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Participating in the Webinar

All attendees will be muted and
will remain in “Listen Only Mode”

Type your questions here so that the moderator

can see them.
Not all questions will be answered but we will get
to as many as possible.

A handout with the slides and room to take notes can

Moderator:
Victor Chedid, MD be downloaded from your control panel.

ACG Virtual Grand Rounds

Join us for upcoming Virtual Grand Rounds!

Week 38 – Thursday, September, 21, 2023

AGA-ACG Clinical Practice Guideline: Pharmacological Management of Chronic Idiopathic
Constipation
Faculty: Lin Chang, MD, FACG
Moderator: William D. Chey, MD, FACG
At Noon and 8pm Eastern

Week 39 – Thursday, September 28, 2023

Identification & Management of Hereditary Pancreatic Cancer Risk
Faculty: Bryson Katona, MD, PhD, CGAF, Beth Dudley Yurkovich, MS, MPH, CGC, CGAF
Moderator: Thomas Slavin Jr., MD, FACMGG, DABCC, Veroushka Ballester, MD, MS
At Noon and 8pm Eastern

Visit gi.org/ACGVGR to Register

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Virtual Grand Rounds

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Navigating the Fellowship Experience

From the trainee lens

Nikki Duong, MD
Clinical Assistant Professor of Medicine
Stanford University

@doctornikkid

Objectives

• Understand the unique challenges that LGBTQ+ trainees face

• Recognize the multiple factors that influence a trainees’ experience

• Gain an understanding of actionable steps to increase inclusivity of

LGBTQ+ trainees

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“Be the best gastroenterologist

you can be… who is gay, but not
the gay gastroenterologist”

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PubMed Search:

“Internal Medicine” AND “training” AND “LGBT” 61

results

“Surgery” AND “training” AND “LGBT” 38 results

“Gastroenterology” AND “training” AND “LGBT” 0

results

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Why this matters?

ACGME 2022 Gastroenterology Program Requirements:

“Programs, in partnership with their Sponsoring Institutions, must

provide a professional, equitable, respectful, and civil environment
that is free from discrimination, sexual and other forms of
harassment, mistreatment, abuse, or coercion of students, fellows,
faculty, and staff.”

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Who identifies as LGBTQ?

5% of graduating
medical students (2019)

3.4% of practicing
physicians (2022)

No data about GI trainees

https://www.sdlgbtn.com/the-percentage-of-gay-doctors/

https://www.aafp.org/news/blogs/freshperspectives/entry/20200303fp-lgbtqphysicians.html

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30% of LGBTQ+ students

concealed their identity
during training

2/3rds of SGM physicians

have heard a disparaging
remark at work

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40% of physicians do not 82% of 1st-year medical

receive formal/adequate students had an implicit
training in LGBT health bias against gay/lesbian
people

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Specialty choice amongst sexual minority

students (Psychiatry vs. Orthopedics)

Mori WS. JAMA Netw Open. 2021.

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Culture Recruitment Retention

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Societies
Diversity Committees
HRC

Chairperson
(GI/MED)
DEI Office
HR
Ombudsperson
ACGME

Program Program Faculty

Admin Director

Housestaff Trainee GME

Medical
students
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Culture shift
Departmental culture Institutional culture

• Promotion of LGBTQ+ • Human Rights Campaign

faculty Healthcare Equality Index
• Recruitment of LGBTQ+ • Partnerships are critical
faculty • Allow for training
• Visibility • Out list
• Allyship • Glossary for cultural
• Welcoming social events transformation
Chugh et al. Journal of
Surgical Ed. 2023.

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Recruitment
• “Culture begins at the first click”

• Easily visible on homepage

• Mission statement

• Welcome message from GI

Women’s committee

• Link to trainee resources within https://medicine.duke.edu/education-and-training/fellowship-programs/gastroenterology-fellowship

DOM

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Deliberate and intentional recruitment

• https://www.tomforth.co.uk/genderbias/
• Virtual town halls
• Recruitment literature displaying a welcoming
culture
• Holistic review of applications
• Mitigate implicit bias
• Diverse selection committee
• Specific recruitment events for diverse
applicants
• Encourage pronouns during zoom interview

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A need for ERAS overhaul

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Recognizing microaggressions and eliminating

them from the training environment
“That’s so gay”

“What does your wife do?”

“Are you so dramatic because

you’re gay?”
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What can I do as an ally?

Listen Be willing to talk

Be open-minded Be cognizant that your peers may

represent the full spectrum of
Stand up for your LGBTQ+ SGM
colleagues against
discrimination

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Retention
How to increase the pipeline?
• Mentorship

• Create a Housestaff council on DEI, Task Force

• Community organizations/Affinity groups (GLMA)

• Prioritize LGBTQ+ research

• Professional development courses

• Support from national societies

• Podcast, editorials, promotion to committees and
society leadership, Grand Rounds, ACG Visiting Scholar
in Equity, Diversity and Ethical Care

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Top 5 tips to optimize

the LGBTQ+ trainee experience
1. A culture of inclusivity starts well before you
interact with the applicant

2. Ensure a holistic review of applications;

encourage openness and invite, but do not demand
self-disclosure

3. Zero tolerance policies; encourage professional

development

4. Offer mentorship

5. Promote locally and nationally

Not a top-down approach, but a well-rounded, holistic, inclusive approach

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Advice from a

Laura Targownik, MD, MSHS, FRCPC

Division Director of Gastroenterology and
Hepatology, University of Toronto
Assoc. Professor of Medicine

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Virtual Grand Rounds

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Financial and Cognitive COIs

• Financial COIs • Cognitive COIs
• I have exchanged insights for money with: • I am a heteronormative, queer-
• Abbvie, Janssen, Takeda, Viatris, allied trans woman, and very
Amgen, Fresenius Kabi, Pfizer, engaged in current discourse
Organon. Lilly, Bristol Myers Squibb around gender and its role in
society
• I have received grant support from:
• Abbvie, Janssen,
• My lived experience informs my
• I have received infrastructural support
interpretation of the evidence, and
from: in how I weight
• Abbvie, Takeda, Pfizer, Amgen. Roche • imperfections in the data
• Absence of data
• I have served on authorship panels for
• Abbvie, Takeda, Pfizer, Bristol Myers • My lived experience informs my
Squibb
views on this talk
• I am on the Scientific Advisory Board for • YMMV
• GoodCap Pharmaceuticals

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NoaisFind
Neither you passion….
borrower
a complete
norsentence
a lender be….

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Virtual Grand Rounds

Who am I?
• Graduate of UCLA Fellowship in Digestive
Diseases 2003
• First Career Award in 2006
• First CIHR Project Grant 2009
• Associate Professor in 2010
• Associate Director of IBD Program at 2012
• Head of GI at University of Manitoba in 2017
• Lead for DEI for Canadian Association of
Gastroenterology 2019
• 200+ peer reviewed publications
• Over 2.5M of funding over career as investigator
• Member of Steering Committee for Rainbows in
Gastroenterology
• Mother of 3, and soon-to-be Bubbie of 1

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Who was I in 2000?

• 27 years old
• First year of GI Fellowship
• Recently married, and new
parent
• Money in pocket from
winning twice on Jeopardy
• Suffering from mentally
crippling gender dysphoria
• Coming to accept who I
was….

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WHAT TRANSITION TAUGHT ME THE

PRACTICAL ADVICE FOR SURVIVING
IMPORTANCE OF PLANNING FOR
THE WINTER
SUCCESS

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Where I
am…..
Where I want
to be….
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Where I wanted
Where I was….
to get to….

INDIVIDUALIZED
DEVELOPMENT PLAN

Where I am Where I want to

right now in D
be in healthcare
medicine….

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Step 1a Step 1b
ASSESSING YOUR SITUATION SETTING YOUR GOALS

Who am I? What are my What do I want to What is my

(self-reflection) resources? achieve? motivation?
• Core values • Human Resources • Ultimate Goals • Personal satisfaction
• Personality attributes • Capital Resources • Proximate Goals • Solving a problem
• Blessings and • Enablers and Barriers • Setting Timelines • Improving the
blemishes landscape
• Communication style • Passion Alignment
• External presentation
• Passions and Pitfalls

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Step 2a Step 2b
IMPROVING YOUR POSITION DECONSTUCTING YOUR GOALS

SELF DEMONSTRATING WHAT WILL I NEED TO ACHIEVE

IMPROVEMENT COMPETENCE
• Seeking mentorship • Identify low-stakes,
relationships small scale tasks to
• Identifying Coaches demonstrate
Formal and informal competence
• Leadership courses • Communicate your
intentions
• Be Selective!

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Step 3
EVALUATING PROGRESS

Re-flection Re-Vision Re-Direction

• How have I grown? • Do I need to set new goals? • Confirming your path vs.
• What am I still challenged by • Were my original goals not as charting a new path
• Am I on track? SMART as I thought? • Seeking opportunities for
• Were my goals to ambitious? • How will I reality test? remediation
• Were my goals to modest? • Walking through open
• Where/Why did I get stuck doors
• Have my passions changed?
• Has my situation changed?
•
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Minority Stress Model

Adverse

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• Survey of 2,890 R2/R3

in 2016/17
• 291 (10%) identified as
SM

• SM Status
• Higher rates of anxiety
and depression
• Effect mediated by
sense of “not belonging”

Wang et al, LGBT Health Volume 7, Number 6, 2020

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Virtual Grand Rounds

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Step 1a Step 1b
ASSESSING YOUR SITUATION SETTING YOUR GOALS

Who am I? What are my What do I want to What is my

(self-reflection) resources? achieve? motivation?
• Core values • Human Resources • Ultimate Goals • Personal satisfaction
• Personality attributes • Capital Resources • Proximate Goals • Solving a problem
• Blessings and • Enablers and Barriers • Setting Timelines • Improving the
blemishes landscape
• Communication style • Passion Alignment
• External presentation
• Passions and Pitfalls

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Growing the pipeline of LGBTQ+ in GIH:

Navigating Research and Grants as a
Physician Scientist
ACG Virtual Grand Rounds
September 20, 2023

Kira Newman, MD, PhD

Clinical Assistant Professor
University of Michigan

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MD/PhD Graduates by Internal Medicine

Subspecialty

Disclosures GI/Hep

• Early career investigator

• Large academic institution
• US-born and US-educated MD/PhD grad
• Doctor for adults

Figure: AAMC. National MD-PhD Program Outcomes Study. 2018. https://store.aamc.org/downloadable/download/sample/sample_id/162/

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Objectives
• Recognize challenges faced by LGBTQ+
trainees in STEM and Medicine

• Describe individual and institutional

strategies to help navigate the
physician-scientist pathway

• Identify grant opportunities for early-

career LGBTQ+ physician-scientists in
GI/Hep

Image: FamilyPracticePride https://www.etsy.com/listing/707132519/pin-lgbtq-medical-pride-pin-from-the

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Challenges for LGBTQ+ in STEM and Medicine

• LGBTQ+ STEM researchers:
• Fewer career opportunities
• Less resources
• More social exclusion by
colleagues
• More harassment
• More likely to leave STEM
• LGBTQ+ medical trainees:
• More burnout
• More discrimination
• More depression/anxiety

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LGBTQ+ Physician Scientists

• LGBTQ+ MD/PhD trainees:
• Greater interest in academic
careers, education, advocacy
• More likely to report past lack of
opportunities/funding
• High value placed of the role of
mentors in professional
advancement

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Navigating the System

Images: Seattle Metro Rapid Transit; Massachusetts Bay Transportation Authority; Tokyo Metro

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General Guidance
• Role Models
• Mentors
• Sponsors

ADM. Rachel Levine, MD, Dr. Jeanne Marazzo, MD, MPH

Assistant Secretary for Health, Incoming NIH-NIAID Director
DHHS

“You can’t be what you can’t see.”

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Resources and Pitfalls

• Supportive environment
• Nondisclosure of queer identity associated with
lower publication rates in STEM
• Need for institutions to be supportive
• Supportive mentorship
• Networks
• Rainbows in Gastro
• GI trainee and early career researcher groups
• Heteroprofessionalism and norms of
impersonality
• Intersectionality
Nelson J, Mattheis A, Yoder JB (2022) Nondisclosure of queer identities is associated with reduced scholarly publication rates. PLOS ONE 17(3):
e0263728. https://doi.org/10.1371/journal.pone.0263728
Mizzi, R.C. (2013). “There aren’t any gays here”: Encountering heteroprofessionalism in an international development workplace. Journal of Homosexuality, 60, 1602-
1624. https://doi.org/10.1080/00918369.2013.824341
Freeman, J.B. (2020). Measuring and resolving LGBTQ disparities in STEM. Policy Insights from the Behavioral and Brain Sciences, 7, 141-148. https://doi.org/10.1177/237273222094323
Image: Hokusai, The Great Wave Off Kanagawa

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Grant Opportunities
• Society grants (ACG, AGA, ASGE, AASLD)
• Career development
• DEI-focused
• Pilot projects
• NIH
• NIDDK
• NIMHD
• NIH Sexual and Gender Minority Research Office
• Foundations
• Doris Duke Foundation
• Crohn’s and Colitis Foundation
• Point Foundation
• Institutional/Internal

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NIH URM definitions

• Underrepresented Populations in US research enterprise
• Individuals from some racial/ethnic minority groups
• Individuals with disabilities
• Individuals from disadvantaged backgrounds (2 or more)
• Homelessness
• Foster care
• Federal Free and Reduced Lunch Program
• No parents/guardians with bachelor’s degree
• Eligible for Federal Pell grants
• Received WIC as parent or child
• Grew up in US rural area or CMS-designated low-income and health
professional shortage area
• Women from above backgrounds

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Summary
• LGBTQ+ physician-scientist trainees may face additional challenges

• Concealment, discrimination, and heteroprofessionalism sap

resources

• Environment, mentorship, and network matter

• Many grant options are available, but most are not LGBTQ+-specific

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Thank you!

[email protected]
@kiranewmanMDPhD

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Questions?

Dr. Kira Newman Dr. Nikki Duong

Dr. Laura Targownik Dr. Victor Chedid

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Unexplained advantages
• White, able-bodied, heterosexual
men in STEM have advantages not
explained by:
• Family responsibilities
• Work attitudes
• Job characteristics
• Background
• Human capital

Erin A. Cech, The intersectional privilege of white able-bodied heterosexual men in STEM. Sci. Adv. 8,eabo1558(2022). DOI:10.1126/sciadv.abo1558

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