning and attending experience

ObjectiveTraining in how to effectively teach endoscopy is not included in most gastroenterology (GI) training programme curricula, yet many gastroenterologists are expected to teach endoscopy in their careers. Near-peer teaching...

WEO Newsletter.

WEO Newsletter.

Development of a Low-Cost Gastroscope Prototype (GP) for Potential Cost-Effective Gastric Cancer Screening in Prevalent Regions

Abstract Background Screening for gastric cancer is known to be associated with reduced mortality in populations with high prevalence. However, many countries with high prevalence do not screen, with high costs being a significant reason for this. Aims To describe, develop, and assess the potential for a low-cost gastroscope for early cancer screening and patient risk stratification. Methods Our interdisciplinary team used both off-the-shelf and fabricated components to create multiple gastroscope prototypes (GP) in iterative fashion based off clinician feedback. Clinician endoscopists were surveyed using Likert scales regarding device potential, video quality, and handling when testing on a GI training device. Video quality comparison to clinically standard high-definition white light endoscopy (HD-WLE) was done using the absolute categorical ratings (ACR) method. Results A candidate cost-effective GP with clinical potential was developed. Although initial versions were scored as inferior via ACR on all views tested when compared to HD-WLE (p < 0.001), participants agreed the concept may be beneficial (M = 4.52/5, SD = 0.72). In testing improved versions, participants agreed the device had the ability to identify discrete (M = 4.62/5, SD = 0.51) and subtle lesions (M = 4/5, SD = 0.7) but most felt video quality, although improved, was still less than HD-WLE. Sufficiency of maneuverability of device to visualize gastric views was rated as equivocal (M = 2.69/5, SD = 1.25). Conclusion The presented low-cost gastroscopic devices have potential for clinical application. With further device development and refinement including the possible addition of technologies in telemedicine and artificial intelligence, we hope the GP can help expand gastric cancer screening for populations in need.

S1495 Efficacy of a Curriculum Teaching Healthcare Disparities in Gastroenterology Fellowship

Introduction: There are many studies identifying healthcare disparities based on sex, race, and economic status in gastroenterology (GI) influenced by the social determinants of health. The Accreditation Council for Graduate Medical Education (ACGME) recently mandated that medical training programs provide education about healthcare disparities. Tools to provide this education are lacking, and methods to address health equity remain unfamiliar to many health care systems, their leaders, and medical educators. The aim of this study was to pilot a healthcare disparities curriculum for our GI fellowship program. Methods: Using the Kern 6-step method, we designed a year-long health disparities curriculum and implemented it in our GI fellowship from 2020 to 2021. During weekly academics, a fellow presented a journal article identifying a disparity in GI followed by guided group discussion about how to apply that study to our own practice and patient population. We developed a validated survey to assess knowledge and attitudes about healthcare disparities before and after implementation of the curriculum. Results: Eleven fellows and 7 attendings completed the survey before, and 8 trainees and 5 attendings completed the survey following completion of the curriculum. We found that awareness and knowledge about health disparities improved through the curriculum. As seen in Figure 1, there were statistically significant differences in recognizing the impact of patient race on medication recommendations (P = 0.03) and referrals for endoscopy (P = 0.01), as well as the effect of socioeconomic status and race on medical outcomes (P = 0.03). We also observed that individuals were open to recognizing and sharing personal bias and engaging in discussions about how to improve our systems to reduce disparities. Conclusion: Our results show that implementation of our curriculum increased awareness of healthcare disparities amongst gastroenterology fellows and attendings. Our curriculum is the first of its kind validated through pre- and post-survey results and fulfills an important new ACGME requirement for training programs. This was our first iteration and we have subsequently modified this curriculum to include guided academic sessions and educator tools through an online platform to be implemented at several GI training programs in the US in the 2022-2023 academic year.Figure 1.: Pre- and post-survey response data. Pre-survey data appears in blue. Post-survey data appears in red. Asterisk represents statistically significant questions, P < 0.05. Graph demonstrates an overall improvement in awareness about existing healthcare disparities following the implementation of our curriculum.

Bridging the Racial, Ethnic, and Gender Gap in Gastroenterology

Bridging the Racial, Ethnic, and Gender Gap in Gastroenterology

Consultative vs Dedicated Inpatient Service for GI Training and Patient Care.

Consultative vs Dedicated Inpatient Service for GI Training and Patient Care.

Canadian Gastroenterology Career Pathway Experiences: Exploring the Gender Divide.

BackgroundWe aimed to determine the persistence of differential career experiences between male and female gastroenterologists in Canada >20 years after they were first noted in the literature.MethodsA 51-question mixed-methods survey was developed focusing on personal, professional and financial characteristics. The survey was disseminated via email and fax to practicing gastroenterologists using provincial college registries and the Canadian Association of Gastroenterology. Numerical data were analyzed using the chi-square test. Qualitative thematic analysis was conducted for short answer responses.FindingsThere were a total of 114 responses (17% response rate) with 35% female respondents. Mean age was 49 years for males and 41 years for females (P = 0.001). Clinical practice types included general GI (63%), urban (82%) and academic (51%). Males reported more endoscopy time (P = 0.001) versus females who spent more time on research (P < 0.001). Men were more likely to be married (P = 0.011), but women were more likely to be responsible for childcare (P = 0.016). Women were more likely to choose between marriage and career and more chose marriage compared to men (P = 0.045). Males earned >$100,000/year higher income than females even when offset by age and work hours (P = 0.048). A salary >$600,000 was reported by 32% of men, compared to 3% of women. Female gastroenterologists reported less mentorship during GI training, challenging relationships with support staff, reduced promotion opportunity, more difficulty publishing and having their competency challenged.InterpretationCompared to previous data, there has not been significant gender-related progress in the past two decades regarding female gastroenterologists’ clinical practices, remuneration and work-life balance.

The Under-representation of Canadian Women in Gastroenterology from Residency to Leadership.

BackgroundTo determine representation of women in gastroenterology (GI) at residency and leadership levels in Canada.MethodsThe Canadian Resident Matching Service provided data for internal medicine (IM), general surgery (GS), GI and cardiology applicant cycles 2014 to 2018. Z-tests were used to compare proportion of women entering each residency program. An internet search was conducted to calculate percentages of women as GI association presidents, residency program directors, division heads and oral speakers at conferences.ResultsIM residency had on average of 1789 applicants with 487 matched (49.4% versus 49.5% women). GS residency had on average 357 applicants with 90 matched (41% versus 54.4% women). GI residency had on average 46 applicants with 34 matched (37% versus 35.3% women). Cardiology residency had on average 76 applicants with 54 matched (29% versus 27.8% women).The Canadian Association of Gastroenterology (CAG) has had two out of 47 (4.2%) women presidents. The Ontario Association of Gastroenterology (OAG) has had no women presidents (0/9). The Association des gastro-entérologues du Québec (AGEQ) has had two out of 15 (13%) women presidents. The Alberta Society of Gastroenterology (ASG) has had one out of five (20%) women presidents. From 2018 to 2020, university division heads ranged from 0% to 13.3% women (0 to 2/15). University GI training program directors ranged from 28.6% to 35.7% (4 to 5/14). Women speakers at CAG’s annual conference varied 27% to 42% from 2016 to 2020, averaging 32.7%. Women speakers at OAG’s, AGEQ’s and ASG’s annual conferences averaged 23.3%, 24.1% and 35%, respectively.ConclusionWomen gastroenterologists display low representation at multiple levels along the GI career pathway.

Upper GI training of young surgeons: a reality full of hurdles. An international survey.

Anecdotal evidence suggests that the training of young surgeons in Upper GI is not homogeneous across the world. This survey aimed to investigate the different training programs and the level of satisfaction of young surgeons with their surgical and scientific education pathway. A multiple-choice and single best answer format questionnaire was sent to 36 Upper GI chairs from international referral centres and then forwarded to young surgeons (attending physician less than 40years old). The same questionnaire containing 5 main topics (demographics, residency, fellowship, academic research and activities, manual skill improvement) was posted online on a Surveymonkey website. San Luigi University Hospital, Orbassano (Turin), Italy; Tertiary University Hospital. Fourteen replies were received from colleagues in 36 referral centres (39% response rate) and 65 voluntary answers from the survey monkey platform. During residency training, only 43% of residents had a specific training in upper GI tract surgery, which was characterized by a small number of interventions performed both with trainer scrubbed and unscrubbed. Fellowship programmes were undertaken by 49% of participants and 64% spent this training period abroad. Operative experience was reported by nearly all respondents with only 27% performing > 10 gastrectomies and only 11% performing > 10 oesophagectomies with the trainer scrubbed. The majority attended less than 10 meetings (58%), and 70% of them published less than 5 papers. The present survey reveals that the young surgeons of the twenty-first century face many hurdles during their surgical training. Overall, the surgical education settings are limited for both practical and scientific training for upper GI trainees. As a result, it is not possible to train in upper GI surgery to a level of competent independent practice.

S1256 TeleHealth in GI: A United States Survey to Assess Its Impact Amidst COVID-19 Pandemic

INTRODUCTION: TeleHealth has garnered a lot of attention amidst the COVID-19 pandemic, and embraced by GI community throughout the United States. While these changes provided healthcare facilities an opportunity to rapidly adopt the remote healthcare delivery model, the uptake and challenges accompanying this practice change are largely unknown. METHODS: A web-based survey was disseminated amongst gastroenterology/hepatology providers (attending physicians, fellows, nurse practitioners, physician assistants), via en masse emails, social media promotion and direct contact by authors, to assess the impact of TeleHealth adoption on clinical practice and GI training programs. RESULTS: 230 respondents (71.7% physicians, 21.3% fellows) completed the survey, with 67.8% academic responses. During COVID era, average weekly half-day clinics increased slightly for GI physicians (P = 0.14), but average number of patients dropped (10.2–6.5; P < 0.001). Respondents from academic centers reported significantly higher use of TeleMedicine (via-phone) (35.8% vs. 25.3%; P = 0.012), in comparison to higher in-person visits in non-academic settings (15.7% vs. 8.7%; P = 0.008). Use of TeleHealth (via-video) was not different between the two settings (P = 0.75). In terms of regional variations, a statistically higher TeleMedicine (via-phone) use was observed in NorthEast (vs. SouthEast, P = 0.005 or West, P = 0.004); top three reasons included less technically inclined population, less platform connectivity burden and fewer privacy concerns. SouthEast had significantly higher in-person visits than NorthEast (P < 0.001). Fellows' participation dropped to less than 50% in attending clinics, and 34.5% fellows noted a compromise in outpatient GI educational mission with adoption of TeleHealth. 95.2% of our respondents foresee future utilization of TeleHealth if adequately reimbursed. CONCLUSION: While our results suggest an almost universal adoption of TeleHealth, we observe a noteworthy variation in its utilization by region and practice type. Furthermore, our survey demonstrates that GI training has suffered significantly with this platform, given lack of consistent supervision in fellows' continuity clinics, and decreased participation in attending clinics. Moreover, our results also emphasize barriers to TeleHealth’s widespread utilization, where lack of adequate equipment/training, patient demographics and reimbursement policies are the foremost challenges.Table 1.: Comparison of outpatient clinics (half-day clinic sessions per week) and patient volume (patients seen per half-day clinic session) before and during COVID-19Figure 1.: Barriers to utilization of TeleHealth and TeleMedicine.

S1241 The COVID-19 Pandemic Effect on Fellow Education in U.S. GI Training Programs (CAFE-GI)

INTRODUCTION: The COVID-19 pandemic has changed the educational experience of trainees in Gastroenterology (GI) training programs. Understanding how these changes have affected GI training is important for ensuring clinical competency of our current trainees and for future curricula planning purposes. METHODS: We sent an email invite to complete the anonymous online survey to all program directors (PD) of ACGME-accredited GI fellowship programs. Surveys were completed between May 11th to June 5th, 2020. The study was approved by the institutional review board. RESULTS: 44/205 (21%) PD completed the survey. At the time of the survey, programs were operating within the following ACGME defined stages of GME training: 7 (15.9%) were at stage 1, “business as usual,” 27 (61.4%) were at stage 2, “increased clinical demands,” and 10 (22.7%) were at stage 3, “pandemic emergency status.” Endoscopy Training: All PD reported decreased outpatient procedure volume for trainees with 70.5% reporting a greater than 75% decrease. 93.2% of PD reported decreased inpatient procedure volume with 34.1% reporting a greater than 75% decrease (Figure 1). Inpatient Consults: All PD reported fellows continued to perform inpatient consultations, but 50% of PD reported changing the structure of the consult service. 27.2% of PD reported a more than 50% decrease in the volume of consultations (Table 1). Outpatient Clinics: 90.9% of PD reported trainees continued outpatient clinics, but 81.9% of PD reported trainees saw fewer patients. The form of patient interaction changed in most programs: 75% used telephone visits; 55% used video visits; and only 30% maintained in-person visits (Table 1). Virtual Conferences: 81.8% of PD reported a high attendance rate (>80%) of virtual conferences. Though, 27.3% of PD considered virtual conferences a worse experience, and 70.5% of PD reported difficulty with engaging fellows in virtual conferences (Table 2). Overall Feedback: 72.7% of PD were worried that the pandemic would significantly decrease endoscopy exposure of the fellows, and 59.1% of PD were worried about the decrease in outpatient clinical experiences. CONCLUSION: The COVID-19 pandemic impact on US GI fellowship programs is significant, with large decreases in endoscopy and clinical encounter volume and shifting of clinical interaction away from in-person visits. Virtual conferences are highly attended, but engagement is challenging. Further adjustment of GI training programs is needed to accommodate these changes.Figure 1.: Volume change of endoscopy procedures performed by fellows during the COVID-19 pandemic.Table 1.: Changes to inpatient consult and outpatient clinic training in GI fellowship during the COVID-19 pandemicTable 2.: Response and feedback about virtual conference and lecture during the COVID-19 pandemic

1195 SUPERVISION DURING ENDOSCOPY VARIES AMONG TRAINEES AND CORRELATES WITH PERCEIVED QUALITY OF ENDOSCOPIC TRAINING

Gastroenterology (GI) training guidelines recommend minimum procedure volumes to be performed prior to completion of fellowship. However, there is no standardized approach to the degree of attending supervision during endoscopic training. The primary aims of this study were to assess patterns and variability of trainee supervision during endoscopic procedures, and the effect that supervision has on perceived quality of training. We developed a 17-item survey consisting of three domains: demographics, procedural supervision and perceived quality of endoscopic training. In October 2019, the survey was e-mailed to GI training program coordinators for dissemination to trainees within their program. A single reminder was distributed one week after the initial survey distribution. In total, 115 GI trainees (70% male) responded to the survey (Table 1). Nearly half of trainees (44%) were in their second year of training. Trainees reported that their attendings actively watched the screen the most during therapeutic EGD maneuvers (93%) followed by polypectomy (85%), colonoscopy inspection/withdrawal (63%), diagnostic EGD (61%) and colonoscopy insertion (40%). With each additional year in training, there was a significant decrease in the average percentage of time respondents reported active attending supervision for all procedures except therapeutic EGD (Figure 1). Furthermore, 10% of second and third year fellows reported that their attendings were “not watching or not in the room” for the majority of colonoscopy withdrawal. Overall, fellows perceived endoscopic training to be of high quality. There was no correlation between fellowship year and reported quality of endoscopic training. However, there was a positive correlation between the percentage of time fellows received supervision (attending actively watching the screen) during all procedure types/maneuvers and perceived quality of endoscopic training (p<0.05). A majority (55%) of fellows reported receiving verbal feedback regarding endoscopy on a daily basis; more frequent verbal feedback correlated with higher perceived quality of endoscopic training (p<0.001). The degree of attending supervision during trainee endoscopy varies by training year, with a significant decrease in active supervision as training progresses. These data show that there is a substantial proportion of the time in which attendings are not actively supervising key procedural elements, such as colonoscopy withdrawal. GI fellows who received more active supervision during endoscopy, as well as more frequent verbal feedback, perceived their training to be of higher quality.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

How To Maximize Trainee Education During the Coronavirus Disease-2019 Pandemic: Perspectives From Around the World

How To Maximize Trainee Education During the Coronavirus Disease-2019 Pandemic: Perspectives From Around the World

P013 IBD 101: AN INTRODUCTORY COURSE FOR FIRST YEAR GASTROENTEROLOGY FELLOWS

Abstract Introduction Inflammatory bowel disease (IBD) management is changing at a rapid rate, with the emergence of multiple new therapies and evolving care goals. In addition, the quality and quantity of IBD fellowship education is highly variable, based on patient populations and institutional expertise. Therefore, it is crucial to develop improved ways to educate our trainees. Here, we describe an educational initiative designed to familiarize first year gastroenterology (GI) fellows to key concepts in the management of IBD. Methods IBD 101 is a one-day course designed to introduce first-year GI fellows to various clinical topics relevant to the management of IBD. The program was held on September 14, 2019. Fellows from U.S. allopathic GI training programs were selected by their training directors for participation. The course included small group didactic sessions led by expert faculty members and group observed structured clinical examinations (OSCEs), in which fellows observed encounters between expert faculty and standardized patients followed immediately by debrief sessions to reinforce key concepts. The topics included need for surgery in IBD, pregnancy and IBD, escalation of care for acute severe UC, initiating biologic therapy, treatment of mild-moderate IBD, treatment of moderate-severe IBD and managing loss of response to therapy. A review of supplemental opportunities for education in IBD was presented at the conclusion of the course. Pre- and post-course surveys using Likert scoring (1=“strongly disagree” through 4=“strongly agree”) were administered to assess baseline knowledge and educational impact of the course on each addressed topic. Results 55 fellows from 32 programs participated. 49/55 (89%) completed pre- and post-course surveys to assess the educational impact of the program on the didactic sessions and on the group OSCE format. 100% of fellows felt that the course content was appropriate for their scope of clinical practice. Substantial improvement in comfort with all addressed clinical topics was noted (figure 1). In the post-course survey, all fellows reported an improved ability to manage and treat patients with IBD. Comparing career interest in IBD, more participants expressed interest in pursuing a career in IBD after participating (pre: 63% vs post: 75%). 96% of attendees stated that they would strongly recommend this course to future GI fellows. Conclusions This single day course for first-year GI trainees was effective and well-received, and offers a novel intervention to address the challenges of IBD education and training. Follow-up of this cohort of trainees and expansion for next year is planned.

Tumor budding in colorectal carcinoma: An institutional interobserver reliability and prognostic study of colorectal adenocarcinoma cases

BackgroundColorectal carcinomas are one of the most commonly diagnosed malignancies. There are many prognostic factors relating to clinical course and disease progression, including tumor stage, metastasis, and tumor budding. In 2016, the International Tumor Budding Consensus Conference (ITBCC) created a system to uniformly assess tumor budding. This system includes a 3-tier system for the grading of tumor budding. In the past, there lacked uniform consensus, however the general grading practice was based on a 2-tiered system. Given that tumor budding is considered to have prognostic value, the accuracy and reproducibility of its assessment is vital. Our study aims to look at interobserver agreement in the scoring of tumor budding. DesignA total of 233 cases of colorectal carcinoma diagnosed in our health system were retrospectively analyzed and routine H&E stained slides of these cases were collected. A representative slide for tumor budding was selected per case. Four investigators with different levels of experience and expertise evaluated the selected slide of each case for tumor budding. Scoring was based on the ITBCC protocol. Clinico-pathological data was collected for each case and analyzed with tumor budding scores. Tumor budding scores per individual investigator and consensus tumor budding score were compared to patient and tumor characteristics including patient survival, tumor grade, tumor stage, and lymph node status. ResultsInter-observer agreement was calculated using Gwet's Agreement Coefficient (AC1) and associated 95% confidence intervals was used to compare the ratings made by 4 pathologists. Overall, there was variation among pathologists in tumor budding score (Gwet's agreement coefficient = 0.25 and 0.326 for 3-tier and 2-tier grading system, respectively). Results show higher reliability with the 2-tier system compared to the 3-tier system. Tumor stage was significantly associated with budding score for all individual investigators and the consensus value (p value < 0.001). ConclusionThere is low inter-observer agreement in the assessment of tumor budding in colorectal carcinoma. This suggests that it is difficult to uniformly grade tumor budding and that our classification system needs improvement. We found that the older 2-tier system (Hase et al.) results in slightly higher inter-observer agreement than the recently proposed 3-tier grading system (ITBCC, 2016), though both systems lead to suboptimal agreement. Worth noting is that observers with subspecialty GI training and more work experience had higher inter-observer agreement. Our results showed that subspecialty training tends to increase agreement more than overall work experience. In addition, our exploratory results showed that there is an association of tumor budding score to tumor stage. While increasing refinement in classification, the 3-tiered system resulted in decreased agreement in tumor budding assessment. Clearly, there is more work to be done in the identification and quantification of tumor buds.

Private practice career after GI training.

Private practice career after GI training.

Proposal to Update the Curriculum in Inflammatory Bowel Diseases for Categorical Gastroenterology Fellows.

Education in inflammatory bowel disease (IBD) varies widely between categorical gastroenterology (GI) programs and is largely related to the presence of expert clinicians, patient population, and the presence of an IBD center. The treatment of IBD is becoming increasingly complex at a rapid pace, widening this educational divide. This manuscript outlines all the current US educational offerings in IBD for GI fellows, including how to obtain supplemental education during the 3-year training period and beyond. It reviews how to assess trainee knowledge in the field of IBD and proposes 8 clinically anchored, entrustable professional activities that should help prioritize important aspects of IBD management to incorporate during categorical GI training.

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.

Current Status of and Recommendations for Nutrition Education in Gastroenterology Fellowship Training in Canada.

Knowledge and skill in the area of nutrition are a key competency for the gastroenterologist. However, standards for nutrition education for gastroenterology fellows in Canada do not exist, and gastroenterologists in training and in practice do not feel confident in their knowledge or skill as it relates to nutrition. This study was undertaken to identify the current status of nutrition education in gastroenterology (GI) fellowship training programs in Canada and to provide insight into the development of nutrition educational goals, processes, and evaluation. Using mixed methods, we did a survey of current and recent graduates and program directors of GI fellowship programs in Canada. We undertook a focus group with program directors and fellows to corroborate findings of the survey and to identify strategies to advance nutrition education, knowledge, and skill of trainees. In total, 89.3% of the respondents perceived that the nutrition education was important for GI training, and 82.1% of the respondents perceived nutrition care would be part of their practice. However, only 50% of respondents had a formal rotation in their program, and it was mandatory only 36% of the time. Of the respondents, 95% felt that nutrition education should be standardized within GI fellowship training. Significant gaps in nutrition education exist with GI fellowship programs in Canada. The creation of standards for nutrition education would be valued by training programs, and such a nutrition curriculum for GI fellowship training in Canada is proposed.