Gender disparity in hepatobiliary endoscopy training and delivery: Results of a nationwide survey

Abstract

Background and study aims

There are far fewer female, independent endoscopic retrograde cholangiopancreatography (ERCP) practitioners than men in the UK. This study aimed to explore what lies behind the disparity by examining the current state of training, attitudes, and other factors that may influence trainees’ decision to pursue ERCP training, with a view to identifying modifiable factors.

Methods

Anonymized responses to an electronic survey distributed to gastroenterology trainees and independent ERCP practitioners in the UK were collected and analyzed.

Results

Of 214 respondents 45% were female. Whereas gender distribution in non-hepatobiliary therapeutic endoscopy was balanced, only 29% of ERCP trainees were female. Eighty percent of those who worked less than full time (LTFT) were female, but 32% felt that LTFT was incompatible with ERCP training. Concerningly, one-quarter of female respondents reported that they had been discouraged. It was noted that females are often treated differently within endoscopy units, including by patients. Fifty percent of females indicated that radiation exposure affected their decision to train in ERCP, compared with 22% of males. A question specific to trainers revealed that 95% felt that male gender was associated with increased confidence. In free-text responses, valuable insights into trainees’ personal experiences were provided, and a selection is presented. Finally, strategies to redress the gender imbalance are proposed.

Conclusions

Gender disparity in HPB endoscopy exists and is stark. Underlying this are attitudes, assumptions, and environmental factors that will require systemic and sustained correction. Ideas about how to address this challenge need to be explored.

Keywords

Pancreatobiliary (ERCP) - Quality and logistical aspects - Training - Quality management

Publication History

Received: 21 August 2024

Accepted after revision: 07 December 2024

Article published online:
05 February 2025

• References

• 1 Royal College of Surgeons. An independent review on diversity and inclusion for the Royal College of Surgeons of England. https://www.rcseng.ac.uk/about-the-rcs/about-our-mission/diversity-review2021/
• 2 World Health Organization. Delivered by women, led by men: A gender and equity analysis of the global health and social workforce. https://www.who.int/publications/i/item/9789241515467
• 3 Moberly T. Men outnumber women three to one in some specialties. BMJ 2018; 363: k4098
• 4 General Medical Council. The state of medical education and practice in the UK 2019. https://www.gmc-uk.org/-/media/documents/ somep-2019-full-report_pdf-81131156.pdf
• 5 Rutter C. British Society of Gastroenterology Workforce Report 2021. https://www.bsg.org.uk/wpcontent/uploads/2021/05/British-Society-of-GastroenterologyWorkforce-Report-2020.pdf
• 6 Beaton D, Rutter M, Sharp L. et al. 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
• 7 Sethi S, Kumar A, Clough J. et al. Women in gastroenterology: the UK trainee experience. Frontline Gastroenterol 2022; 13: 484-489
• 8 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
• 9 Suhail FK, Luo Y, Williams K. et al. Sex differences impact ergonomic endoscopic training for gastroenterology fellows. Gastrointest Endosc 2024; 99: 146-154.e1
• 10 Gomez LE, Bernet P. Diversity improves performance and outcomes. J Natl Med Assoc 2019; 111: 383-392
• 11 British Society of Gastroenterology. BSG Workforce Report 2023. https://www.bsgorg.uk/workforce-reports
• 12 Joint Advisory Group for Gastrointestinal Endoscopy. JAG guidance on recovery of training in gastrointestinal endoscopy. https://www.thejag.org.uk/covid-recovery-training
• 13 Ahmed W, Kluettgens B, Stockman C. et al. P285 ERCP workforce, workload, and experience: early results from the BSG national survey of ERCP practitioners. Gut 2023; 72: A200-A201
• 14 Biswas S, Alrubaiy L, China L. et al. Trends in UK endoscopy training in the BSG trainees’ national survey and strategic planning for the future. Frontline Gastroenterol 2018; 9: 200-207
• 15 Saunsbury E, Haddadin Y, Gadhok R. et al. UK-wide survey of gastroenterology and hepatology trainees in 2022: endoscopy, workforce planning and the Shape of things to come. Frontline Gastroenterol 2024; 15: 35-41
• 16 British Society of Gastroenterology. Advice on flexible training/working in gastroenterology. https://www.bsg.org.uk/flexible-training-working-in-gastroenterology
• 17 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
• 18 Yu JX, Berzin TM, Enestvedt B. et al. Gender disparities in advanced endoscopy fellowship. Endosc Int Open 2021; 9: E338-E342
• 19 Yong CM, Abnousi F, Rzeszut AK. et al. Sex differences in the pursuit of interventional cardiology as a subspecialty among cardiovascular fellows-in-training. JACC Cardiovasc Interv 2019; 12: 219-228
• 20 Erez Y V, Kesselman A, Abbey-Mensah G. et al. A glance at gender-specific preferences influencing interventional radiology selection. J Vasc Interv Radiol 2016; 27: 142-143 e1