Diversity, equity, and inclusion in gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy Position Statement

Statements

1 The European Society of Gastrointestinal Endoscopy (ESGE) adheres to the overarching principles of equality of opportunity, fair treatment, nondiscrimination, and diversity of health care professionals.

2 ESGE strongly supports the creation of collaborations within and between national and international endoscopy societies to disseminate the principles of diversity, equality, and inclusion (DEI) in the field of gastrointestinal (GI) endoscopy.

3 ESGE aims to reflect the diversity of its membership in all its scientific and educational activities.

4 ESGE supports the fostering of collaborative work settings that empower all members of the endoscopy team to reach their full potential.

5 ESGE supports international and national endoscopy societies in promoting equitable access to high quality endoscopy training.

6 ESGE recommends the implementation of ergonomic principles in endoscopy units to prevent injuries and to provide adapted workplace conditions for personnel with disabilities and/or special needs.

7 ESGE recommends comprehensive mentorship, that includes diverse backgrounds, and equitable sponsorship for professional development, training, and academic excellence.

8 ESGE recommends that endoscopists actively identify, discuss, and attempt to accommodate reasonable patient preferences and expectations regarding endoscopy procedures.

9 ESGE advocates for educational and awareness campaigns targeting both health care professionals and patients, as well as the adoption of cost-effective health care strategies to address disparities and enhance equity in endoscopy care.

10 ESGE is committed to increasing support for underrepresented scholars and minorities pursuing research in endoscopy.

11 ESGE identifies mentorship and sponsorship as factors that may mitigate the barriers to academic careers for underrepresented endoscopy scholars.

12 ESGE recognizes the need to increase awareness of diversity, equity, and inclusion (DEI) in the field of endoscopy and supports publications on these topics.

Publication History

Article published online:
25 September 2024

• References

• 1 Braveman P, Gruskin S. Defining equity in health. J Epidemiol Community Health 2003; 57: 254-258
• 2 Shannon G, Jansen M, Williams K. et al. Gender equality in science, medicine, and global health: where are we at and why does it matter?. Lancet 2019; 393: 560-569
• 3 Hong L, Page SE. Groups of diverse problem solvers can outperform groups of high-ability problem solvers. Proc Natl Acad Sci U S A 2004; 101: 16385-16389
• 4 Curtis M, Schmid C, Struber M. Gender diversity and corporate performance. Credit Suisse, Research Institute. 2012 https://www.yumpu.com/en/document/view/4578273/gender-diversity-and-corporate-performance-credit-suisse/31
• 5 Hassan C, Ponchon T, Bisschops R. et al. European Society of Gastrointestinal Endoscopy (ESGE) Publications Policy – Update 2020. Endoscopy 2020; 52: 123-126
• 6 Dobbin F, Kalev A. Why firms need diversity managers and task forces. In: Pilati M, Sheikh H, Tilly C, Sperotti F. , eds. How global migration changes the workforce diversity equation. Newcastle: Cambridge Scholars Publishing; 2014: 170-198
• 7 Dobbin F, Kalev A. Why diversity programs fail And what works better. Harvard Business Review 2016; 94: 52-60
• 8 Lok A, Burke CA, Crowe SE. et al. Society leadership and diversity: hail to the women!. Gastrointest Endosc 2017; 86: 413-415
• 9 Women in Endoscopy (WIE). Accessed 20 May 2024: https://womeninendo.org/
• 10 Sulik J, Bahrami B, Deroy O. The diversity gap: when diversity matters for knowledge. Perspect Psychol Sci 2022; 17: 752-767
• 11 Cryer B, Quezada S, Culpepper-Morgan JA. et al. Bridging the racial ethnic, and gender gap in gastroenterology. Gastroenterology 2022; 163: 800-805
• 12 AAMC (Association of American Medical Colleges). Active physicians by sex and specialty. 2017. Accessed 20 May 2024: https://www.aamc.org/data-reports/workforce/data/active-physicians-sex-and-specialty-2017
• 13 Pallardy C. Male and female active physicians: 70 statistics by specialty. Becker’s GI & Endoscopy. 2015. Accessed 20 May 2024: https://www.beckersasc.com/gastroenterology-and-endoscopy/male-female-active-physicians-70-statistics-by-specialty.html
• 14 Kesavarapu K, Schwartz J, Ikonomi E. et al. What’s holding women back? A review of gender inequality in gastroenterology in the USA. Lancet Gastroenterol Hepatol 2019; 4: 898-900
• 15 Singh A, Burke CA, Larive B. et al. Do gender disparities persist in gastroenterology after 10 years of practice?. Am J Gastroenterol 2008; 103: 1589-1595
• 16 Mourits MJE, Schröder CP. Gender pay gap in a large university hospital in the Netherlands. Ned Tijdschr Geneeskd 2024; 168: D7920
• 17 Venezia L, Labarile N, Maselli R. et al. Women in gastroenterology: what is the current situation? Results of an Italian national survey. Dig Dis Sci 2024; 69: 1990-1995
• 18 Hoffman KM, Trawalter S, Axt JR. et al. Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. Proc Natl Acad Sci USA 2016; 113: 4296-4301
• 19 Napoli AM, Choo EK, Dai J. et al. Racial disparities in stress test utilization in an emergency department chest pain unit. Crit Pathw Cardiol 2013; 12: 9-13
• 20 Amutah C, Greenidge K, Mante A. et al. Misrepresenting race – the role of medical schools in propagating physician bias. N Engl J Med 2021; 384: 872-878
• 21 Asch SM, Kerr EA, Keesey J. et al. Who is at greatest risk for receiving poor-quality health care?. N Engl J Med 2006; 354: 1147-1156
• 22 Sabin Janice A. Tackling implicit bias in health care. N Engl J Med 2022; 387: 105-107
• 23 Heidari S, Babor TF, De Castro P. et al. Sex and gender equity in research: rationale for the SAGER guidelines and recommended use. Res Integr Peer Rev 2016; 1: 2
• 24 Bisschops R, Wilmer A, Tack J. A survey on gastroenterology training in Europe. Gut 2002; 50: 724-729
• 25 Maida M, Alrubaiy L, Bokun T. et al. Current challenges and future needs of clinical and endoscopic training in gastroenterology: a European survey. Endosc Int Open 2020; 8: E525-E533
• 26 Antonelli G, Voiosu AM, Pawlak KM. et al. Training in basic gastrointestinal endoscopic procedures: a European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA) Position Statement. Endoscopy 2024; 56: 131-150
• 27 Waschke KA, Anderson J, Valori RM. et al. ASGE principles of endoscopic training. Gastrointest Endosc 2019; 90: 27-34
• 28 Koo P, Yung V, Dutta A. et al. Choosing a career in advanced endoscopy or general gastroenterology. Dig Dis Sci 2017; 62: 1409-1411
• 29 David YN, Dixon RE, Kakked G. et al. Gender-specific factors influencing gastroenterologists to pursue careers in advanced endoscopy: perceptions vs reality. Am J Gastroenterol 2021; 116: 539-550
• 30 Dutta S, Dunnington G, Blanchard MC. et al. And doctor, no residents please!. J Am Coll Surg 2003; 197: 1012-1017
• 31 Raju SA, Harris R, Cook C. et al. UK-wide study of the opinions of gastroenterology trainees: COVID-19, Shape of training and the future workforce. Frontline Gastroenterol 2022; 13: 386-391
• 32 Papadopoulou A, Ribes-Koninckx C, Baker A. et al. Pediatric endoscopy training across Europe: a survey of the ESPGHAN National Societies Network 2016-2019. Endosc Int Open 2022; 10: E1371-E1379
• 33 Becq A, Sobhani I, Vauquelin B. et al. Endoscopic training during fellowship: A nationwide French study: Impact of theoretical courses and simulation-based training during fellowship. Clin Res Hepatol Gastroenterol 2022; 46: 101837
• 34 Sethi S, Kumar A, Clough J. et al. Women in gastroenterology: the UK trainee experience. Frontline Gastroenterol 2022; 13: 484-489
• 35 European Section and Board of Gastroenterology and Hepatology (EBGH). Accessed 20 May 2024: https://www.eubogh.org/blue-book/
• 36 Rembacken BJ, Dixon S, Albuquerque A. et al. Barriers and bias standing in the way of female trainees wanting to learn advanced endoscopy. United European Gastroenterol J 2019; 7: 1141-1145
• 37 Buschbacher R. Overuse syndromes among endoscopists. Endoscopy 1994; 26: 539-544
• 38 Hansel SL, Crowell MD, Pardi DS. et al. Prevalence and impact of musculoskeletal injury among endoscopists: a controlled pilot study. J Clin Gastroenterol 2009; 43: 399-404
• 39 Ridtitid W, Coté GA, Leung W. et al. Prevalence and risk factors for musculoskeletal injuries related to endoscopy. Gastrointest Endosc 2015; 81: 294-302.e4
• 40 Costello B, James T, Hall C. et al. Does manual abdominal pressure during colonoscopy put endoscopy staff and patients at risk? Experiences of endoscopy nurses and technicians. Gastroenterol Nurs 2023; 46: 386-392
• 41 Pawa S, Banerjee P, Kothari S. et al. Are all endoscopy-related musculoskeletal injuries created equal? Results of a national gender-based survey. Am J Gastroenterol 2021; 116: 530-538
• 42 Harris-Adamson C, Shergill AK. Endoscopist injury: shifting our focus to interventions. Gastrointest Endosc 2021; 94: 260-262
• 43 Morais R, Vilas-Boas F, Pereira P. et al. Prevalence, risk factors and global impact of musculoskeletal injuries among endoscopists: a nationwide European study. Endosc Int Open 2020; 8: E470-E480
• 44 Villa E, Attar B, Trick W. et al. Endoscopy-related musculoskeletal injuries in gastroenterology fellows. Endosc Int Open 2019; 7: E808-E812
• 45 Shergill AK, McQuaid KR. Ergonomic endoscopy: an oxymoron or realistic goal?. Gastrointest Endosc 2019; 90: 966-970
• 46 Cohen DL, Naik JR, Tamariz LJ. et al. The perception of gastroenterology fellows towards the relationship between hand size and endoscopic training. Dig Dis Sci 2008; 53: 1902-1909
• 47 Rice SC, Slaughter JC, Smalley W. et al. The impact of distraction minimization on endoscopic mentoring and performance. Endosc Int Open 2020; 8: E1804-E1810
• 48 Rabinowitz LG, Grinspan LT, Kim MK. Mentorship and women in gastroenterology. Lancet Gastroenterol Hepatol 2021; 6: 604-605
• 49 Yu JX, Berzin TM, Enestvedt B. et al. Gender disparities in advanced endoscopy fellowship. Endosc Int Open 2021; 9: E338-E342
• 50 Capers Q, Clinchot D, McDougle L. et al. Implicit racial bias in medical school admissions. Acad Med 2017; 92: 365-369
• 51 Woodward Z, Rodriguez Z, Jou JH. et al. Gender disparities in gastroenterology fellowship director positions in the United States. Gastrointest Endosc 2017; 86: 595-599
• 52 Louissaint J, May FP, Williams S. et al. Effective mentorship as a means to recruit, retain, and promote underrepresented minorities in academic gastroenterology and hepatology. Am J Gastroenterol 2021; 116: 1110-1113
• 53 Sharma G, Narula N, Ansari-Ramandi MM. et al. The importance of mentorship and sponsorship: tips for fellows-in-training and early career cardiologists. JACC Case Rep 2019; 1: 232-234
• 54 Ayyala MS, Skarupski K, Bodurtha JN. et al. Mentorship is not enough: exploring sponsorship and its role in career advancement in academic medicine. Acad Med 2019; 94: 94-100
• 55 Carman KL, Dardess P, Maurer M. et al. Patient and family engagement: a framework for understanding the elements and developing interventions and policies. Health Aff (Millwood) 2013; 32: 223-231
• 56 Cahill J. Patient participation: a concept analysis. J Adv Nurs 1996; 24: 561-571
• 57 Sondhi AR, Kurlander JE, Waljee AK. et al. A telephone-based education program improves bowel preparation quality in patients undergoing outpatient colonoscopy. Gastroenterology 2015; 148: 657-658
• 58 Bytzer P, Lindeberg B. Impact of an information video before colonoscopy on patient satisfaction and anxiety - a randomized trial. Endoscopy 2007; 39: 710-714
• 59 GOV.UK. Equality Act 2010: guidance. Accessed 20 May 2024: https://www.gov.uk/guidance/equality-act-2010-guidance
• 60 Münch A, Aust D, Bohr J. et al. Microscopic colitis: Current status, present and future challenges: statements of the European Microscopic Colitis Group. J Crohns Colitis 2012; 6: 932-945
• 61 Wagner CV, Bowyer H, Rees CJ. et al. PWE-034 Patient-reported experience of comfort and dignity in flexible sigmoidoscopy: data from the Nhs Bowel Scope Screening Pilot. Gut 2014; 63: A137-A137
• 62 Varadarajulu S, Petruff C, Ramsey WH. Patient preferences for gender of endoscopists. Gastrointest Endosc 2002; 56: 170-173
• 63 Farraye FA, Wong M, Hurwitz S. et al. Barriers to endoscopic colorectal cancer screening: are women different from men?. Am J Gastroenterol 2004; 99: 341-349
• 64 Anglade P, Ibrahim H, Abdel-Razig S. Does provider gender matter in endoscopy? An international perspective. Gastrointestinal Endoscopy 2021; 93: 1160-1168
• 65 Tierney M, Bevan R, Rees CJ. et al. What do patients want from their endoscopy experience? The importance of measuring and understanding patient attitudes to their care.. Frontline Gastroenterol 2016; 7: 191-198
• 66 Wong VK, Zhang H-B, Enns R. Factors associated with patient absenteeism for scheduled endoscopy. World J Gastroenterol 2009; 15: 2882-2886
• 67 Carethers JM. Racial and ethnic disparities in colorectal cancer incidence and mortality. Adv Cancer Res 2021; 151: 197-229
• 68 Saade R, Tsang T, Kmeid M. et al. Overutilization of surgical resection for benign colorectal polyps: analysis from a tertiary care center. Endosc Int Open 2021; 9: E706-E712
• 69 Liang PS, Kwon SC, Cho I. et al. Disaggregating racial and ethnic data: a step toward diversity, equity, and inclusion. Clin Gastroenterol Hepatol 2023; 21: 567-571
• 70 Skrzypczak T, Mamak M. Assessing the readability of online health information for colonoscopy – analysis of articles in 22 European languages. J Cancer Educ 2023; 38: 1865-1870
• 71 Schiffinger M, Latzke M, Steyrer J. Two sides of the safety coin? How patient engagement and safety climate jointly affect error occurrence in hospital units.. Health Care Manage Rev 2016; 41: 356-367
• 72 Greene J, Hibbard JH. Why does patient activation matter? An examination of the relationships between patient activation and health-related outcomes.. J Gen Intern Med 2012; 27: 520-526
• 73 McMillan SS, Kendall E, Sav A. et al. Patient-centered approaches to health care: a systematic review of randomized controlled trials. Med Care Res Rev 2013; 70: 567-596
• 74 World Health Organization. Health promotion glossary. Accessed 20 May 2024: https://www.who.int/publications-detail-redirect/WHO-HPR-HEP-98.1
• 75 Sint Nicolaas J, de Jonge V, Korfage IJ. et al. Benchmarking patient experiences in colonoscopy using the global rating scale. Endoscopy 2012; 44: 462-472
• 76 Das S, Deepa OV, Xavier B. The effectiveness of video assisted teaching on awareness, anxiety and satisfaction of patients undergoing upper gastro intestinal endoscopy. Int J Adv Nursing Manage 2014; 2: 266-272
• 77 Nijsten T, Bergstresser PR. Patient advocacy groups: let’s stick together. J Invest Dermatol 2010; 130: 1757-1759
• 78 Kent A. The role of voluntary consumer organisations in genetic services in the United Kingdom. Community Genet 1999; 2: 156-161
• 79 Rabeharisoa V. The struggle against neuromuscular diseases in France and the emergence of the “partnership model“ of patient organisation. Soc Sci Med 2003; 57: 2127-2136
• 80 Terry SF, Davidson ME. Empowering the public to be informed consumers of genetic technologies and services. Community Genet 2000; 3: 148-150
• 81 Vertovec S. Super-diversity and its implications. Ethnic Racial Studies 2007; 30: 1024-1054
• 82 Bolaños-Guzmán CA, Zarate CA. Underrepresented minorities in science: ACNP strives to increase minority representation and inclusion. Neuropsychopharmacology 2016; 41: 2421-2423
• 83 Carethers JM, Quezada SM, Carr RM. et al. Diversity within US gastroenterology physician practices: the pipeline, cultural competencies, and gastroenterology societies approaches. Gastroenterology 2019; 156: 829-833
• 84 Rahal HK, Tabibian JH, Issaka R. et al. Diversity, equity, and inclusion in gastroenterology and hepatology: a survey of where we stand. Am J Gastroenterol 2022; 117: 1954-1962
• 85 AlShebli BK, Rahwan T, Woon WL. The preeminence of ethnic diversity in scientific collaboration. Nat Commun 2018; 9: 5163
• 86 Mastrorocco E, Terrin M, Migliorisi G. et al. Gender authorship in major American and European gastroenterology journals: the gap is still unfilled. Endoscopy 2024;
• 87 Williams LB, Surratt HL, King VL. et al. The disparities researchers equalizing access for minorities (DREAM) scholars program: career development for underrepresented health equity researchers. J Clin Transl Sci 2021; 5: e170
• 88 Hofstra B, Kulkarni VV, Munoz-Najar Galvez S. et al. The diversity-innovation paradox in science. Proc Natl Acad Sci USA 2020; 117: 9284-9291
• 89 Carr RM, Quezada SM, Gangarosa LM. et al. From intention to action: operationalizing AGA diversity policy to combat racism and health disparities in gastroenterology. Gastroenterology 2020; 159: 1637-1647
• 90 Nonnemaker L. Women physicians in academic medicine: new insights from cohort studies. N Engl J Med 2000; 342: 399-405
• 91 Oliveira DFM, Ma Y, Woodruff TK. et al. Comparison of National Institutes of Health grant amounts to first-time male and female principal investigators. JAMA 2019; 321: 898-900
• 92 Rabinowitz LG, Anandasabapathy S, Sethi A. et al. Addressing gender in gastroenterology: opportunities for change. Gastrointest Endosc 2020; 91: 155-161
• 93 Esposito I, Simsek C, Nowak A. et al. United European Gastroenterology Equality and Diversity Plan. United European Gastroenterol J 2023; 11: 484-487
• 94 Burgess A, van Diggele C, Mellis C. Mentorship in the health professions: a review. Clin Teach 2018; 15: 197-202
• 95 Norman MK, Mayowski CA, Wendell SK. et al. Delivering what we PROMISED: outcomes of a coaching and leadership fellowship for mentors of underrepresented mentees. Int J Environ Res Public Health 2021; 18: 4793
• 96 Jawaid N, Boctor M, LoMonaco J. et al. Canadian gastroenterology career pathway experiences: exploring the gender divide. J Can Assoc Gastroenterol 2022; 5: 177-183
• 97 Bhavsar-Burke I, Dilly CK, Oxentenko AS. How to promote professional identity development and support fellows-in-training through teaching, coaching, mentorship, and sponsorship. Clin Gastroenterol Hepatol 2022; 20: 2166-2169
• 98 Abimbola S. The foreign gaze: authorship in academic global health. BMJ Glob Health 2019; 4: e002068
• 99 Edem B, Nkereuwem E, Wariri O. Voices in the wilderness: how exclusionist article processing charge policies of academic journals underscore what is wrong with global health. Lancet Glob Health 2021; 9: e1205-e1207
• 100 Hu X. What more can we do in peer review to achieve equity in scientific publication?. Health Serv Insights 2022; 15 11786329221139416
• 101 Kern-Goldberger AR, James R, Berghella V. et al. The impact of double-blind peer review on gender bias in scientific publishing: a systematic review. Am J Obstet Gynecol 2022; 227: 43-50.e4
• 102 Okike K, Hug KT, Kocher MS. et al. Single-blind vs double-blind peer review in the setting of author prestige. JAMA 2016; 316: 1315-1316
• 103 Borsuk RM, Aarssen LW, Budden AE. et al. To name or not to name: the effect of changing author gender on peer review. BioScience 2009; 59: 985-989