Women in Research:
Breaking the glass ceiling
Catalina Vladut is a young Gastroenterology specialist affiliated to the Clinical Emergency Hospital ‘Agrippa Ionescu’, Bucharest, Romania. Her interest in research led her to enroll in her PhD in pancreatology. She is member of UEG’s Young Talent Group and their cross-representative on UEG’s Equality & Diversity Task Force. This is her unique perspective on the session ‘Career Chat: Women in Research’ at UEG Week 2019.
Watch the Facebook live video of the Career Chat session.
The ‘glass ceiling’ is used as a metaphor to describe the frequent and undefined barriers in the workplace that exist for women, but also (other) minorities such as ethnicity, age, or social status. Introduced in 1839 by French feminist and author George Sand, the metaphor was first used in 1978 in a speech by Marianne Schriber and Katherine Lawrence [1,2]. In 2018, an article in the Economist reported on a gender pay gap of 14% (in decline), with a higher equality rate in Northern Europe, whilst Japan, South Korea and Turkey remain at the bottom of the list [3].
Although we see an overall increase of female researchers, a number of problems remain: women in research receive less funding, take longer to apply for leading positions, and have less representation in research institutions. In health care, diversity among providers brings solutions to patients that have specific needs. Sometimes it is easier for patients to speak to a healthcare professional of the same gender, e.g. when being referred to colonoscopy. Diversity among staff brings new and different approaches, leading to the best possible care for all patients.
Taking advantage of UEG Week 2019, UEG’s Equality & Diversity Task Force together with Young Talent Group organized the session "Career Chat: Women in Research" to highlight the hot topic of research gender bias and encourage women to enter and advance in research careers.
The audience and the panel were both male and female, with Dr. Luigi Ricciardiello acting as the moderator alongside Iris Dotan, Patrizia Burra, and Julia Mayerle. These three powerful female role models offered different perspectives on careers in medical research and the work-family conflict. Iris Dotan is director of the Division of Gastroenterology at the Rabin Medical Center, Petah Tikva, Israel. Patrizia Burra is head of the Multivisceral Transplant Unit at Padua University Hospital, Italy. Julia Mayerle is Professor of Gastroenterology and Hepatology at Munich University Hospital, Ludwig-Maximilian-University, Germany. Currently, Julia is member of UEG’s Research Committee. Luigi Ricciardello is Associate Professor in the Department of Medical and Surgical Sciences, Gastroenterology Unit of the University of Bologna, and chair of UEG’s Research Committee. All speakers agreed that while the interest in research required a lot of time and effort, the output was extraordinary; and although the work-family conflict occurs early in a woman’s GI career, it is not absent in the male GI career either and should therefore not be disregarded. Moreover, the panel agreed that diversity in a department offers different solutions for developing unique areas.
The lounge setting allowed for free discussions between senior and young GI’s and an open dialogue with somewhat difficult questions to be asked out loud. However, the feedback from the panel was positive and provided essential take-home messages.
Read Catalina’s ten ideas to get your research career on track.
References:
- Federal Glass Ceiling Commission. Good for Business: Making Full Use of the Nation's Human Capital. Washington, D.C.: U.S. Department of Labor, March 1995.
- Harlan, Elizabeth (2008). George Sand. Yale University Press. p. 256. ISBN 978-0-300-13056-0.
- The glass-ceiling index, The Economist
Women in Research:
Ten ideas to get your research career on track
Catalina Vladut is a young Gastroenterology specialist affiliated to the Clinical Emergency Hospital ‘Agrippa Ionescu’, Bucharest, Romania. Her interest in research led her to enroll in her PhD in Pancreatology. She is member of UEG’s Young Talent Group and their cross-representative on UEG’s Equality & Diversity Task Force. Here are her tips for your research career, based on the session ‘Career Chat: Women in Research’ at UEG Week 2019.
Read also Catalinas’ perspective on the Career Chat session.
- Fellowships are an essential part of one’s medical education, especially when it comes to research. Even if some centers provide less clinical practice, if these are centers of excellence in research, the experience will boost your knowledge. This means making a big change in your life, but the benefit will be remarkable regardless how long you stay there. UEG helps young investigators with a Visiting Fellowship or a Research Fellowship.
- ‘Most of us spend too much time on what is urgent and not enough on what is important’ (Stephen Covey). Time management is essential when it comes to effectiveness, efficiency, and productivity. Set priorities and identify tasks that need immediate attention (urgent vs. important). Be flexible as there can be changes along the way.
- Identify and hold-on to your passion: basic or translational science, clinical practice, management, different topics in GI, etc. Try to make all these experiences so that in the end you know what your field of interest is.
- Choose a great mentor in an excellence center, according to your field of interest, but never forget that it is a two-way street. Therefore, you should become a good mentee and be willing to develop yourself.
- Emotional and practical support at home is essential. The partner is the key ingredient to a happy life, being able to share the burden and take on some tasks. Never forget the family support, especially grandparents who can be a great solution. However, family and work remain two separate entities in your life. Try not to intertwine them, yet do not neglect one of the two. Studies show that maintaining a good work-life balance increases productivity.
- Networking helps you expand your horizon and improve your medical knowledge. Participating in scientific meetings, workshops, or courses and interacting with worldwide experts can bring new perspectives and offer you the tools necessary to develop yourself and your home hospital.
- Healthy mind, healthy body. Be careful about burn-out: studies have shown that burn-out occurs 1.6 times more often in female physicians. Do not overwork yourself and try to find the time to relax. Find a passion or hobby and give it the amount of time it deserves.
- Self-confidence: be aware of your strength and do not underestimate your assets. Go forward to apply for grants and other opportunities.
- Face the ‘mommy gap bias’, meaning the challenge of reentering your medical career after staying at home with your children. Many medical programs were implemented to facilitate the career reentry, yet all you need is dedication and willpower. Moreover, studies show that while paternity leave is overlooked, it can have a great positive impact on the mothers’ health [1].
- Be aware of the sacrifice! The keyword was ‘sacrifice’ since both senior male and female GI’s that attended the Career Chat were able to admit that every choice has an impact on the personal or professional life. However, all these choices define us for who we become in time.
References:
- Burtle A, Bezruchka. “Population Health and Paid Parental Leave: What the United States Can Learn from Two Decades of Research”. Healthcare (Basel). 2016 Jun; 4(2): 30. doi: 10.3390/healthcare4020030
New & improved Basic Science Courses
Your opportunity! Your chance to select the topic that best matches your research focus!
Apply by March 6, 2020
UEG Education: learn, advance, excel
Exciting new UEG Education learning formats to look out for in 2020.
There are many different ways to learn, both in the classroom and online. Here, Natalie Wood, Lead Editor of UEG E-learning, introduces some exciting new UEG Education learning formats to look out for in the coming months and provides a rundown of what’s already on offer. A reminder of how UEG Education hopes to cater for all!
Hopefully, the fact that you're reading this GI Hive blog means you’re already aware of what UEG Education has to offer. But do you know about the exciting new learning opportunities coming your way? All are designed to complement the different learning formats already available to benefit your learning.
UEG Masterclass
One of our exciting new projects is the "UEG Masterclass”. This format offers the best of both worlds — a blended learning experience that connects online and classroom elements. Learners will undertake a short, tailored programme of online learning before spending 2 days with expert faculty and fellow participants for case-based learning in small groups. The classroom element will reinforce and build on the online learning. Indeed, a UEG Masterclass will not only provide participants with an excellent knowledge base but the confidence to apply what they have learnt.
For those of you with an interest in pancreatic disease, the very first multidisciplinary UEG Masterclass will be on chronic pancreatitis. Thanks to the hard work of the Masterclass taskforce, led by Programme Director and Education Committee member Djuna Cahen, our expert faculty is in place and the programme is agreed, with the classroom element taking place at the House of European Gastroenterology in Vienna on January 21–22, 2021. Spaces are limited, so make sure you don't miss the opportunity to take part — registration will soon be open!
UEG Webinars
Another new learning format we’re introducing is “UEG Webinars”. We’ll be inviting experts to cover new, hot or controversial topics, topics that are becoming better understood, and to perhaps offer differing or new perspectives. The webinars may take the form of a debate or a case presentation, for example, but you will always have the opportunity to interact with the experts and to ask questions, all from the comfort of your own chosen location! UEG Webinars will be scheduled for the evening and last ~30 minutes (depending on the level of interactivity). Registration is completely free, but spaces will be limited, so don’t forget to sign up if you're interested.
The eagle-eyed amongst you may have already seen the announcement for the inaugural UEG Webinar “What's new in FMT?”, which will take place on March 3, 2020, at 19:00 (GMT)/20:00 (CE). We’re very lucky to have lined up experts Georgina Hold and Josbert Keller for the webinar and Imran Aslam from the UEG Education Committee as moderator. Registration is now open, so sign up for free if you want to learn who faecal microbiota transplantation (FMT) is for, how it's performed and whether or not it's safe!
UEG Learning bytes
The final new activity we’re bringing your way in the coming months is “UEG Learning bytes”. Each one will cover a single specific topic in the field and meet a single learning objective. Taking just a few minutes to watch, these online videos will provide a condensed and quick way to enhance your knowledge. The UEG Learning bytes will be freely available to those with a myUEG account via ueg.eu/education.
So far, the topics that we plan to cover as Learning bytes include variceal banding, HRM tracing, PEG placement and foreign bodies, with many more ideas in the pipeline. Look out for the UEG Learning bytes, starting in Q2 2020.
Current offerings
For those of you who can't wait for the new activities to launch, why not remind yourself of the UEG Education offerings you can already access? There are many well-established activities that are designed to complement each other and offer different ways of learning, according to your preferences — many also have the benefit of being CME accredited!
Our classroom courses offer intense face-to-face learning experiences and all provide the perfect opportunity to network with peers and experts. Unlike previous years, you can now choose to attend one of three Basic Science Courses – with groups sizes capped at 15 there is increased emphasis on hands-on training and interaction with tutors and faculty. The Basic Science Courses on offer in 2020 are “Gut microbiota: relevance, analysis, modulation”, “Basic & translational research in motility & neurogastroenterology” and “Hot topics in experimental GI cancer”. Or you could apply for our ever-popular clinically oriented Summer School, which combines practical skills training with state-of-the-art lectures and case presentations. Alternatively, you could choose the Young Investigators Meeting, which specialises in research, statistics and writing papers, or the Evidence-Based Medicine Course, which takes place during UEG Week and uses clinical cases to explore how best to tackle the search for evidence on which clinical practice can be based.
If online learning works for you then there are 20 UEG online courses to choose from, plus several others from member societies. Most of the courses last no longer than an hour and all are split into sections that you can dip in and out of when you have time. The courses are generally made up of comprehensive PPT slides, bespoke presentations and video footage, and there is an opportunity to test your pre- and post-course knowledge. High-quality infographic course overviews are also available for our most recent online courses. Topics covered so far include ERCP, gastrointestinal NETs, GORD (both diagnosis and pathophysiology), chronic and autoimmune pancreatitis, constipation, colorectal polyps and polypectomy. More online courses will be made available in 2020, starting with the epidemiology and aetiology of IBD and acute pancreatitis — both coming soon!
The “Mistakes in…” series offers another chance to learn from the experts, this time in a written format. The beauty of these concise articles is that they go beyond what can be found in textbooks and equip learners with the tips and insight needed to avoid making the mistakes that are obvious to those with experience. Each article discusses up to 10 mistakes, which may be common or infrequent but with a high clinical impact. More than 40 articles have been published so far and new articles are added on an ongoing basis — all are available for free to myUEG users! And for those of you who like watching presentations, we were asked to put together a “Mistakes in…” session for both UEG Week 2018 and UEG Week 2019, with more sessions to come in 2020!
For case-based online learning, our ‘Decide on the Spot’ articles present a brief scenario and then pose one or more questions for you to answer, with the correct answer and discussion posted online shortly after. The cases are generally clinical, but relevant basic science scenarios are available too. Details of the DOTs articles are posted on various social media channels with interactive polling available.
For those who like controversy or debate, our "Head-to-Head" blogs are very short opinion-based articles that promote opposing viewpoints on a whole range of topics. Discussion of topics is actively encouraged via Social Media polls, so be sure to have your say! The Head-to-Head blogs can be found alongside the GI Hive blogs, which provide young European gastroenterologists with up-to-date information on life, career development and education.
UEG Education roadmap 2020 and strategy
Finally, if you would like to hear more about the UEG Education roadmap for 2020 and the strategy for the years ahead, please take a look at the article from UEG Education Chair, Charles Murray, which he recently wrote for the UEG Journal. In addition to all the projects mentioned above, Charlie outlines how, in collaboration with the EBGH, we are mapping UEG Education content to the Blue Book, making UEG the go-to resource for anyone undertaking the European Specialty Examination in Gastroenterology and Hepatology [ESEGH].
All in all, regardless of how you like to learn, we hope that UEG Education provides you with all the resources you need to learn, advance and excel!
Mistakes in acute diverticulitis and how to avoid them
The incidence of acute diverticulitis is rising worldwide.
Acute diverticulitis is an inflammatory complication of diverticulosis and can either be uncomplicated or complicated. Making the distinction between uncomplicated and complicated acute diverticulitis is essential because treatment strategies differ between the two.
Here, we discuss 10 mistakes frequently made when managing patients with acute diverticulitis. We focus on using the correct terminology, diagnostic preference and several treatment options, such as omitting or administering antibiotics, radiological interventions and various aspects of surgery. Acute diverticulitis is an important topic because its incidence is rising worldwide and it is becoming a considerable burden on healthcare systems. Most of the discussion included here is evidence-based, supplemented with many years’ combined clinical experience where evidence is lacking.EDS Visceral Medicine Course
April 2-4, 2020 / Belgrade, Serbia
Registration and application for travel grants are open!
How to identify possible scientific partners
Follow these tips on how to find potential research collaborators.
Finding new potential collaborators and the exchange with colleagues to promote your research is crucial for GI specialists.
Pedro Rodrigues, a new member of the Young Talent Group in 2020, shares the most useful tips on how to identify a possible scientific partner.
Tip 1: Do attend the most important meetings in your field of expertise.
It is essential to attend the most relevant congresses in order to maximize the opportunity to meet new potential collaborators and to promote your own work. In this regard, attending UEG Week on a yearly basis and being actively involved in the several activities that are organized by UEG (Summer School, Basic Science Courses, Young Investigators Meeting, etc.) constitutes the perfect platform to meet new people and establish good partnerships.
Tip 2: Try to synergize with good people.
Don’t go only for the best, but for the friendly ones. It is important to be surrounded by good friends. Therefore, identify good collaborators not only by their area of expertise but also try to connect with easy-going and friendly people that will make your scientific life stronger, easier and straightforward.
Tip 3: Identify partners that complement your research and interests.
Selecting collaborators that are able to complement your research is key. Joint efforts between people with different perspectives helps us with overcoming our flaws and weaknesses and will greatly increase our success.
Tip 4: Engage researchers from different areas in order to create your own multidisciplinary network.
Collaborate with partners from different fields and topics, which may generate innovative and different ideas, and will allow you to develop richer and more complete projects . Diversity is the key to greater achievements. To help you get in touch with other researchers, UEG is establishing a dedicated platform, the UEG Researchers Network. You can already register to receive the latest information on EU funding calls and other opportunities
Tip 5: Collaborate with researchers that do not come with problems, but with solutions.
Your collaborators should add significant value to your research, instead of fomenting fights. Each one of your partners should be able to contribute with valuable ideas and projects.
Tip 6: Select partners from all over the world.
Including worldwide investigators in your network is key in order to increase the probability of identifying new research calls and to apply for funding with your collaborative group.
Tip 7: Don’t forget to move!!!
Mobility is one of the most important factors when you are considering the creation of your collaborative networks. Meeting people from other institutions and connect with other types of work will greatly enrich your CV and will allow you to select important partners to be included in your daily life. In this regard, the UEG Research Fellowship constitutes an excellent opportunity to visit a new research institution, to learn new techniques, to develop new projects and ideas and finally to effectively connect with new scientific partners.
Tip 8: Be involved in relevant associations and groups, and ask for help whenever necessary.
Contact and be actively involved in national and international gastroenterology associations, including UEG. By doing so, you will be able to meet people that might help you in your quest. Do not hesitate to contact them when you need help in finding new scientific partners. Thus, becoming part of UEG and diving into the UEG Talent Pool is key in getting to know new people and to interact with key potential collaborators.
Tip 9: Don´t be shy! Just do it.
If you are interested in establishing a new collaboration please make the first move! Approach people and make the first contact. Do not hesitate to introduce yourself and to try to establish a potential collaboration.
Summer School in Prague
This intense, clinically-oriented course is an educational concept for gastroenterology trainees, combining state-of-the-art lectures with practical skills training.
Find out more
Liver biopsy for evaluation of fibrosis in chronic liver disease: Yes or no?
Two experts present their viewpoints
Chronic liver disease affects many millions of people worldwide and is a major cause of premature death. Assessing liver fibrosis in patients with chronic liver disease can determine disease stage and progression, and also response to therapy, but whether this is best performed via a liver biopsy or noninvasive methods is a matter for debate.
Here, two European experts present their opposing viewpoints on how to assess fibrosis in the setting of chronic liver disease.
Yes—Dina Tiniakos
Biopsy is the reference method for evaluating liver fibrosis and the ‘gold standard’ against which noninvasive methods are compared. The histological stage of fibrosis is one of the most important prognostic factors in patients with chronic liver disease, independent of aetiology. Advanced fibrosis is a strong prognostic factor in alcohol-related liver disease and the most important prognostic indicator in nonalcoholic fatty liver disease (NAFLD), where individual histological fibrosis stages are associated with distinct patient outcomes.
Liver biopsy is the only way to diagnose nonalcoholic steatohepatitis (NASH) and, generally, offers the added value of assessing disease severity, highlighting possible concurrent disease and evaluating fibrosis progression or regression in paired biopsy samples. The known limitations of sampling and interobserver variability are minimized by high-quality biopsy techniques (using ≤16-gauge needles, core length >15 mm) and evaluation by expert hepatopathologists. Recently, digital image analysis and second harmonic generation technology have enabled objective quantitative and qualitative assessment of liver tissue collagen and can highlight subtle differences in fibrosis between biopsy samples.
Noninvasive methods of assessing liver fibrosis are widely used with increasing accuracy for diagnosing the absence of fibrosis or presence of severe fibrosis/cirrhosis and, therefore, are helpful to select patients for liver biopsy. However, noninvasive methods cannot distinguish intermediate stages of fibrosis and some serum marker measurements may reflect fibrotic processes in other organs. Failure of application (2–5%), unreliable results (11–15%) and false-positive results in acute inflammation, cholestasis or liver congestion are known limitations of transient elastography, while the patented serum markers have limited availability. While noninvasive tests reduce the need for liver biopsy for fibrosis evaluation they cannot replace it.
References
- Almpanis Z, Demonakou M and Tiniakos D. Evaluation of liver fibrosis: "Something old, something new…". Ann Gastroenterol 2016; 29: 445–453.
- Lackner C and Tiniakos D. Fibrosis and alcohol-related liver disease. J Hepatol 2019; 70:294–304.
No–Laurent Castera
Over the past decade, there has been growing interest in novel noninvasive strategies for the evaluation of fibrosis, given the well-known limitations of taking liver biopsy samples — invasiveness, limited patient acceptance, rare but potentially life threatening complications, sampling variability, pathologist experience, and cost. Taking liver biopsy samples also appears unrealistic considering the magnitude of the nonalcoholic fatty liver disease (NAFLD) epidemic, with around 25% of the general population affected in Western countries.
Noninvasive testing currently relies on two different but complementary approaches: measuring the levels of serum biomarkers and estimating liver stiffness using ultrasound-based elastography techniques, with transient elastography (FibroScanTM) being the pioneer. Although these two approaches are complementary, they are based on different rationales and concepts. Transient elastography measures liver stiffness related to elasticity, which corresponds to a genuine and intrinsic physical property of the liver parenchyma. By contrast, serum biomarkers are combinations of several, not strictly liver-specific, blood parameters that are optimized to predict the stages of fibrosis as assessed by liver biopsy.
The most validated noninvasive biomarker tests are FIB-4, AST to platelet ratio index (APRI), NAFLD fibrosis score (nonproprietary formula) and FibroTestTM (proprietary), while FibroScanTM is the most validated elastography technique. All these tests are better at ruling severe fibrosis-cirrhosis out than ruling it in. They also have prognostic value in the context of cirrhosis. For instance, they are able to identify the subgroup of NAFLD patients at high risk of developing liver-related complications and death. As a result, noninvasive tests are now widely used in routine clinical practice and included in national and international guidelines.
References
- European Association for the Study of the Liver and Asociacion Latinoamericana para el Estudio del Higado. EASL-ALEH Clinical Practice Guidelines: Non-invasive tests for evaluation of liver disease severity and prognosis. J Hepatol 2015; 63: 237–264.
- Castera L, Friedrich-Rust M and Loomba R. Noninvasive assessment of liver disease in patients with nonalcoholic fatty liver disease. Gastroenterology 2019; 156: 1264–281.
Basic research training for gastroenterology researchers
A 3-day educational programme built on a platform of evidence-based medicine and adult learning principles.
Find out more
An elusive lesion in the colon
How to ensure detection of subtle lesions during screening colonoscopy?
A 55-year-old female patient with no family history of colorectal cancer (CRC) underwent a scheduled screening colonoscopy. The colonoscopy was performed by an experienced endoscopist (adenoma detection rate [ADR] of 54%), using a high-resolution colonoscope with narrow-band imaging (NBI) cabaility. Carbon dioxide was used for bowel insufflation. The patient was sedated with midazolam and propofol, with adequate oxygen supplementation and continuous monitoring of her blood pressure and oxygen saturation. The video shows the colonoscopy and two photos (figure 1) are provided of the ascending colon and of the area near the hepatic flexure during withdrawal of the scope.
Figure 1 | Images of the ascending colon and of the area near the hepatic flexure during withdrawal of the colonoscope under conventional white-light and narrow-band imaging conditions. Case Question 1:
Which of the following statements is correct?A. There is a serrated lesion without dysplasia
B. There is a serrated lesion with dysplasia
C. There is an adenoma with low-grade dysplasia
D. There is an adenoma with high-grade dysplasia
Case Question 2:
What is the minimum length of time you should spend inspecting the right colon (including the cecum, ascending colon and hepatic flexure)?A. 3 minutes
B. 4 minutes
C. 5 minutes
D. 6 minutes
Case Question 3:
Which of the following is more likely to increase the adenoma detection rate (ADR)?A. Better training
B. Chromoendoscopy
C. A mucosal exposure device/cap
D. All of the above
Mistakes in... booklet 2019 out!
The booklet in 2019 contains eight most recent Mistakes in… articles, covering a wide range of topics.
Mistakes in... session at UEG Week 2019
Learn from experts about mistakes in the gastroenterology field and how to avoid them.
Mistakes in decompensated liver cirrhosis and how to avoid them
Protecting against future decompensation episodes is key
Patients with early stages of chronic liver disease and even those with compensated cirrhosis can present without any clinical symptoms, which means that liver disease and ongoing liver damage can remain unidentified for many years. However, morbidity and mortality drastically increase once the stage of ‘decompensated cirrhosis’ has been reached.1,2 Decompensated cirrhosis describes the development of clinically overt signs of portal hypertension and/or impairment of hepatic function (e.g. variceal bleeding, ascites or overt hepatic encephalopathy). The first hepatic decompensation event significantly increases the risk that further complications of liver cirrhosis and decompensation episodes will occur.2 Moreover, individuals who have advanced stages of liver cirrhosis are four times more susceptible to infection, which is, in turn, the most frequent trigger of hepatic decompensation.3,4
Optimal management is required to sufficiently treat patients who have decompensated liver cirrhosis, to protect them from future decompensation episodes and prevent further deterioration of hepatic function. However, decompensated liver cirrhosis is a highly complex disease and there are many pitfalls that may occur with regard to comorbidities, management of acute complications and appropriate medication.
In this article, we cover some of the mistakes frequently made when managing decompensated liver cirrhosis and ways to prevent them. The discussion is based on the available evidence and our personal clinical experience.
ERCP
Enhance your knowledge about ERCP