Faculty Bibliography

Colorectal cancer (CRC) is the second most common cause of cancer deaths within the United States. Screening is effective in reducing the incidence and mortality of CRC; however, lower screening rates among the medically underserved have contributed to disparate outcomes in morbidity and mortality. Interventions to increase screening in this group include outreach at patient, community, provider, health system, and policy levels. In this article, we discuss the barriers and strategies to increase screening adherence in the medically underserved.

INTRODUCTION/UNASSIGNED:Variceal hemorrhage is a severe and often fatal consequence of portal hypertension from liver cirrhosis. Although endoscopic and radiographic interventions have largely replaced balloon tamponade, the Sengstaken-Blakemore tube (SBT) remains a critical salvage therapy. However, declining use has led to limited provider experience and familiarity with SBT placement and management. METHODS/UNASSIGNED:We implemented a hands-on, manikin-based simulation program for fellows and attendings from gastroenterology and critical care to improve provider familiarity with SBT placement and management. Standardized SBT kits were developed and distributed across all sites. Annual simulation sessions included presession didactics, live demonstrations, and small-group hands-on practice. Pre- and postsession surveys assessed self-reported confidence in SBT placement, management, and removal using a 5-point Likert scale. A Wilcoxon signed-rank test analyzed changes in confidence. RESULTS/UNASSIGNED:Fifty-four participants participated in 2023. Prior to training, only 20% of participants reported having received any formal instruction on SBT placement or management and 39% had never placed an SBT in a real-life scenario. Confidence in SBT placement (mean 3.00-4.30), management (1.78-4.31), and removal (2.17-4.43) significantly increased after the simulation. DISCUSSION/UNASSIGNED:This simulation-based intervention was associated with improved self-reported confidence in SBT placement, management, and removal for a high-acuity, low-frequency procedure. Given interest, emergency medicine, surgery, and internal medicine were included in subsequent years. Our results underscore the importance of structured training in bridging knowledge and skill gaps across gastroenterology and critical care disciplines. Future work should assess long-term retention and explore curriculum integration.

PURPOSE/OBJECTIVE:Studies show women are underrepresented in gastroenterology (GI). Understanding representation is crucial to improving representation. This study describes the geographic distribution of women in academic GI in the United States (US). METHODS:We conducted a cross-sectional study of 224 US GI fellowship programs in 2023 by review of program websites and direct inquiry. Gender distribution of trainees and faculty across US regions was evaluated. Program characteristics were examined in univariate analyses. Logistic regression models assessed factors associated with women in leadership, adjusting for program type and region. RESULTS:Women comprised 39.3% of 1,801 fellows and 30.2% of 3,899 GI faculty. Percentage of women fellows was highest in the West (50%), Northeast (38%), South (33%), and Midwest (33%), (p = 0.014). Median percentage of senior women faculty was highest in the Northeast (27%) (p = 0.009). Programs with women GI division chiefs had more women GI fellowship program directors (60% vs 40%, p = 0.001) and higher median percentage of women faculty (33% vs 26%, p = 0.016). The presence of a woman GI division chief was independently associated with having a woman GI fellowship program director (p = 0.008) and increased percentage of women faculty (p < 0.001). CONCLUSION/CONCLUSIONS:Gender representation varied regionally, with some institutions lacking women faculty or trainees. Women in leadership are associated with greater faculty gender diversity, potentially impacting trainee recruitment, faculty retention, and patient care. The association between women GI division chiefs and increased women faculty and program directors highlights how leadership gender diversity may support recruitment and retention of women in academic GI.

INTRODUCTION/BACKGROUND:Implicit bias can influence patient-clinician communication through clinician implicit bias (actual) or patients' perception of bias (perceived). Few curricula focus on skills to address implicit bias. We developed and evaluated a skills-based curriculum addressing implicit bias in clinical encounters. MATERIALS & METHODS/METHODS:A 60-minute session was delivered to 4 cohorts of learners (N = 458, ranging from first-year medical students to attendings) in academic medical settings. All had prior exposure to the topic of implicit bias. Instruction grounded in the Implicit Bias Recognition and Management framework described the impact of actual and perceived bias and patients' recommendations for restoring rapport once bias had impacted an encounter. Through audience response systems or role-plays with feedback, participants developed verbal procedures-personalized, verbatim statements to restore patient rapport when implicit bias has impacted an encounter. Learners submitted their verbal procedures online, which were then coded to identify helpful and unhelpful elements. Investigators coded verbal procedures and assigned point values for "helpful" and "unhelpful" elements resulting in scores from -1-6. RESULTS:Each approach yielded helpful elements. Overall, of submitted verbal procedures, 91.3 % were "helpful" and 8.6 % "unhelpful." Compared to audience response systems, verbal procedures developed through role-plays included significantly more "helpful" elements (2.21/1.29, p = 0.003 and 2.46/1.87 p = 0.009). CONCLUSIONS:Findings suggest learners can develop verbatim statements to restore rapport with patients in a single session if those learners have prior foundational knowledge about implicit bias and its relevance to healthcare disparities. PRACTICE IMPLICATIONS/CONCLUSIONS:Teaching verbal procedures could expand skill-building opportunities within implicit bias curricula.

BACKGROUND:Health equity is receiving increased attention in medical education. However, guidance is often lacking on how to integrate health equity into routine medical education. Journal club presents an opportunity to deepen medical educators' and learners' understanding of health equity principles and use it as a lens through which to critically appraise the literature. AIM/OBJECTIVE:We present a health equity framework, iteratively co-created by faculty and learners, that can be applied in a journal club setting. SETTING/METHODS:Academic medical center in New York City, USA. PARTICIPANTS/METHODS:Faculty, residency program directors, medical students, and residents. PROGRAM DESCRIPTION/METHODS:Authors developed the health equity journal club framework during a medical student selective course. Learner and faculty applied the framework to journal club articles; their feedback informed revisions. Framework domains included authorship, ethics, methodology, language, peer review, and references. PROGRAM EVALUATION/RESULTS:Learner evaluations were overall positive, and 86% (n = 13) of responding residency program directors (n = 15) across 15 departments who were surveyed plan to use the framework moving forward. DISCUSSION/CONCLUSIONS:A health equity journal club framework applied to critical appraisal of the literature may facilitate health equity as a routine part of medical education. Co-creating the framework proved vital to inclusion of learner voices.

BACKGROUND AND AIMS/OBJECTIVE:The COVID-19 pandemic significantly decreased procedural volume in 2020, thus limiting training opportunities. First-year fellows (1YF) are particularly susceptible to reduction in endoscopic volume as they build foundational endoscopic skills. We used an objective validated tool, the Assessment of Competency in Endoscopy (ACE), to determine the effect of the pandemic on endoscopy competency in gastroenterology fellows. METHODS:This was a prospective cohort study conducted across two fellowship programs in New York City. Our primary outcome was the comparison of ACE scores of fellows starting gastroenterology fellowships in 2020 to the scores of those starting in 2016-2018. Our secondary outcome was to compare colonoscopy quality metrics and endoscopy volume between these cohorts. RESULTS:ACE scores were available from 11 pandemic and 10 pre-pandemic 1YFs, and five pandemic and 19 pre-pandemic second (2YF) and third-year fellows (3YF). ACE scores for 1YFs showed significantly higher rating in the pre-pandemic cohort for 4 domains including knowledge of indications and medical issues (p = 0.03), effective and efficient use of air, water, and suction (p = 0.04), pathology identification (p = 0.001), and overall hands-on skills (p = 0.004). 2YFs showed no significant differences. 3YFs showed significantly lower scores in the pandemic cohort in the effective and efficient use of air, water, and suction (p = 0.03), fellows' knowledge of therapeutic tools (p = 0.05), and fellows overall cognitive skills (p = 0.05). There were no significant differences in quality metrics between the cohorts, except longer procedure time for the pandemic cohort (p < 0.01). CONCLUSION/CONCLUSIONS:Following the COVID-19 pandemic, there was a decline in multiple aspects of endoscopic competency both at the beginning and the end of fellowship training. These trends are likely the result of a decrease in overall procedure volume early in training and highlight the need for supplementing trainee education with other modalities.