Female gastroenterology (GI) fellows performed a significantly lower number of colonoscopies and esophagogastroduodenoscopies (EGDs) during training compared to their male counterparts, though the difference was small, a retrospective study found.

In a survey of 25 accredited programs that provided data on 360 fellows, multivariable analysis showed that women performed an average of 1,003 total procedures during their 3-year training versus 1,127 for men (RR 0.94, 95{44affb6c5789133b77de981cb308c1480316fee51f5fd5f1575b130f48379a33} CI 0.89-0.99, P=0.032), reported Lin Chang, MD, of the University of California in Los Angeles, and colleagues.

Northeastern programs reported a higher number of total colonoscopy and EGD procedures performed (RR 1.31, 95{44affb6c5789133b77de981cb308c1480316fee51f5fd5f1575b130f48379a33} CI 1.07-1.60, P=0.009) while academic programs reported lower numbers (RR 0.54, 95{44affb6c5789133b77de981cb308c1480316fee51f5fd5f1575b130f48379a33} CI 0.31-0.91, P=0.022), according to the findings in Clinical Gastroenterology and Hepatology.

“Non-academic programs are traditionally more clinically focused, whereas fellows in academic programs may divide their time amongst both clinical and research-based work, which may have resulted in fewer procedures performed,” the authors wrote.

Fellows choosing to specialize in motility or functional GI performed fewer endoscopies (RR 0.66, 95{44affb6c5789133b77de981cb308c1480316fee51f5fd5f1575b130f48379a33} CI 0.46-0.95, P=0.024), while those planning to specialize in transplant hepatology completed fewer colonoscopies versus those who chose general GI practice (RR 0.84, 95{44affb6c5789133b77de981cb308c1480316fee51f5fd5f1575b130f48379a33} CI 0.73-0.98, P=0.021).

Not surprisingly, more EGDs were performed by fellows who chose to specialize in interventional endoscopy, as compared to general GI fellows (RR 1.21, 95{44affb6c5789133b77de981cb308c1480316fee51f5fd5f1575b130f48379a33} CI 1.00-1.47, P=0.046).

The American Society for Gastrointestinal Endoscopy (ASGE) recommends GI fellows perform at least 275 colonoscopies and 130 EGDs to achieve procedural competency.

“Both male and female GI fellows across the nation have exceeded the minimum number of EGDs and colonoscopies as recommended by the ASGE,” the researchers wrote. “However, this study highlights that various factors such as fellow demographics and training environment are associated with variability in the procedure volume attained by trainees.”

While gender gaps have previously been reported among surgical residents, with women performing fewer surgeries in training, disparities among GI fellows had not been explored, Chang and coauthors explained.

The group argued that GI program directors should “examine their fellows’ endoscopy volumes and competency. If discrepancies based on gender exist, programs should investigate the reasons for these differences and appropriately address them.”

“It is well known that women have historically been under-represented in the medical field, and while the gender gap is decreasing, only around 30{44affb6c5789133b77de981cb308c1480316fee51f5fd5f1575b130f48379a33} of GI fellows and 15{44affb6c5789133b77de981cb308c1480316fee51f5fd5f1575b130f48379a33} of practicing gastroenterologists in the United States are women,” Chang told MedPage Today.

“Looking into the reasons for the observed gender gap would be an interesting next step,” she added.

For their study, Chang and colleagues evaluated endoscopy case volume among GI fellows at accredited programs. They contacted 180 programs, of which 25 GI responded (14{44affb6c5789133b77de981cb308c1480316fee51f5fd5f1575b130f48379a33} response rate), requesting the total number of colonoscopies and EGDs performed during the 3-year program. Participants included fellows who graduated from June 2013 to June 2019. Additional data on fellows were collected, such as demographics, subspecialties, research status, and location.

The primary outcome assessed gender disparities among GI fellows, quantified by the volume of endoscopic procedures performed.

Overall, two-thirds of the 360 fellows were men, and about half were white. A little less than a third were in Western programs and a little more than a third were from Midwestern programs. Two-thirds of the programs had at least 12 fellows. The vast majority of participants were clinical fellows (88{44affb6c5789133b77de981cb308c1480316fee51f5fd5f1575b130f48379a33}), while primary career choice was general GI for 63{44affb6c5789133b77de981cb308c1480316fee51f5fd5f1575b130f48379a33}. More women than men took parental leave during training (23{44affb6c5789133b77de981cb308c1480316fee51f5fd5f1575b130f48379a33} and 16{44affb6c5789133b77de981cb308c1480316fee51f5fd5f1575b130f48379a33}, respectively).

The analysis had several limitations, the researchers acknowledged, including the low survey response rate and reliance on self-reported information. Another limitation was that total procedure volume was evaluated rather than competence of the fellows.

Last Updated October 14, 2021

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    Zaina Hamza is a staff writer for MedPage Today, covering Gastroenterology and Infectious disease. She is based in Chicago.


The authors disclosed no conflicts of interest.