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Introduction
The virtual space has created new opportunities for gastroenterology fellows, but direct conversations about education and career development on the national level have been limited. On Oct. 16, 2021, the American Gastroenterological Association and EndoscopyNow hosted an online Fellows Forum titled “Navigating New Frontiers of Training in Gastroenterology.” Close to 100 fellows attended and had the chance to listen to discussions from a national panel of faculty with expertise in medical education, ask candid questions, and share experiences in breakout rooms specific to their year of training. Reading materials were also provided, which are cited throughout this article. What follows is a rundown of the discussion and points of particular interest for fellows.
What do fellows value?
Dr. Laura Raffals kicked off the event by asking fellows to create word clouds related to their challenges (“Balance” was the most common answer) and joys (“Family”). These answers underscore that, when faced with pressures to be 100% at work and home, it is human connection, particularly family, that sustains us. Fellows, however, worried that spending time with family conflicted with spending time on GI training and that they would be perceived as “that person who always leaves early.”1
Attendees discussed that “there are only 168 hours in a week,” (time is a zero-sum game), and it is important to be self-aware and honest about one’s personal values and commit the commensurate time and energy to those values. Consider personal development exercises.2 Faculty have a crucial role in coaching fellows on time management based on personal values.3
Has COVID-19 reduced fellows’ endoscopic skills?
One brave attendee asked: Is this generation of fellows “weaker” because of limited scoping during the pandemic? Faculty discussed that, even prepandemic, it was “not all about quantity; the quality of exposure matters just as much.” From their perspective, prepared, goal-directed, and helpful fellows would maximize learning during endoscopy blocks (see below). Lawrence Schiller, MD, providing the long view, reassured fellows that with a proactive attitude it all evens out in the end.
Fellows reflected that, although social isolation and burnout were rampant, some individuals stepped up to do extra work, supported colleagues with personal or family health issues, and scoped COVID-positive patients if others could not. In future years, the pandemic will be seen as a case study for those in leadership positions. The decisions that health systems, administrators, and providers made will be remembered, as well as how algorithms for “practice as usual” changed.4
What fellows can do to maximize endoscopic learning (attendings’ perspective):
- Know the patient before the case. Prior endoscopy reports, patient comorbidities, and medical history including details like anticoagulation use or issues with anesthesia.
- Help the work flow (and reduce the attending’s stress level). Consent patients and complete preprocedure paperwork if possible.
- Come into the scope block with a plan. Example: “I want to get to the cecum. The attending can withdraw, and I will take out polyps we find.”
- Ask about decision-making. Example: “Why did you choose to place a clip over that polypectomy site?” or “Why did you choose that instrument and not the other?”
- Give feedback on problematic behavior. Attendings that treat fellows like burdens and undermine fellow scope time should be reported. Fellows may be concerned about being perceived as a “troublemaker,” but discussing these situations with program directors is a civic duty.
How can we improve diversity?
We cannot wait for, and must instead proactively recruit, diverse trainees, as well as create inclusive environments. Mentorship is key. However, recent work showing imbalances in gender of mentor-mentees and extra pressure on women mentors raises concerns about sustainability.5,6 The panel suggested that interested fellows could engage students earlier in the pipeline, participate in community awareness and exposure programs, and dedicate education time to health equity.7 Fellows raised concerns about barriers for international medical graduates, which would require institutional and federal policy changes would to implement change.
How can fellows develop better practice patterns?
Sri Komanduri, MD, focused on complex endoscopic cases.8 Having live video, using polls, and listening to other attendings comment on cases was illuminating and sometimes humbling. The panel discussed that simulation labs could strongly enhance endoscopic skill training, but if unavailable, companies are often willing to sponsor events for teaching purposes.9 If training on specific topics is not offered at an institution, regional weekend courses are also an option.
Raman Muthusamy, MD, MS, discussed his philosophy towards endoscopic complications: be prepared and follow your instinct if something feels off. He and Dr. Ikuo Hirano emphasized the importance of following up with patients after a complication. The panel also suggested that fellows can build quality improvement experience by contributing to GI morbidity and mortality conferences or start them if not already offered.
Where is the future headed?
Amrita Sethi, MD, outlined the trend towards virtual platforms and getting the global GI community involved in education efforts. She pointed out the need for a gold standard on assessing competency in endoscopy. From a practice perspective, implementation of telemedicine in GI merits further study, as so far this technology has been attractive to providers and patients alike. Todd Baron, MD, stressed that newer technologies, including artificial intelligence, will not replace the endoscopist but may reduce the need for screening procedures and instead increase demand for specific diagnostic and therapeutic procedures. He used the examples of therapeutic applications of endoscopic ultrasound and the development of single-use duodenoscopes.
Concerns about transitioning from training to independent practice
During the third-year breakout session, fellows discussed anxieties about starting practice and living up to expectations: “What if it’s my first week and there’s something I can’t do?” Faculty recommended getting to know colleagues at a new institution, being confident in your training, and staying engaged with your own complications.10 Fellows described the surprising amount of time and energy they dedicated to the job search and got counseling from Dr. Schiller, who recommended defining what “success” and “satisfaction” look like (again, defining one’s values). He recommended that, for fellows looking at private practice positions, one should ask: How much autonomy do I want? How much business risk am I willing to accept? Fellows need more formal education on practice management and the “business side” of gastroenterology.11
Conclusions
The 2021 AGA EndoscopyNow forum was unique in its discussion of issues impacting GI fellows. The forum revealed that worries about personal well-being, training quality, and future career prospects have affected fellows everywhere: you are not alone. Presentations and lively conversation between seasoned faculty who reflected on career development, education, and medical management demonstrate the importance of seeking advice from colleagues and mentorship. Based on this event, future sessions with conversations between faculty and fellows to assess needs and set priorities for directions in training would be welcome.
Dr. Liu is a gastroenterology fellow, Northwestern University, Chicago. The author has no conflicts of interest to disclose.
References
1. Katzka DA and Proctor DD. Gastroenterology. 2009;136(4):1147-8.
2. Sull D and Houlder D. Do Your Commitments Match Your Convictions? Harv Bus Rev. 2005 Jan 1. https://hbr.org/2005/01/do-your-commitments-match-your-convictions.
3. Keswani RN et al. Gastroenterology. 2020;159(1):26-9.
4. Sethi A et al. Clin Gastroenterol Hepatol. 2020;18(8):1673-81.
5. Rabinowitz LG et al. Gastrointest Endosc. 2021;93(5):1047-56.e5.
6. Rabinowitz LG et al. Gastrointest Endosc. 2020;91(1):155-61.
7. Lee-Allen J, Shah BJ. Gastroenterology. 2021;160(6):1924-8.
8. Richter JM et al. Am J Gastroenterol. 2016;111(3):348-52.
9. Muthusamy VR and Komanduri S. Clin Gastroenterol Hepatol. 2019 Mar;17(4):580-3.
10. Liu H and Boyatzis RE. Front Psychol. 2021. doi: 10.3389/fpsyg.2021.685829.
11. Amann ST et al. “Words” to practice by: A guide to understand the business vernacular of a healthy practice. https://webfiles.gi.org/links/pm/TheHealthOfMyPracticeToolboxPMCommitteeToolbox.pdf.
Introduction
The virtual space has created new opportunities for gastroenterology fellows, but direct conversations about education and career development on the national level have been limited. On Oct. 16, 2021, the American Gastroenterological Association and EndoscopyNow hosted an online Fellows Forum titled “Navigating New Frontiers of Training in Gastroenterology.” Close to 100 fellows attended and had the chance to listen to discussions from a national panel of faculty with expertise in medical education, ask candid questions, and share experiences in breakout rooms specific to their year of training. Reading materials were also provided, which are cited throughout this article. What follows is a rundown of the discussion and points of particular interest for fellows.
What do fellows value?
Dr. Laura Raffals kicked off the event by asking fellows to create word clouds related to their challenges (“Balance” was the most common answer) and joys (“Family”). These answers underscore that, when faced with pressures to be 100% at work and home, it is human connection, particularly family, that sustains us. Fellows, however, worried that spending time with family conflicted with spending time on GI training and that they would be perceived as “that person who always leaves early.”1
Attendees discussed that “there are only 168 hours in a week,” (time is a zero-sum game), and it is important to be self-aware and honest about one’s personal values and commit the commensurate time and energy to those values. Consider personal development exercises.2 Faculty have a crucial role in coaching fellows on time management based on personal values.3
Has COVID-19 reduced fellows’ endoscopic skills?
One brave attendee asked: Is this generation of fellows “weaker” because of limited scoping during the pandemic? Faculty discussed that, even prepandemic, it was “not all about quantity; the quality of exposure matters just as much.” From their perspective, prepared, goal-directed, and helpful fellows would maximize learning during endoscopy blocks (see below). Lawrence Schiller, MD, providing the long view, reassured fellows that with a proactive attitude it all evens out in the end.
Fellows reflected that, although social isolation and burnout were rampant, some individuals stepped up to do extra work, supported colleagues with personal or family health issues, and scoped COVID-positive patients if others could not. In future years, the pandemic will be seen as a case study for those in leadership positions. The decisions that health systems, administrators, and providers made will be remembered, as well as how algorithms for “practice as usual” changed.4
What fellows can do to maximize endoscopic learning (attendings’ perspective):
- Know the patient before the case. Prior endoscopy reports, patient comorbidities, and medical history including details like anticoagulation use or issues with anesthesia.
- Help the work flow (and reduce the attending’s stress level). Consent patients and complete preprocedure paperwork if possible.
- Come into the scope block with a plan. Example: “I want to get to the cecum. The attending can withdraw, and I will take out polyps we find.”
- Ask about decision-making. Example: “Why did you choose to place a clip over that polypectomy site?” or “Why did you choose that instrument and not the other?”
- Give feedback on problematic behavior. Attendings that treat fellows like burdens and undermine fellow scope time should be reported. Fellows may be concerned about being perceived as a “troublemaker,” but discussing these situations with program directors is a civic duty.
How can we improve diversity?
We cannot wait for, and must instead proactively recruit, diverse trainees, as well as create inclusive environments. Mentorship is key. However, recent work showing imbalances in gender of mentor-mentees and extra pressure on women mentors raises concerns about sustainability.5,6 The panel suggested that interested fellows could engage students earlier in the pipeline, participate in community awareness and exposure programs, and dedicate education time to health equity.7 Fellows raised concerns about barriers for international medical graduates, which would require institutional and federal policy changes would to implement change.
How can fellows develop better practice patterns?
Sri Komanduri, MD, focused on complex endoscopic cases.8 Having live video, using polls, and listening to other attendings comment on cases was illuminating and sometimes humbling. The panel discussed that simulation labs could strongly enhance endoscopic skill training, but if unavailable, companies are often willing to sponsor events for teaching purposes.9 If training on specific topics is not offered at an institution, regional weekend courses are also an option.
Raman Muthusamy, MD, MS, discussed his philosophy towards endoscopic complications: be prepared and follow your instinct if something feels off. He and Dr. Ikuo Hirano emphasized the importance of following up with patients after a complication. The panel also suggested that fellows can build quality improvement experience by contributing to GI morbidity and mortality conferences or start them if not already offered.
Where is the future headed?
Amrita Sethi, MD, outlined the trend towards virtual platforms and getting the global GI community involved in education efforts. She pointed out the need for a gold standard on assessing competency in endoscopy. From a practice perspective, implementation of telemedicine in GI merits further study, as so far this technology has been attractive to providers and patients alike. Todd Baron, MD, stressed that newer technologies, including artificial intelligence, will not replace the endoscopist but may reduce the need for screening procedures and instead increase demand for specific diagnostic and therapeutic procedures. He used the examples of therapeutic applications of endoscopic ultrasound and the development of single-use duodenoscopes.
Concerns about transitioning from training to independent practice
During the third-year breakout session, fellows discussed anxieties about starting practice and living up to expectations: “What if it’s my first week and there’s something I can’t do?” Faculty recommended getting to know colleagues at a new institution, being confident in your training, and staying engaged with your own complications.10 Fellows described the surprising amount of time and energy they dedicated to the job search and got counseling from Dr. Schiller, who recommended defining what “success” and “satisfaction” look like (again, defining one’s values). He recommended that, for fellows looking at private practice positions, one should ask: How much autonomy do I want? How much business risk am I willing to accept? Fellows need more formal education on practice management and the “business side” of gastroenterology.11
Conclusions
The 2021 AGA EndoscopyNow forum was unique in its discussion of issues impacting GI fellows. The forum revealed that worries about personal well-being, training quality, and future career prospects have affected fellows everywhere: you are not alone. Presentations and lively conversation between seasoned faculty who reflected on career development, education, and medical management demonstrate the importance of seeking advice from colleagues and mentorship. Based on this event, future sessions with conversations between faculty and fellows to assess needs and set priorities for directions in training would be welcome.
Dr. Liu is a gastroenterology fellow, Northwestern University, Chicago. The author has no conflicts of interest to disclose.
References
1. Katzka DA and Proctor DD. Gastroenterology. 2009;136(4):1147-8.
2. Sull D and Houlder D. Do Your Commitments Match Your Convictions? Harv Bus Rev. 2005 Jan 1. https://hbr.org/2005/01/do-your-commitments-match-your-convictions.
3. Keswani RN et al. Gastroenterology. 2020;159(1):26-9.
4. Sethi A et al. Clin Gastroenterol Hepatol. 2020;18(8):1673-81.
5. Rabinowitz LG et al. Gastrointest Endosc. 2021;93(5):1047-56.e5.
6. Rabinowitz LG et al. Gastrointest Endosc. 2020;91(1):155-61.
7. Lee-Allen J, Shah BJ. Gastroenterology. 2021;160(6):1924-8.
8. Richter JM et al. Am J Gastroenterol. 2016;111(3):348-52.
9. Muthusamy VR and Komanduri S. Clin Gastroenterol Hepatol. 2019 Mar;17(4):580-3.
10. Liu H and Boyatzis RE. Front Psychol. 2021. doi: 10.3389/fpsyg.2021.685829.
11. Amann ST et al. “Words” to practice by: A guide to understand the business vernacular of a healthy practice. https://webfiles.gi.org/links/pm/TheHealthOfMyPracticeToolboxPMCommitteeToolbox.pdf.
Introduction
The virtual space has created new opportunities for gastroenterology fellows, but direct conversations about education and career development on the national level have been limited. On Oct. 16, 2021, the American Gastroenterological Association and EndoscopyNow hosted an online Fellows Forum titled “Navigating New Frontiers of Training in Gastroenterology.” Close to 100 fellows attended and had the chance to listen to discussions from a national panel of faculty with expertise in medical education, ask candid questions, and share experiences in breakout rooms specific to their year of training. Reading materials were also provided, which are cited throughout this article. What follows is a rundown of the discussion and points of particular interest for fellows.
What do fellows value?
Dr. Laura Raffals kicked off the event by asking fellows to create word clouds related to their challenges (“Balance” was the most common answer) and joys (“Family”). These answers underscore that, when faced with pressures to be 100% at work and home, it is human connection, particularly family, that sustains us. Fellows, however, worried that spending time with family conflicted with spending time on GI training and that they would be perceived as “that person who always leaves early.”1
Attendees discussed that “there are only 168 hours in a week,” (time is a zero-sum game), and it is important to be self-aware and honest about one’s personal values and commit the commensurate time and energy to those values. Consider personal development exercises.2 Faculty have a crucial role in coaching fellows on time management based on personal values.3
Has COVID-19 reduced fellows’ endoscopic skills?
One brave attendee asked: Is this generation of fellows “weaker” because of limited scoping during the pandemic? Faculty discussed that, even prepandemic, it was “not all about quantity; the quality of exposure matters just as much.” From their perspective, prepared, goal-directed, and helpful fellows would maximize learning during endoscopy blocks (see below). Lawrence Schiller, MD, providing the long view, reassured fellows that with a proactive attitude it all evens out in the end.
Fellows reflected that, although social isolation and burnout were rampant, some individuals stepped up to do extra work, supported colleagues with personal or family health issues, and scoped COVID-positive patients if others could not. In future years, the pandemic will be seen as a case study for those in leadership positions. The decisions that health systems, administrators, and providers made will be remembered, as well as how algorithms for “practice as usual” changed.4
What fellows can do to maximize endoscopic learning (attendings’ perspective):
- Know the patient before the case. Prior endoscopy reports, patient comorbidities, and medical history including details like anticoagulation use or issues with anesthesia.
- Help the work flow (and reduce the attending’s stress level). Consent patients and complete preprocedure paperwork if possible.
- Come into the scope block with a plan. Example: “I want to get to the cecum. The attending can withdraw, and I will take out polyps we find.”
- Ask about decision-making. Example: “Why did you choose to place a clip over that polypectomy site?” or “Why did you choose that instrument and not the other?”
- Give feedback on problematic behavior. Attendings that treat fellows like burdens and undermine fellow scope time should be reported. Fellows may be concerned about being perceived as a “troublemaker,” but discussing these situations with program directors is a civic duty.
How can we improve diversity?
We cannot wait for, and must instead proactively recruit, diverse trainees, as well as create inclusive environments. Mentorship is key. However, recent work showing imbalances in gender of mentor-mentees and extra pressure on women mentors raises concerns about sustainability.5,6 The panel suggested that interested fellows could engage students earlier in the pipeline, participate in community awareness and exposure programs, and dedicate education time to health equity.7 Fellows raised concerns about barriers for international medical graduates, which would require institutional and federal policy changes would to implement change.
How can fellows develop better practice patterns?
Sri Komanduri, MD, focused on complex endoscopic cases.8 Having live video, using polls, and listening to other attendings comment on cases was illuminating and sometimes humbling. The panel discussed that simulation labs could strongly enhance endoscopic skill training, but if unavailable, companies are often willing to sponsor events for teaching purposes.9 If training on specific topics is not offered at an institution, regional weekend courses are also an option.
Raman Muthusamy, MD, MS, discussed his philosophy towards endoscopic complications: be prepared and follow your instinct if something feels off. He and Dr. Ikuo Hirano emphasized the importance of following up with patients after a complication. The panel also suggested that fellows can build quality improvement experience by contributing to GI morbidity and mortality conferences or start them if not already offered.
Where is the future headed?
Amrita Sethi, MD, outlined the trend towards virtual platforms and getting the global GI community involved in education efforts. She pointed out the need for a gold standard on assessing competency in endoscopy. From a practice perspective, implementation of telemedicine in GI merits further study, as so far this technology has been attractive to providers and patients alike. Todd Baron, MD, stressed that newer technologies, including artificial intelligence, will not replace the endoscopist but may reduce the need for screening procedures and instead increase demand for specific diagnostic and therapeutic procedures. He used the examples of therapeutic applications of endoscopic ultrasound and the development of single-use duodenoscopes.
Concerns about transitioning from training to independent practice
During the third-year breakout session, fellows discussed anxieties about starting practice and living up to expectations: “What if it’s my first week and there’s something I can’t do?” Faculty recommended getting to know colleagues at a new institution, being confident in your training, and staying engaged with your own complications.10 Fellows described the surprising amount of time and energy they dedicated to the job search and got counseling from Dr. Schiller, who recommended defining what “success” and “satisfaction” look like (again, defining one’s values). He recommended that, for fellows looking at private practice positions, one should ask: How much autonomy do I want? How much business risk am I willing to accept? Fellows need more formal education on practice management and the “business side” of gastroenterology.11
Conclusions
The 2021 AGA EndoscopyNow forum was unique in its discussion of issues impacting GI fellows. The forum revealed that worries about personal well-being, training quality, and future career prospects have affected fellows everywhere: you are not alone. Presentations and lively conversation between seasoned faculty who reflected on career development, education, and medical management demonstrate the importance of seeking advice from colleagues and mentorship. Based on this event, future sessions with conversations between faculty and fellows to assess needs and set priorities for directions in training would be welcome.
Dr. Liu is a gastroenterology fellow, Northwestern University, Chicago. The author has no conflicts of interest to disclose.
References
1. Katzka DA and Proctor DD. Gastroenterology. 2009;136(4):1147-8.
2. Sull D and Houlder D. Do Your Commitments Match Your Convictions? Harv Bus Rev. 2005 Jan 1. https://hbr.org/2005/01/do-your-commitments-match-your-convictions.
3. Keswani RN et al. Gastroenterology. 2020;159(1):26-9.
4. Sethi A et al. Clin Gastroenterol Hepatol. 2020;18(8):1673-81.
5. Rabinowitz LG et al. Gastrointest Endosc. 2021;93(5):1047-56.e5.
6. Rabinowitz LG et al. Gastrointest Endosc. 2020;91(1):155-61.
7. Lee-Allen J, Shah BJ. Gastroenterology. 2021;160(6):1924-8.
8. Richter JM et al. Am J Gastroenterol. 2016;111(3):348-52.
9. Muthusamy VR and Komanduri S. Clin Gastroenterol Hepatol. 2019 Mar;17(4):580-3.
10. Liu H and Boyatzis RE. Front Psychol. 2021. doi: 10.3389/fpsyg.2021.685829.
11. Amann ST et al. “Words” to practice by: A guide to understand the business vernacular of a healthy practice. https://webfiles.gi.org/links/pm/TheHealthOfMyPracticeToolboxPMCommitteeToolbox.pdf.