Women in gastroenterology: the UK trainee experience

UK ERCP sedation practices, patient comfort and endoscopist characteristics: National Endoscopy Database (NED) analysis on behalf of the JAG and BSG

Objectives

This analysis assessed current endoscopic retrograde cholangiopancreatography (ERCP) practice within the UK, including use of sedation and patient comfort.

Methods

ERCPs conducted over 1 year (1 July 2021-30 June 2022) and uploaded to the National Endoscopy Database (NED) were analysed. The endoscopist workforce was classified by gender and specialty, use of sedation was analysed. Logistic regression was used to assess associations between patient age, gender and procedure indications on moderate to severe discomfort risk.

Results

27 812 ERCPs were performed by 491 endoscopists in 175 sites and uploaded to NED, an estimated 50% of total UK activity. 13% were training procedures, 94% of the endoscopists were male, with 72% being gastroenterologists. Most ERCPs were performed under conscious sedation (89%). The discomfort rate among patients aged 60-90 undergoing ERCP under conscious sedation was 4.2% (95% CI 3.9% to 4.5%), with only 5.5% (95% CI 5.2% to 5.9%) receiving greater than 5 mg midazolam or 100 µg fentanyl.Younger patients (<30 years) had a higher discomfort risk during conscious sedation ERCPs than those aged 70-79 (OR 3.0, 95% CI 2.2 to 4.3, p<0.05), while male patients had a lower discomfort risk compared with females (OR 0.9, 95% CI 0.8 to 1.0, p=0.05).Enhanced sedation (propofol or general anaesthetic) was associated with lower frequency of discomfort (0.3%, 95% CI 0.1 to 0.6) compared with conscious sedation (5.1%, 95% CI 4.9% to 5.4%, p<0.05).

Conclusions

Conscious sedation is well tolerated for most patients and prescribing practices have improved. However, triage of more patients, particularly young females, to enhanced sedation lists should be considered to reduce discomfort rates in future.

Regional survey of foundation trainee doctors' views on a career in gastroenterology: implications for diversity and inclusion

Objective

We aimed to establish the perception of foundation doctors (FDs) towards gastroenterology, focusing on identifying determinants which make the career desirable or undesirable between genders, and to recognise factors to increase diversity in recruitment.

Method

An electronic survey was circulated to Northwest of England FDs, categorical variables and data were analysed using χ2 test including comparisons by gender and exposure to gastroenterology either as an undergraduate or FD.

Results

133 responses were received (males 55.6%, 37 foundation year 1 (FY1) doctors, 85 FY2 doctors and 11 FY3 doctors). Four (3.0%) FDs were considering a career in gastroenterology. Gastroenterology was perceived positively by 72 (54.1%) of FDs. Significant differences were found between genders in the importance of the following factors influencing specialty selection; patient-centred care (female 52.5% vs male 25.7%, p=0.01), good mentorship (female 67.8% vs male 45.9, p=0.012), income (female 33.9% vs male 59.5%, p=0.003) and length of training (female 27.1% vs male 52.7%, p=0.003). The male predominant existing workforce (female 27.1% vs male 6.8%, p=0.001), and requirement to be a medical registrar (female 74.6% vs male 56.8%, p=0.033) were negatively perceived aspects of gastroenterology among female FDs. Most FDs (female 80.5%, male 70.7%) indicated increased acceptability of less than full time training and greater flexibility may attract more females to gastroenterology.

Conclusion

Increased flexibility in training and greater postfoundation exposure and mentorship may improve diversity within the specialty. The role of general medicine poses significant concern for FDs and may need further evaluation.