UK-wide study of the opinions of gastroenterology trainees: COVID-19, Shape of Training and the future workforce

IntroductionThe COVID-19 pandemic has disrupted training. Gastroenterology higher specialty training is soon to be reduced from 5 years to 4. The British Society of Gastroenterology Trainees Section biennial survey aims to delineate the impact of COVID-19 on training and the opinions on changes to training.MethodsAn electronic survey allowing for anonymised responses at the point of completion was distributed to all gastroenterology trainees from September to November 2020.ResultsDuring the first wave of the COVID-19 pandemic, 71.0% of the respondents stated that more than 50% of their clinical time was mostly within general internal medicine. Trainees reported a significant impact on all aspects of their gastroenterology training due to lost training opportunities and increasing service commitments. During the first wave, 88.5% of the respondents reported no access to endoscopy training lists. Since this time, 66.2% of the respondents stated that their endoscopy training lists had restarted. This has resulted in fewer respondents achieving endoscopy accreditation. The COVID-19 pandemic has caused 42.2% of the respondents to consider extending their training to obtain the skills required to complete training. Furthermore, 10.0% of the respondents reported concerns of a delay to completion of training. The majority of respondents (84.2%) reported that they would not feel ready to be a consultant after 4 years of training.ConclusionsReductions in all aspects of gastroenterology training were reported. This is mirrored in anticipated concerns about completion of training in a shorter training programme as proposed in the new curriculum. Work is now required to ensure training is restored following the pandemic.

Sex Differences in Anemia and Red Blood Cell Transfusions Among General Internal Medicine Inpatients

Background: Epidemiological data from the general population have shown that women have lower hemoglobin values compared to men. Previous research on surgical patients showed that women were significantly more likely to receive red blood cell (RBC) transfusions compared to men in the peri-operative period due to multiple factors including the application of absolute transfusion thresholds. Sex differences in RBC transfusion frequencies have not been well studied in non-surgical settings. Here we investigated sex differences in anemia and in RBC transfusion frequencies in patients admitted to General Internal Medicine (GIM) wards. Study design and methods: This was a retrospective cohort study using de-identified electronic patient data from all patients admitted to the GIM wards from the emergency department across 4 different hospitals between 2010 and 2017, who had at least 1 CBC test during their admission. Patients with multiple hospital admissions during the study period, those who were pregnant, those who underwent surgery during the admission, and those transferred to or from another service besides GIM during their admission were excluded. Severity of anemia was stratified using the WHO sex-specific quantitative thresholds for hemoglobin: mild anemia (110 to 119 g/L in women and 110 to 129 g/L in men), moderate anemia (80 to 109 g/L in both men and women) and severe anemia (lower than 80 g/L in both men and women). Results: The study cohort consisted of 51,073 inpatients (24,666 men and 26,407 women). The median hemoglobin at the time of admission was significantly higher (p < 0.001) in men (median 135 g/L, IQR 31) compared to women (median 127 g/L, IQR 25). The prevalence of moderate and severe anemia was significantly higher (p < 0.001) in female inpatients (56%) compared to males (44%). The proportion of patients who received RBC transfusions during their admission was not significantly different (p = 0.36) between men (49%) and women (51%). There was no significant sex difference (p = 0.28) observed in the median hemoglobin prior to RBC transfusions between men (median 68 g/L, IQR 10.5) and women (median 68 g/L, IQR 11). The number of patients with pre-transfusion hemoglobin less than 70 g/L, the commonly used threshold for transfusion in the in-patient setting, was not significantly different (p = 0.91) between men and women. However, among the patients with hemoglobin < 70 g/L, a significantly lower proportion (p < 0.001) of women (82%) received RBC transfusions compared to men (91%). Conclusions: In a large cohort of GIM inpatients, we observed significantly higher prevalence of moderate and severe anemia in women compared to men. While there was no sex difference in overall RBC transfusion frequencies in this inpatient population, there was a lower proportion of women receiving RBC transfusions compared to men in the subgroup of patients with hemoglobin less than 70 g/L. Disclosures No relevant conflicts of interest to declare.

Article Review – Short Communication on Probiotic Claim Substantiation

This article review focused on the analysis of the journal article “More Information Needed on Probiotic Supplement Product Labels” by Merenstein et al., 2019, published in the Journal of General Internal Medicine. The aim of such a review was to communicate a short critique as well as highlighting the need for fieldwork in regulatory compliance. Here, the review started with a general summary of the article, but also in conjunction with the literature review that the authors established. This was necessary to understand the article in its field of expertise whilst giving a clearer purpose on the need for more fieldwork of this kind. Without such understanding, it would have been difficult to understand the regulatory compliance of dietary supplement label regulations in the US. Then, a thorough analysis and deconstruction of the articles structure, as well as article critique, were established. The authority of the paper and other topics such as authority, accuracy, relevance, etc., were examined for effectiveness in conveying the research question that the authors were concerned with; that more information may be needed for product labels in probiotic supplements in the US. Lastly, the graphs, tables, and figures were evaluated to make a conclusion about the study as well as a discussion on the recent advances related to the label compliance of probiotic supplements. The paper, albeit was on the shorter side, was effective and was also simple in establishing a need for more information on the label. Thus, more transparency on clinical substantiation is needed.

Patient Characteristics and Utilization of an Online Patient Portal in a Rural Academic General Internal Medicine Practice

Background: Online patient portals have the potential to improve patient engagement and health care outcomes. This is especially true among rural patient populations that may live far from their health care providers and have transportation barriers to access care. This study compared the characteristics of active users of an online patient portal to non-users and assessed utilization among users in a rural academic primary care clinic to identify disparities in adoption and use. Methods: We conducted a cross sectional study of 28,028 patients in a general internal medicine clinic between June 2019 and May 2020 to assess a) characteristics of patients who had an online patient portal account and used the patient portal compared to those who did not register for an account, and b) the frequency of use of the patient portal (number of logons and number of messages sent and received) by patients over the study period. We compared results based on demographic characteristics, focusing on gender, age, race, presence or absence of nine chronic illnesses, smoking status, and BMI. Results: In the study cohort of 28,028 patients, 82% were active users of the patient portal. Females, patients aged 41-65, and non-smokers were more likely to use the portal than their counterparts. In total, patients with eight out of nine chronic illness groups studied (heart failure, cerebrovascular disease, history of a myocardial infarction, peripheral vascular disease, and renal disease) were less likely to use the patient portal than patients without these chronic conditions. On average, patients log onto the patient portal 25 times per year and send and receive 6 messages to and from the clinic. We found that females, patients older than 65, former smokers and obese patients logged on and sent and received more messages compared to the overall cohort. Although the sample size was small, on average Black patients logged onto the patient portal 19 times and sent and received 3.6 messages compared to White patients who logged on 25 times with 5.8 messages on average over the yearlong study period.Conclusions: In a rural academic internal medicine clinic, female patients, aged 41-65, non-smokers, and those without certain chronic conditions were more likely to use an online patient portal. Recognizing and addressing barriers to patient portal use is essential for robust and sustained patient portal uptake and ensuring that the benefits of portal use are equally distributed among all patients.

Systematic reviews in high impact general internal medicine journals.

The search uses the 5 highest impact General and Internal Medicine journals that publish systematic reviews from the 2011 Journal Citation Reports in combination with the SRs subset in PubMed and a modified version of 5-term “balanced” optimized search strategy for identifying SRs by Montori et al. It was limited to 2008-2012.