Search

Background: Motility disorders are frequently encountered in gastroenterology (GI) practice, yet a national structured training curriculum for GI fellows in motility disorders is lacking. Since GI fellowships vary considerably in opportunities for specialized esophageal motility (EM) training, novel educational technology may be leveraged to provide standardized EM curriculum to train GI fellows in esophageal manometry. Methods: GI fellows participated in an online EM learning program at a single academic center from 2017 to 2022. Fellows answered case-based questions and were provided with evidence-based, corrective feedback related to core EM learning objectives. The primary outcome was change in knowledge and comfort in interpretation and clinical application of EM studies. Results: Sixty-nine fellows actively participated in the online EM curriculum. 65 fellows completed a pre-curriculum test, and 54 fellows completed a post-curriculum test. There was a cumulative improvement between pre-curriculum test and post-curriculum test scores from 70 to 87%, respectively (p < 0.001). Fellows had a mean improvement of 19% in questions as they progressed through the curriculum. Prior to enrolling in the EM course, 26% of fellows felt comfortable in interpreting EM studies compared to 54% of fellows after completion of the program (p < 0.001). Conclusion: An online, technology-based curriculum was effective in educating GI fellows on core competencies of EM. Fellows demonstrated improvement in proficiency of clinically important EM studies and increased comfort in interpreting EM studies. Further studies are needed to evaluate the use of technology-based learning to widely disseminate a structured training curriculum in EM, particularly in training programs without a motility presence. [ABSTRACT FROM AUTHOR]

Diseases related to the digestive system account for a significant proportion of the diseases burden in the United States and result in 36.8 million ambulatory visits, 3.8 million hospital admissions, and 22.2 million gastrointestinal endoscopies. To meet the challenge that this quantum of gastroenterological disorders poses, we are obligated to select and train competent gastroenterologists. Admission into a Gastroenterology (GI) fellowship program is highly selective. In 2023, only 62.7% of candidates who applied were successful in matching into a fellowship program, making it even more competitive than a cardiology fellowship (match rate of 68.4%). Therefore, it is imperative that we ensure that the selection process is fair and transparent. Additionally, we need to be socially more responsible by emphasizing diversity and inclusivity to produce gastroenterologists who reflect the changing society we live in. An analysis of current practices indicates that the process of selection is not standardized and is more subjective than objective. This review is an attempt to identify deficiencies that can be rectified by the introduction of a standardized system that includes structured interviews, Standard Letters of Recommendation (SLOR), and objective scoring protocols-all of which would make the process of selection more equitable, diverse, and inclusive. Newer methods like Casper exam, Psychometric testing, and Preference Signaling can also be explored to this end., Competing Interests: Declarations Conflict of interest The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: The aim was to assess the knowledge, attitudes, and practices (KAPs) of endoscopy among gastroenterologists in the diagnosis and management of IBD in China., Methods: A multicenter cross-sectional KAP study was performed. The questionnaire was developed and improved using feedback and opinions from a team of experienced IBD specialist professors and then distributed and collected online. In addition, eight fellow gastroenterologists participated in an IBD endoscopy training program were asked to review endoscopic images, and the consistency of the endoscopic scores before and after training was calculated., Results: A total of 193 participants from 12 provincial-level administrative regions encompassing both the Northern and Southern parts of China completed the study questionnaire. The median age of the participants was 40 (36, 45) years, with the majority being female (70.5%). The median professional experience as gastroenterologists was 11 (7, 17) years, while the median experience as endoscopists was 8 (3, 15) years. The median knowledge score was 8 out of 10 points for single-choice questions; however, most gastroenterologists believed that some concepts in these endoscopic indices were vague, including those regarding deep ulcerations, ulcerated surfaces, affected surfaces and narrowing in open-answer questions. The UCEIS and SES-CD were considered most consistent with clinical activity score in the evaluation of UC and CD, respectively. IBD subspecialists and gastroenterologists who had previously received IBD endoscopy screening training were more likely to use endoscopic indices (p<0.001, p = 0.029, respectively). The Rutgeerts score demonstrated the most significant improvement in consistency before and after training, from 0.407 (95% CI: 0.025-0.999) to 0.909 (95% CI: 0.530-1.000)., Conclusions: We propose the elucidation of ambiguous definitions in endoscopic indices, enhancement of training, and the application of innovative technology to enhance the application of endoscopic evaluation and endoscopic indices in clinical practice., (© 2024. The Author(s).)

Background: Women remain underrepresented in gastroenterology (GI). Studies have identified that a lack of formal mentorship for women contributes to this underrepresentation. While many GI divisions have adopted models for supporting GI fellows and faculty, there is a gap in our knowledge regarding mentorship options for internal medicine (IM) residents interested in GI., Aims: To evaluate representation of women at each level of their career (resident, fellow, and attending) and examine trends in representation of women in GI compared to other IM subspecialties., Methods: We analyzed AAMC Physician Specialty Data Reports to compare gender representation and growth of women representation across all IM subspecialties and residencies from 2007 to 2021., Results: In 2021, 44.3% of IM residents, 37.8% of GI fellows, and 19.7% of actively practicing attending gastroenterologists were women. Since 2007, GI comprised significantly lower proportions of women attendings except for cardiology, and lower representation in fellows, except for cardiology and nephrology, than other IM subspecialties (p < 0.001). There was a consistently higher proportion of women GI fellows than attendings over the past 14 years (p < 0.01)., Conclusions: GI has among the lowest representation of women at each career level compared to other IM subspecialties. Given the previously reported preference of gender congruent mentoring, the underrepresentation of senior academic gastroenterologists who are women may be a contributing factor to lower proportions of women trainees choosing to pursue GI., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Training in HPB surgery lacks uniformity across regions covered by the E-AHPBA. Accreditation has been in place for centers and fellowship programs, but with low uptake. The decision whether to continue, change or cease such accreditation is being discussed. Thus, a strengths, weaknesses, opportunities, and threats (SWOT) analysis was conducted., Methods: A mixed-methods, cross-sectional study among stakeholders in E-AHPBA, ESSO and UEMS under the E-AHPBA executive council was founded, ensuring representation by gender and geographic distribution., Results: Responses were collected from across E-AHPBA regions, with response from 15 of 24 subchapters. The most frequent and recurring themes are presented in a SWOT matrix which allows for paired evaluations of factors deemed to be helpful (Strengths and Opportunities), those that are harmful (Weaknesses and Threats)., Conclusion: This study identified both helpful and harmful effects to an accreditation process of HPB centers or HPB fellowship training across the E-AHPBA membership region. Formal accreditation of centers is not within the scope, nor jurisdiction nor financial capacity for E-AHPBA in the current situation. A strong interest in formal HPB training should be capitalized into E-AHPBA strategic planning towards a structured accreditation system for HPB fellowship programs or HPB training tracks., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background and Aims: Since the onset of the Coronavirus disease 2019 (COVID-19) pandemic, there has been a significant opportunity to leverage virtual platforms for communication and dissemination of knowledge. An online survey was conducted to examine the viewpoints of World Gastroenterology Organization (WGO) leaders concerning the necessity, primary priority areas, and implementation strategies for a virtual global gastroenterology educational program., Methods: We conducted a survey of leaders of WGO member societies to assess their opinions on creating opportunities for global education using virtual platforms, identifying practical implementation steps and priority educational areas., Results: Responses were obtained from 57/117 (48.7%) contacted leaders with 56/57 (98.2%) identifying such a need. Five mutually exclusive priority educational topics were proposed in the survey: clinical gastroenterology, endoscopy, nutritional support, research methodology, and professional development. Overall, most participants prioritized clinical gastroenterology (45/57; 78.9%) and endoscopy/hand skills (27/57; 47.3%) as educational topics to be addressed by the virtual global gastroenterology educational program. A majority of WGO member society leaders surveyed favored monthly teaching activities (33/57; 57.8%), ideally carried out between 1500-2100 local time (31/57; 54.3%), ideally with no administrative fees (47/57; 82.4%)., Conclusions: This truly global survey of WGO member societies achieved a good response rate and provides important insights into the need for and scope of future virtual education programs under the aegis of the WGO.

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.

Background: Virtual interviews are still recommended for fellowship applications, 3 years after the beginning of the COVID-19 pandemic. Improving equity by reducing the cost for the applicants has been the most important reason for continuing virtual interviews. However, some argue that important information may be missed in a virtual setting. Our objective was to assess the perspective of Gastroenterology (GI) fellowship interviewers and applicants toward virtual interviews., Methods: We designed two different anonymous surveys directed at GI programs and GI applicants who were interviewed for GI fellowship programs from 2020 to 2022 and matched to a GI program. Survey links were emailed to the Program Directors (PDs) and Program Coordinators via the AGA listserv starting in January 2023. A descriptive analysis was performed using Excel, and Fisher's exact tests were performed using R version 4.3.1., Results: Sixty-one applicants and 79 interviewers responded to our survey. More than 80% of applicants strongly agreed (n = 36; 59%) and agreed (n = 14; 23%) that they would prefer in-person interviews if money was not an issue. When applicants were asked about the interview format in order of their preference, "in-person, hybrid, virtual" was the most popular answer (n = 16; 26.2%). Most interviewers (n = 47; 59.5%) do not prefer virtual interviews over in-person interviews. Furthermore, some interviewers were rarely able to judge the applicants' interpersonal (n = 17; 21.5%) and ethical skills (n = 16; 20.3%). These results differed according to the type of interviewer (p = 0.013 and 0.018, respectively)., Conclusion: Based on our survey, most programs still prefer in-person interviews. Despite the several advantages of virtual interviews, the majority of applicants would prefer an in-person setting if the financial burden was not a factor. Nonetheless, many applicants think that the cost savings outweigh all the disadvantages associated with virtual interviews. The lack of empathy, personal connections, and engagement may impact the ability of interviewers to judge and ultimately rank a candidate. The virtual interview is here to stay, and we need input from the applicants and the interviewers to make the process more productive., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

GI fellowships do not mandate curricula in career development. Often, fellows resort to peer mentorship for guidance. Fellows should recognize that the path to a successful career varies greatly based on how one defines and measures success. Through introspection, fellows will be able to craft their ideal post-fellowship position that balances wants versus needs. In this article, we cover the breadth of post-fellowship opportunities available with a focus on unique considerations for LGBTQ+ and IMG trainees., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background and Aims: Intestinal ultrasonography (IUS) is challenging to learn. This prospective study examined how the accuracy of IUS increases with operator experience ("learning curve") and if prior abdominal ultrasound experience facilitates the learning process., Methods: The study included two trainees with limited abdominal ultrasound experience (< 50 exams) and two with extensive experience (> 500 exams). Each trainee performed 99 examinations and reported four IUS findings. An expert sonographer repeated the exam, and concordance (k) between the expert and trainees was assessed in three consecutive testing periods of 33 exams each., Results: A progressive improvement in concordance was observed for all IUS findings from Period 1 to Period 3, overall and for both groups of trainees, although those with experience in abdominal ultrasound had faster learning curves. The minimum number of examinations required to achieve concordance with the expert operator for detecting increased bowel wall thickness was 84 and detecting bowel dilatation was 79. However, a minimum of 97 examinations was necessary to achieve concordance for detecting intra-abdominal complications, considered an advanced IUS competence., Conclusion: Basic competence in IUS can be acquired with relatively few examinations, while advanced competence requires more extensive training, particularly for gastroenterologists without abdominal ultrasound experience., Competing Interests: Conflict of interest CB served as a consultant for Takeda, Ferring, AbbVie, Galapagos, MSD and Janssen. SS received lecture fees from Takeda Pharmaceuticals and Janssen Pharmaceuticals and served as a consultant and advisory board member for AbbVie and Janssen Pharmaceuticals. FF served as consultant for MSD, Amgen, AbbVie, Jannsen, Galapagos and Pfizer. AA received consulting/advisory board fees from AbbVie, Allergan, Amgen, Arena, Biogen, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Celltrion, Eli Lilly, Ferring, Galapagos, Gilead, Janssen, MSD, Mylan, Nestlé, Pfizer, Protagonist Therapeutics, Roche, Samsung Bioepis, Sandoz and Takeda; speaker's fees from AbbVie, Amgen, Arena, Biogen, Bristol Myers Squibb, Eli Lilly, Ferring, Galapagos, Gilead, Janssen, MSD, Novartis, Pfizer, Roche, Samsung Bioepis, Sandoz, Takeda and Tigenix; and research grants from Biogen, MSD, Pfizer and Takeda. DR provided consultancies for Biogen, Celltrion, Galapagos, Janssen and Takeda. GM served as speaker or advisory board member for Alfa Sigma, Arena Pharmaceuticals, Fresenius Kabi, Galapagos, Gilead, Janssen Cilag, Roche and Takeda. GF received consultancy fees from Ferring, MSD, AbbVie, Takeda, Janssen, Amgen, Sandoz, Samsung Bioepis, and Celltrion., (Copyright © 2024. Published by Elsevier Ltd.)

Purpose of Review: Endoscopy-related injuries (ERIs) are prevalent in gastrointestinal endoscopy. The aim of this review is to address the growing concern of ERIs by evaluating the ergonomic risk factors and the efficacy of interventions and educational strategies aimed at mitigating these risks, including novel approaches., Recent Findings: ERIs are highly prevalent, exacerbated by factors such as repetitive strain, nonneutral postures, suboptimal equipment design, and the procedural learning curve. Female sex and smaller hand sizes have been identified as specific risk factors. Recent guidelines underscore the importance of ergonomic education and the integration of ergonomic principles into the foundational training of gastroenterology fellows. Advances in equipment design focus on adaptability to different hand sizes and ergonomic positions. Furthermore, the incorporation of microbreaks and macrobreaks, along with neutral monitor and bed positioning, has shown promise in reducing the incidence of ERIs. Wearable sensors may be helpful in monitoring and promoting ergonomic practices among trainees., Summary: Ergonomic wellness is paramount for gastroenterology trainees to prevent ERIs and ensure a sustainable career. Effective strategies include ergonomic education integrated into curricula, equipment design improvements, and procedural adaptations such as scheduled breaks and optimal positioning. Sensor-based and camera-based systems may allow for education and feedback to be provided regarding ergonomics to trainees in the future., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

GI fellowships do not mandate curricula in career development. Often, fellows resort to peer mentorship for guidance. Fellows should recognize that the path to a successful career varies greatly based on how one defines and measures success. Keywords are preferr Through introspection, fellows will be able to craft their ideal post-fellowship position that balances wants versus needs. In this article, we cover four practical tips for trainees entering the job negotiation process., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

This article summarizes the evolution of endoscopy training from its origins of simple bedside instruction to its current state of competency-based curricula and incorporation of novel training methods, including simulation, gamification for the trainee, and improving education skills of the tutors., Competing Interests: Disclosures None., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Gastrointestinal diseases impose a significant morbidity, mortality, and health care cost burden, affecting millions annually in the United States alone. Endoscopy plays a crucial role in managing these conditions. Despite technological advancements in endoscopy, ensuring efficient, high-quality care remains challenging. A critical need to standardize high-quality endoscopy is for education reform in the training of endoscopists. Traditional apprenticeship-based training methods are dependent on the trainer as well as the patient case mix. Simulation-based mastery learning (SBML) emerges as a promising strategy to improve endoscopy training. This review discusses the current state of SBML for optimizing upper endoscopy and colonoscopy efficiency., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Purpose of the Review: This review article explores the role of medical media in gastroenterology and hepatology, highlighting its benefits for enhancing clinical practice, education, and patient engagement. It also provides practical guidance for gastroenterologists and hepatologists on effectively implementing these tools in their daily practice., Recent Findings: Recent findings highlight that medical media significantly boosts citation rates and dissemination of research, enhances promotional efforts, and fosters greater engagement from patients and trainees. These advances underscore the growing role of medical media in amplifying academic impact and improving educational outreach in gastroenterology and hepatology. Integrating medical media into pediatric gastroenterology and hepatology offers numerous benefits, from enhanced education and professional development to improved patient engagement. By understanding the roles of contributor, creator, and consumer and leveraging the right platforms and content types, pediatric gastroenterologists and hepatologists can effectively utilize medical media to advance their field and provide better care., (© 2024. The Author(s).)

Purpose of the Review: The purpose of this review is to detail steps and strategies needed to have success as an interventional gastroenterologist at a tertiary care academic medical center., Recent Findings: Development of a specific niche within interventional endoscopy (IE), can allow an incoming academic interventional endoscopist to make a clinical and academic impact on a regional and national level. As the evolution of IE training continues, the development of a niche will become streamlined, supporting a more efficient academic progression for incoming IE faculty. By showcasing the experience of a junior academic interventional endoscopists, we demonstrate how expansion of a specific clinical interest within interventional endoscopy (IE), in conjunction with a mentoring environment, can facilitate academic and clinical progression at an academic medical center., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Competing Interests: The authors declare that they have no conflict of interest.

Endoscopic retrograde cholangiopancreatography [ERCP] is a complex procedure with a flat learning curve. It is associated with the risk of serious complications such as pancreatitis, bleeding, cholangitis and perforation. Endosonography should therefore also be offered for the precise indication of the higher-risk ERCP. Numerous factors influence the success of ERCP. In addition to structured training for the initial acquisition of skills and a minimum number of ERCPs of varying degrees of difficulty, maintaining a good quality of ERCP also requires a regular minimum number of examinations performed per year. There is extensive evidence that shows a significant correlation between ERCP volumes and primary success rates, lower lengths of hospital stay, fewer unwanted readmissions and fewer complications. The cut-offs for differentiating between high-volume and low-volume centers were chosen inconsistently in the studies, with the highest evidence for a cut-off value of 200 ERCPs/year. The question of specialization in ERCP has been given a relevance by the current developments in german hospital reform. Here, a minimum number of ERCPs should be defined for groups of different specialization. However, a minimum number alone will not be able to achieve good treatment quality. In terms of high-quality patient care, it is necessary to offer ERCPs in specialized gastroenterology center, which, in addition to a sufficient number of ERCPs for training and to maintain competence, offer an on-call service and complementary procedures such as EUS and which are embedded in appropriately accessible clinics that have the necessary resources for complication management., Competing Interests: Alle Autoren und Autorinnen sind Mitglieder der DGVS. Die Autoren und Autorinnen 1–6 und 8–12 arbeiten in leitenden Funktionen in Gastroenterologien in denen auch ERCPs durchgeführt werden., (Thieme. All rights reserved.)

Objective: General surgery trainees interested in performing hepatopancreatobiliary (HPB) surgery can choose from multiple fellowship pathways, namely HPB, surgical oncology (SO), and abdominal transplant-HPB (TXP-HPB). Although focused on similar operations, each program offers distinct clinical and technical emphases., Design: An annual inter-institutional exchange between TXP-HPB and SO fellowships, starting in 2014., Setting and Participants: TXP-HPB fellows from Washington University in St. Louis (WUSTL) and SO fellows from Memorial Sloan Kettering Cancer Center (MSKCC)., Results: About 14 fellows have participated in the exchange so far, 13 of whom responded to our survey. At MSKCC, TXP-HPB fellows performed a median of 24 cases, including 6 major pancreatic resections, 3 major hepatectomies, 4 hepatic artery infusion pump insertions, and 1 major biliary case. At WUSTL, SO fellows performed a median of 16 cases, including 5 liver transplants, 2 major pancreatic resections, 2 major hepatectomies, and 2 major biliary cases. About 92.3% of respondents stated they would repeat the rotation, with SO fellows emphasizing the exposure to vascular anastomoses and transplant-HPB fellows appreciating the oncologic focus., Conclusions: A monthlong inter-institutional exchange offers a unique opportunity to standardize and improve HPB education., (Copyright © 2024 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

The European Pancreatic Club Lifetime Achievement Award is a distinction awarded for research on the pancreas and service to European Pancreatology. It comes with the obligation to submit a review article to our society's journal, Pancreatology. It was awarded to me 2023 and I take this opportunity to highlight my journey with the central organ AKA the pancreas, that is inseparatable from "Pancreas 2000" - an educational program for future pancreatologists, inaugurated by Karolinska Institutet., (Copyright © 2024 The Author. Published by Elsevier B.V. All rights reserved.)

Background: Conversational chatbots, fueled by large language models, spark debate over their potential in education and medical career exams. There is debate in the literature about the scientific integrity of the outputs produced by these chatbots., Aims: This study evaluates ChatGPT 3.5 and Perplexity AI's cross-sectional performance in responding to questions from the 2023 Italian national residency admission exam (SSM23), comparing results and chatbots' concordance with previous years SSMs., Methods: Gastroenterology-related SSM23 questions were input into ChatGPT 3.5 and Perplexity AI, evaluating their performance in correct responses and total scores. This process was repeated with questions from the three preceding years. Additionally, chatbot concordance was assessed using Cohen's method., Results: In SSM23, ChatGPT 3.5 outperforms Perplexity AI with 94.11% correct responses, demonstrating consistency across years. Concordance weakened in 2023 (κ=0.203, P = 0.148), but ChatGPT consistently maintains a high standard compared to Perplexity AI., Conclusion: ChatGPT 3.5 and Perplexity AI exhibit promise in addressing gastroenterological queries, emphasizing potential educational roles. However, their variable performance mandates cautious use as supplementary tools alongside conventional study methods. Clear guidelines are crucial for educators to balance traditional approaches and innovative systems, enhancing educational standards., Competing Interests: Declaration of competing interest The authors declare that they have no conflicts of interest to disclose., (Copyright © 2024 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.)

Background: Recent advancement and complexity in the management of inflammatory bowel disease (IBD) has made it challenging for gastroenterology (GI) fellows to obtain competency and confidence in managing the complex IBD patient. We aimed to evaluate the confidence and training in IBD among GI fellows in Saudi Arabia., Methods: We conducted an electronic, voluntary, and anonymous multicenter survey study of GI fellows in Saudi Arabia, from 1/5/2023 to 1/9/2023. The survey evaluated the fellows' confidence level in IBD management, methods of training received, and the amount of additional training desired in 20 core IBD domains. GI fellows' preferred learning method was also evaluated., Results: A total of 65 GI fellows responded to the survey. In the entire cohort, >50% of fellows reported low confidence in 7 out of 20 IBD management domains, which included 71% in managing j-pouch disorders, 67% in managing the elderly/frail patient with IBD, 60% in managing extraintestinal manifestations, 57% in recommending preventative health services, and 54% in counseling patients on small molecules. Receiving >4 IBD didactic sessions per year was significantly associated with high confidence in managing j-pouch disorders (44.4% vs 13.3%, P = 0.05) and managing the elderly/frail patient with IBD (86.7% vs 50.0%, P = 0.03). Doing an external rotation to expand IBD knowledge was associated with high confidence in managing the elderly/frail patient with IBD (100% vs 26.7%, P = 0.01)., Conclusion: Many GI fellows lacked confidence and training in key domains of IBD management. Enhancing IBD exposure with didactics and external rotations improved fellows' confidence in specific domains., (Copyright © 2024 Copyright: © 2024 Saudi Journal of Gastroenterology.)

Background: Therapeutic endoscopy and gastroenterology fellows often participate in endoscopic retrograde cholangiopancreatography (ERCP) during their training period. However, it is generally feared that trainee involvement may increase ERCP-related complications, mainly because of the side-viewing nature of the endoscope and the higher risk of pancreatic duct cannulation. There is no concrete evidence to support this notion. This systematic review and meta-analysis aims to investigate the resultsof trainee participation on adverse events related to ERCP., Methods: PubMed, EMBASE, Google Scholar, SCOPUS, and Web of Science databases were searched from inception to 31 May 2023 for studies evaluating the ERCP outcomes defined as success rates, procedure time, failed attempts, and adverse events with and without trainee participation. A random effect model was used to perform the meta-analysis, and heterogeneity was assessed using the I 2 statistics., Results: Seven studies were included in the final analysis, including 17,088 ERCPs. The pooled odds ratio (pOR) of success rate, incomplete/failed attempts in the trainee and no trainee groups were 0.466 (95% CI 0.13 to 1.66, I 2  = 97.8%, p = 0.239) and 3.2 (95% CI 0.70 to 14.55), I 2  = 98.5%, p = 0.134), respectively. The pOR of post-ERCP pancreatitis and bleeding in the trainee vs. no trainee groups was 0.97 (95% CI 0.76 to 1.23, I 2  = 0%, p = 0.78) and 1.3 (95% CI 0.59 to 2.83, I 2  = 49%, p = 0.54). The pOR of all adverse events in both groups was 1.028 (95% CI 0.917 to 1.152, I 2  = 0%, p = 0.636). Surprisingly, the pooled std mean difference for the procedure time was 0.217 (95% - 0.093 to 0.05, I 2  = 98.5%, p = 0.17)., Conclusion: This meta-analysis comprising of 17,088 ERCPs in seven studies demonstrated comparable ERCP outcomes related to trainee participation regarding success rates, procedure time, and adverse events. Trainees' involvement in ERCP within a proper teaching setting appears safe and does not compromise the overall procedure's success., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background and Aims: Women, on average, have smaller hand sizes as well as lower muscle mass and strength. With the increasing number of women entering training programs in gastroenterology, our aim was to study the subtle gender differences in endoscopy ergonomics., Methods: A survey instrument regarding demographic information, personal preferences in endoscopy styles and techniques, and endoscopy-related injury was sent to practicing gastroenterologists. Statistical analysis was performed on the data., Results: The survey was answered by 107 gastroenterologists, 41 (38.3%) female subjects and 66 (61.7%) male subjects. Female participants were shorter in height, had smaller hand sizes, and performed fewer weekly cases. More men (45.5%) than women (20%) performed advanced endoscopic procedures. Women preferred the following: (1) holding the endoscope with the umbilical cord outside the forearm; (2) using the right hand to turn the small wheel; and (3) using a pediatric colonoscope to perform colonoscopy in a petite patient or one with a low body mass index. Endoscopy-related injury was reported in 49.5% of all gastroenterologists, with women reporting a significantly higher risk of injury (63.4%) than men (40.9%) (P = .02). Although higher weekly case volumes and performance of advanced endoscopy procedures were not independent risk factors for endoscopy-related injury, female gender was found to be an independent risk factor for injury., Conclusions: Gender differences exist in endoscopy styles and techniques, as well as endoscopy-related injury. Providing gender-specific training in endoscopy may improve ergonomics and decrease the risk of injury., Competing Interests: Disclosure The following authors disclosed financial relationships: A. Bhatt: ownership of stocks in Boston Scientific and Medtronic. N. Thosani: royalties from UpToDate. P. Patil: none declared., (Copyright © 2024 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.)

Objective: This study aimed to discuss the application value of an artificial intelligence-based diagnosis and recognition system (AIDRS) in the teaching activities for Bachelor of Medicine and Bachelor of Surgery (MBBS) in China. The learning performance of graduate students in gastroenterology during gastroscopy training with and without AIDRS was assessed., Methods: The study recruited 32 graduate students of the gastroenterology program at Jiangsu province hospital of Chinese medicine and Xiangyang No. 1 People's Hospital from March 2018 to March 2022 and randomly divided them into AIDRS (n = 16) and non-AIDRS (n = 16) groups. The AIDRS software was used for real-time monitoring of blind spots of gastroscopy to aid in lesion diagnosis and recognition in the AIDRS group. Only a conventional gastroscopic procedure was implemented in the non-AIDRS group. The final performance score, success rate of gastroscopy, lesion detection rate, and pain score of patients were compared between the two groups during gastroscopy. A self-prepared teaching and learning satisfaction questionnaire was administered to the two groups of students., Results: The AIDRS group had a higher final performance score (92.60 ± 2.83 vs. 89.21 ± 3.57, t = 2.98, P < 0.05), a higher success rate of gastroscopy (448/480 vs. 417/480, χ 2  = 11.23, P < 0.05), and a higher detection rate of lesions (51/52 vs. 41/53, χ 2  = 8.56, P < 0.05) compared with the non-AIDRS group. The pain scores of patients were lower in the AIDRS group than in the non-AIDRS group (3.40 [2.23, 3.98] vs. 4.45 [3.72, 4.75], Z = 3.04, P < 0.05). Besides, the average time for gastroscopy was lower in the AIDRS group than in the non-AIDRS group (7.15 ± 1.24 vs. 8.21 ± 1.26, t = 2.38, P = 0.02). The overall satisfaction level with the teaching program was higher in the AIDRS group (43.51 ± 2.29 vs. 40.93 ± 2.07, t = 3.33, P < 0.05)., Conclusion: In the context of medicine-education cooperation, AIDRS offered valuable assistance in gastroscopy training and increased the success rate of gastroscopy and teaching and learning satisfaction. AIDRS is worthy of wider-scale promotion., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Austria, ein Teil von Springer Nature.)

Background: Diversity in medicine has garnered significant attention in recent medical workforce research, as studies consistently reveal the beneficial impact of race-concordant visits on patient outcomes, adherence, and satisfaction. While diversity among residency and fellowship program directors has been studied in other fields, little is known about the diversity within niche fellowship programs such as transplant hepatology. This study aims to investigate the demographic information of program directors in transplant hepatology fellowship programs., Methods: We identified transplant hepatology fellowship programs and their program directors from the American College of Gastroenterology website. Multiple reviewers compiled demographic and training information from internet searches, which was analyzed using chi-square analysis. In assessing racial diversity, researchers identified perceived race using multiple indicators, including name, physical appearance, and affiliation with identity associations., Results: Our study analyzed data from 72 program directors, with 61.11% being male. Among the program directors, 55.6% appeared non-Hispanic White, 36.11% appeared Asian, while apparent Hispanics and Blacks represented 5.56% and 4.17%, respectively. Our analysis also found that male program directors appeared largely non-Hispanic white (72.72%) and were significantly more likely to be professors (p = 0.045) rather than associate or assistant professors., Discussion: Our findings indicate that transplant hepatology fellowship programs are primarily led by male and non-Hispanic White physicians. To attract underrepresented medical students and residents, it is critical to make meaningful efforts to improve diversity and ensure equitable representation of leaders. Future research should focus on developing strategies to build a more inclusive workforce while addressing existing leadership inequities., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: The updated Shape of Training curriculum has shortened the duration of specialty training. We present the potential role of out of programme clinical fellowships., Method: An electronic online survey was sent to all current fellows to understand their experiences, training opportunities and motivations.Data were collected on fellows' endoscopic experiences and publications using PubMed for all previous doctors who have completed the Sheffield Fellowship Programme., Results: Since 2004, 39 doctors have completed the Sheffield Fellowship.Endoscopic experience: current fellows completed a median average of 350 (IQR 150-500) gastroscopies and 150 (IQR 106-251) colonoscopies per year. Fellows with special interests completed either 428 hepato-pancreato-biliary procedures or 70 endoscopic mucosal resections per year.Medline publications: Median average 9 publications(IQR 4-17). They have also received multiple national or international awards and 91% achieved a doctoral degree.The seven current fellows in the new Shape of Training era (57% male, 29% Caucasian, aged 31-40 years) report high levels of enjoyment due to their research projects, supervisory teams and social aspects. The most cited reasons for undertaking the fellowship were to develop a subspecialty interest, take time off the on-call rota and develop endoscopic skills. The most reported drawback was a reduced income.All current fellows feel that the fellowship has enhanced their clinical confidence and prepared them to become consultants., Conclusion: Out of programme clinical fellowships offer the opportunity to develop the required training competencies, subspecialty expertise and research skills in a supportive environment., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Competing Interests: We declare no competing interests. Editorial note: The Lancet Group takes a neutral position with respect to territorial claims in published maps.

Background: a majority of resident physicians in Germany are not satisfied with their training conditions. However, training satisfaction is important for physician retention and patient care. Although federal and state laws define the general training regulations and conditions, considerable variability still exists concerning their implementation in the healthcare units. Little is known about the expectations concerning training for gastroenterology board certification by trainers and trainees in Germany. This lack of data hinders discussion on and improvement of training in gastroenterology in Germany., Aim: assessment of preferred training conditions among trainers and trainees for board certification in gastroenterology in Germany., Methods: an anonymous, voluntary survey consisting of single- and multiple-choice questions utilizing the Likert scale and fill-in responses was circulated to all members of the German Society for Digestive and Metabolic Diseases (DGVS - Deutsche Gesellschaft für Gastroenterologie, Verdauungs und Stoffwechselerkrankungen), as well as through the student council mailing lists of all German medical schools. The survey aimed to assess the consent regarding the ideal implementation of training regulations for gastroenterology board certification. Department heads, senior physicians, board-certified physicians, and outpatient-care physicians were classified as trainers and residents and students as trainees. Subgroups defined by place of work, age, gender, professional position, employment status, and parental status were investigated., Results: 958 responses were included in the final analysis. We found a broad consensus among trainers and trainees on most aspects of our survey. Considerable differences were seen in items on part-time work, overtime, protected time for research, and advanced endoscopy training., Conclusion: the broad consensus seen in this survey is indicative of a shared vision for training conditions among trainers and trainees. However, the areas of dissent identified in this survey may assist trainers to better understand the expectations of trainees. Furthermore, this survey creates a sound basis upon which training conditions for board certification in gastroenterology in Germany can be discussed and improved., Competing Interests: The authors declare that they have no conflict of interest., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

Competing Interests: We declare no competing interests. JLY and SKS are the joint first authors. TS and AA are the joint senior authors.

Our team of nutrition experts developed an online nutrition curriculum consisting of 21 modules to serve as a resource for a stand-alone nutrition curriculum or as a supplement to existing nutrition electives during the Pediatric Gastroenterology fellowship. From April 2020 through January 2023, 2090 modules were completed by 436 fellows from 75 different programs across North America. The program was accessed most during tight restrictions on in-person learning during the COVID-19 pandemic. Overall, participants posttest scores improved from baseline pretest scores indicating retention of information from the modules. The overall success of this program suggests that there should be continued efforts to develop and offer online learning opportunities in clinical nutrition. There is an opportunity to expand the audience for the curriculum to include pediatric gastroenterologists from across the globe., (© 2023 European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.)

The advent of social media has changed numerous aspects of modern life, with users developing and maintaining personal and professional relationships, following and sharing breaking news and importantly, searching for and disseminating health information and medical research. In the present paper, we reviewed available literature to outline the potential uses, pitfalls and impacts of social media for providers, scientists and institutions involved in digestive health in the domains of patient care, research and professional development. We recommend that these groups become more active participants on social media platforms to combat misinformation, advocate for patients, and curate and disseminate valuable research and educational materials. We also recommend that societies such as NASPGHAN assist its members in accessing training on effective social media use and the creation and maintenance of public-facing profiles and that academic institutions incorporate substantive social media contributions into academic promotion processes., (© 2024 The Authors. Journal of Pediatric Gastroenterology and Nutrition published by Wiley Periodicals LLC on behalf of European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.)

Background and Aims: Endoscopic-related injuries (ERIs) for gastroenterologists are common and can impact longevity of an endoscopic career. This study examines sex differences in the prevalence of ERIs and ergonomic training during gastroenterology fellowship., Methods: A 56-item anonymous survey was sent to 709 general and advanced endoscopy gastroenterology fellows at 73 U.S. training programs between May and June 2022. Demographic information was collected along with questions related to endoscopic environment, ergonomic instruction, technique, equipment availability, and ergonomic knowledge. Responses of female and male gastroenterology fellows were compared using χ 2 and Fisher exact tests., Results: Of the 236 respondents (response rate, 33.9%), 113 (44.5%) were women and 123 (52.1%) were men. Female fellows reported on average smaller hand sizes and shorter heights. More female fellows reported endoscopic equipment was not ergonomically optimized for their use. Additionally, more female fellows voiced preference for same-gender teachers and access to dial extenders and well-fitting lead aprons. High rates of postendoscopy pain were reported by both sexes, with significantly more women experiencing neck and shoulder pain. Trainees of both sexes demonstrated poor ergonomic awareness with an average score of 68% on a 5-point knowledge-based assessment., Conclusions: Physical differences exist between male and female trainees, and current endoscopic equipment may not be optimized for smaller hand sizes. This study highlights the urgent need for formal ergonomic training for trainees and trainers with consideration of stature and hand size to enhance safety, comfort, and equity in the training and practice of endoscopy., Competing Interests: Disclosure R. Williams: Advisory board for Universal Diagnostics and Medtronic. All other authors disclosed no financial relationships., (Published by Elsevier Inc.)

Background/objectives: The impact of competency-based training programs on pancreatic endoscopic retrograde cholangiopancreatography (ERCP) performance remains unclear. This study aimed to describe the learning curves of pancreatic ERCP and subsequent performance during independent practice., Methods: This was a multicenter prospective cohort study involving advanced endoscopy trainees (AETs). In the 1st phase, trainees were assessed on every 5th ERCP using the ERCP and EUS Skills Assessment Tool (TEESAT). Cumulative sum (CUSUM) analysis of pancreatic ERCP evaluations was used to establish learning curves. During the 2nd phase (1st year of independent practice), now-graduated participants documented their performance on key ERCP quality indicators., Results: A total of 24 AETs (20 training programs) received sufficient evaluations for CUSUM analysis. Pancreatic ERCP accounted for 14.6 % (196/1339) of all ERCPs evaluated with 45 % of pancreatic ERCPs carrying a Grade 3 level of complexity. A minority of AETs (16.7 %) performed enough pancreatic ERCPs to generate meaningful learning curves with no AETs achieving competence in pancreatic cannulation, sphincterotomy, or stone clearance during Phase 1. In Phase 2, a total of 3620 ERCPs were performed, of which 281 (7.8 %) were pancreatic ERCPs. While the overall pancreatic duct cannulation rate was 92.2 %, the native papilla pancreatic duct cannulation rate was 85.7 %, which was below the recommended 90 % threshold., Conclusions: Advanced endoscopy training offers a low level of exposure to pancreatic ERCP, which is mirrored in independent practice, highlighting the inadequate training in pancreatic ERCP. Given the complexity of pancreatic ERCP, novel strategies are warranted to improve training in pancreatic ERCP., Competing Interests: Declaration of competing interest Author S.H. is a Consultant for Boston Scientific. Author S.W. is a Consultant for Exact Sciences and Castle Biosciences and received research support from Lucid, Ambu, and CDx. Author R.N.K is a Consultant for Boston Scientific and Medtronic. Author M.H. report no conflicts of interest., (Copyright © 2023 IAP and EPC. Published by Elsevier B.V. All rights reserved.)