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Mishra S, Jena A, Rabinowitz LG, Kamani L, Paudel MS, Premkumar M, Dutta U, Tandan M, Kochhar R, Sharma V. Perceptions regarding the impact of gender on training and career advancement among gastroenterologists in India and other South Asian countries. Indian J Gastroenterol 2024:10.1007/s12664-024-01523-3. [PMID: 38466552 DOI: 10.1007/s12664-024-01523-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 01/02/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND There are limited studies on the impact of gender on training and career advancement in gastroenterology. AIM The aim was to study this impact and understand the perceptions of work-life balance and beliefs regarding gender dynamics among gastroenterologists in India and other South Asian countries. METHODS A web-based survey was conducted among trainees and attending physicians in South Asia from November 15, 2021, to March 30, 2022. The survey instrument had four components: demographic features, training, career advancement and work-life balance. RESULTS As many as 622 gastroenterologists completed the survey, of which 467 responses were from India (mean age: 41.1 years; females: 11.5%). A higher proportion of female respondents from India believed that gender bias in recruiting and training had negatively impacted their careers (40.7% females vs. 1.5% males). Radiation hazard for fertility (11.1% females vs. 1.9% males, p < 0.001) and as a health concern (14.8% females vs. 5.1% males, p = 0.005) were significant career deterrents for females. A higher proportion of female participants from India faced a career interruption (59.3% females vs. 30.3% males, p ≤ 0.001). Common reasons were pregnancy (37%) and childcare provision (25.9%). More females believed that women were more productive than men (40.8% females vs. 16.9% males, p < 0.001) and that a salary gap existed (44.7% females vs. 29.1% males, p < 0.001). The incidence of self-perceived burnout was 63% among females and 51.6% among males (p = 0.115). CONCLUSION Gender-related factors impact the training and career of female gastroenterologists.
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Affiliation(s)
| | - Anuraag Jena
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Loren Galler Rabinowitz
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Lubna Kamani
- Department of Gastroenterology, Liaquat National Hospital and Medical College, Karachi, Pakistan
| | - Mukesh Sharma Paudel
- Department of Gastroenterology, National Academy of Medical Sciences, Kathmandu, Nepal
| | - Madhumita Premkumar
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Usha Dutta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Manu Tandan
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, 500 082, India
| | - Rakesh Kochhar
- Department of Gastroenterology, Paras Hospitals, Panchkula, 134 109, India
| | - Vishal Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
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Kays MN, Rupert DD, Negris O, Thompson B, Clayman ML, Mordell L, Pendergrast T, Bloomgarden E, Bhayani RK, Jain S. Flattening Hierarchical Structures to Empower Women Trainee Leaders on Social Media Teams. J Med Internet Res 2023; 25:e47800. [PMID: 37276011 PMCID: PMC10280333 DOI: 10.2196/47800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 05/22/2023] [Indexed: 06/07/2023] Open
Abstract
We share our experience empowering women trainees and leadership through a flattened hierarchical social media team structure with supporting evidence from measurable outcomes.
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Affiliation(s)
- Marah N Kays
- Kansas City University, Kansas City, MO, United States
| | - Deborah D Rupert
- School of Medicine, Stony Brook University, Stony Brook, NY, United States
| | - Olivia Negris
- School of Medicine, Rush Medical College, Rush University Medical Center, Chicago, IL, United States
| | - Beatrix Thompson
- School of Medicine, Harvard University, Boston, MA, United States
| | - Marla L Clayman
- Center for Healthcare Organization and Implementation Research, Department of Veterans Affairs, Bedford, MA, United States
| | - Lisa Mordell
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL, United States
| | - Tricia Pendergrast
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Eve Bloomgarden
- NorthShore University Health System, Chicago, IL, United States
| | - Rakhee K Bhayani
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, United States
| | - Shikha Jain
- Division of Hematology and Oncology, University of Illinois at Chicago, Chicago, IL, United States
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Beaton D, Rutter M, Sharp L, Oppong KW, Awadelkarim B, Everett SM, Mitra V. UK ERCP sedation practices, patient comfort and endoscopist characteristics: National Endoscopy Database (NED) analysis on behalf of the JAG and BSG. Frontline Gastroenterol 2023; 14:384-391. [PMID: 37581181 PMCID: PMC10423606 DOI: 10.1136/flgastro-2023-102424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 04/19/2023] [Indexed: 08/16/2023] Open
Abstract
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.
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Affiliation(s)
- David Beaton
- Gastroenterology, North Tees and Hartlepool NHS Foundation Trust, Stockton-on-Tees, UK
| | - Matt Rutter
- Gastroenterology, North Tees and Hartlepool NHS Foundation Trust, Stockton-on-Tees, UK
- Newcastle University, Newcastle upon Tyne, UK
| | - Linda Sharp
- Newcastle University, Newcastle upon Tyne, UK
| | - Kofi W Oppong
- Hepatobiliary Unit, Freeman Hospital, Newcastle upon Tyne, UK
| | | | - Simon M Everett
- Gastroenterology, St James's University Hospital NHS Trust, Leeds, UK
| | - Vikramjit Mitra
- Gastroenterology, North Tees and Hartlepool NHS Foundation Trust, Stockton-on-Tees, UK
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Beaton D, Sharp L, Trudgill NJ, Thoufeeq M, Nicholson BD, Rogers P, Docherty J, Penman ID, Rutter M. UK endoscopy workload and workforce patterns: is there potential to increase capacity? A BSG analysis of the National Endoscopy Database. Frontline Gastroenterol 2022; 14:103-110. [PMID: 36818791 PMCID: PMC9933584 DOI: 10.1136/flgastro-2022-102145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 05/31/2022] [Indexed: 02/24/2023] Open
Abstract
Background The lack of comprehensive national data on endoscopy activity and workforce hampers strategic planning. The National Endoscopy Database (NED) provides a unique opportunity to address this in the UK. We evaluated NED to inform service planning, exploring opportunities to expand capacity to meet service demands. Design Data on all procedures between 1 March 2019 and 29 February 2020 were extracted from NED. Endoscopy activity and endoscopist workforce were analysed. Results 1 639 640 procedures were analysed (oesophagogastroduodenoscopy (OGD) 693 663, colonoscopy 586 464, flexible sigmoidoscopy 335 439 and endoscopic retrograde cholangiopancreatography 23 074) from 407 sites by 4990 endoscopists. 89% of procedures were performed in NHS sites. 17% took place each weekday, 10% on Saturdays and 6% on Sundays. Training procedures accounted for 6% of total activity, over 99% of which took place in NHS sites. Median patient age was younger in the independent sector (IS) (51 vs 60 years, p<0.001). 74% of endoscopists were male. Gastroenterologists and surgeons each comprised one-third of the endoscopist workforce; non-medical endoscopists (NMEs) comprised 12% yet undertook 23% of procedures. Approximately half of endoscopists performing OGD (52%) or colonoscopies (48%) did not meet minimum annual procedure numbers. Conclusion This comprehensive analysis reveals endoscopy workload and workforce patterns for the first time across both the NHS and the IS in all four UK nations. Half of all endoscopists perform fewer than the recommended minimum annual procedure numbers: a national strategy to address this, along with expansion of the NME workforce, would increase endoscopy capacity, which could be used to exploit latent weekend capacity.
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Affiliation(s)
- David Beaton
- Gastroenterology, North Tees and Hartlepool NHS Foundation Trust, Stockton-on-Tees, UK,Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Linda Sharp
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | | | - Mo Thoufeeq
- Department of Gastroenterology, Sheffield Teaching Hospitals, Sheffield, UK
| | - Brian D Nicholson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | | | - Ian D Penman
- Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Matt Rutter
- Gastroenterology, North Tees and Hartlepool NHS Foundation Trust, Stockton-on-Tees, UK,Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Lakshmanan S, Kane S, Dibble C, Roland B. Need for Awareness and Training in Women's Gastrointestinal Health: A Call to Action. J Womens Health (Larchmt) 2021; 31:125-129. [PMID: 33887148 DOI: 10.1089/jwh.2020.8826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Women's gastrointestinal (GI) health is a topic that is not well understood nor taught in most training programs. In this article, we highlight the importance of proper training in women's GI health among gastroenterologists and fellows, and identify some common conditions to provide the best possible treatment for their female patients.
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Affiliation(s)
- Seetha Lakshmanan
- Department of Medicine, Roger Williams Medical Center, Providence, Rhode Island, USA
| | - Sunanda Kane
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Christy Dibble
- Department of Gastroenterology, Women & Infants Hospital/Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Bani Roland
- Department of Gastroenterology, Women & Infants Hospital/Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
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Yu JX, Berzin TM, Enestvedt B, Anderson MA, Popov VB, Thompson CC, Schulman AR. Gender disparities in advanced endoscopy fellowship. Endosc Int Open 2021; 9:E338-E342. [PMID: 33655031 PMCID: PMC7892265 DOI: 10.1055/a-1311-0899] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 10/07/2020] [Indexed: 12/04/2022] Open
Abstract
Background and study aims Women remain underrepresented in gastroenterology, especially advanced endoscopy. Women represent 30 % of general gastroenterology fellows; yet in 2019, only 12.8 % of fellows who matched into advanced endoscopy fellowship (AEF) programs were women. Methods We administered a web-based survey to the program directors (PDs) of AEF programs that participated in the 2018-2019 American Society for Gastroenterology (ASGE) match. We assessed PD and program characteristics, in addition to perceived barriers and facilitators (scale 1-5, 5 = most important) influencing women pursuing AEF training. Results We received 38 (59.3 %) responses from 64 PDs. 15.8 % (6/38) of AEF PDs and 13.2 % (5/38) of endoscopy chiefs were women. By program, women represented 14.8 % (mean) ± 17.0 % (SD) of AEF faculty and 12.0 % (mean) ± 11.1 % (SD) of AEF trainees over the past 10 years. 47.4 % (18/38) programs reported no female advanced endoscopy faculty and 31.6 % (12/38) of programs have never had a female fellow. Percentage of female fellows was strongly associated with percentage of female AEF faculty (ß = 0.43, P < 0.001). Inflexible hours and call (mean rank 3.3 ± 1.1), exposure to fluoroscopy (2.9 ± 1.1), lack of women endoscopists at national conferences/courses (2.9 ± 1.1) and lack of female mentorship (2.9 ± 1.0) were cited as the most important barriers to recruitment. Conclusion We utilized a survey of AEF PDs participating in the ASGE match to determine program characteristics and identify contributors to gender disparity. Women represent a minority of AEF PDs, endoscopy chiefs, advanced endoscopy faculty and AEF trainees. Our study highlights perceived barriers and facilitators to recruitment, and emphasizes the importance of having female representation in faculty, and leadership positions in endoscopy.
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Affiliation(s)
- Jessica X. Yu
- Division of Gastroenterology and Hepatology, Oregon Health and Science University, Portland, OR
| | - Tyler M. Berzin
- Center for Advanced Endoscopy, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, United States
| | - Brintha Enestvedt
- Division of Gastroenterology and Hepatology, Oregon Health and Science University, Portland, OR
| | - Michelle A. Anderson
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, United States
| | - Violeta B. Popov
- Division of Gastroenterology, NYU Langone Medical Center, New York, New York, United States,Division of Gastroenterology, VA NY Harbor Healthcare System, New York, New York, United States
| | - Christopher C. Thompson
- Division of Gastroenterology, Brigham and Women’s Hospital, Boston, Massachusetts, United States
| | - Allison R. Schulman
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, United States,Department of Surgery, University of Michigan, Ann Arbor, MI
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Feld LD. Baby Steps in the Right Direction: Toward a Parental Leave Policy for Gastroenterology Fellows. Am J Gastroenterol 2021; 116:505-8. [PMID: 33481380 DOI: 10.14309/ajg.0000000000001145] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 12/22/2020] [Indexed: 12/11/2022]
Abstract
The American Board of Medical Specialties announced in July 2020 the adoption of a parental leave policy for residents and fellows allows for a minimum of 6 weeks of leave. This policy includes caveats: vacation and/or sick leave can be applied toward these 6 weeks, this leave can only be utilized once during training (whether for parental, caregiver, or medical leave), and this policy only applies to training programs of 2 or more years' duration. Although the new existence of a parental leave policy is a step in the right direction, trainees are in need of a more robust and evidence-based policy. There are particular challenges to be addressed in the male-dominated and procedural field of gastroenterology, in which women are underrepresented and female gastroenterology trainees are more likely to have career decisions limited around the availability of parental leave. This article reviews the evidence supporting the creation of a parental leave policy for gastroenterology fellows, with potential benefits to individual trainees as well as the field, in order to promote equity, recruitment, retention, and advancement of women in gastroenterology.
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David YN, Dixon RE, Kakked G, Rabinowitz LG, Grinspan LT, Anandasabapathy S, Greenwald DA, Kim MK, Sethi A, Kumta NA. Gender-Specific Factors Influencing Gastroenterologists to Pursue Careers in Advanced Endoscopy: Perceptions vs Reality. Am J Gastroenterol 2021; 116:539-50. [PMID: 33657041 DOI: 10.14309/ajg.0000000000001112] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 11/13/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION In 2020, only 19% of 63 matched advanced endoscopy (AE) fellows were women. This study evaluates the gender-specific factors that influence gastroenterologists to pursue careers in AE. METHODS An anonymous survey was distributed to gastroenterology fellows and attendings through various gastroenterology society online forums. Data were collected on demographics, training, mentorship, current practice, family planning, and career satisfaction. RESULTS Women comprised 71.1% of the 332 respondents. 24.7% of female fellows plan to pursue an AE career compared with 37.5% of male fellows (P = 0.195). The main motivating factor for both genders was interest in the subject area. Interest in another subspecialty was the main deterring factor for both genders. Women were more deterred by absence of same-sex mentors (P < 0.001), perception of gender-based bias in the workplace (P = 0.009), family planning (P = 0.018), fertility/pregnancy risks from radiation (P < 0.001), and lack of ergonomic equipment (P = 0.003). AE gastroenterologists of both genders were satisfied with their career decision and would recommend the field to any fellow. Most respondents (64%) believed that more female role models/mentors would improve representation of women in AE. DISCUSSION There are multiple gender-specific factors that deter women from pursuing AE. Increasing the number of female role models is strongly perceived to improve representation of women in AE. Most AE attendings are satisfied with their career and would recommend it to fellows of any gender. Thus, early targeted mentorship of female trainees has potential to improve recruitment of women to the field.
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Kamani L, Pausawasdi N, Hooft JEV, Sethi A, Sachithanandan S. Redesigning the Landscape for Women and Leadership: Insights Gained from the Covid-19 Pandemic. On Behalf of Women in Gastroenterology Network Asia Pacific (WIGNAP) and Women in Endoscopy (WIE). Clin Endosc 2020; 53:620-622. [PMID: 33027586 PMCID: PMC7548141 DOI: 10.5946/ce.2020.202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 09/06/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- Lubna Kamani
- Liaquat National Hospital and Aga Khan University Hospital, Karachi, Pakistan
| | | | | | - Amrita Sethi
- Columbia University Irving Medical Center, New York, NY, USA
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