All right, thank you very much for the ASGE and the course directors for the invitation. So it's an exciting time. You're close to graduating from fellowship. You've worked very hard, a lot of dedication, training. And so I think it's an exciting time. So I'm going to go over some of the top tips for surviving your first year at the job. So it actually all starts now. Fellowship training is the last time you're going to get supervised training. So try to keep learning, see that extra consult, or do that extra procedure, because these are all procedures that are supervised. But remember that even after fellowship, you're never going to be alone. Try to keep notes. I know during fellowship, I kept a lot of notes. As an interventional endoscopist, you can see I have more notes in EUS and ERCP than other notes. I happen to also share some of my notes with our advanced fellows. So anything you see that's interesting, new guidelines, key articles, you can put them and save them in your notes. And try to develop time management skills early on during your fellowship, because putting the effort up front will really help you make your life easier throughout your first year. Most institutions have electronic health record technical staff. So try to work with them to create order sets. For example, if you're going into IBD, try to create order sets with them. If you are planning on doing outpatient colonoscopies, they can create, depending on your endoscopy platform, templates, which are very easy to work through, or common clinical scenarios. I often use dot phrases, for example, for patient letters that I'm going to be sending them, pathology results for referring letters. You can also keep, you can also help them, they can also help you create automated responses as well. And also think of a procedural flow, because if you're in an outpatient setting, what I do is I look at, in my notes I put the patient's initials, indication, pertinent labs or imaging, and sort of have an idea of what procedure, what you're going to do in the procedure. So an interventional endoscopy, if you're doing an ERCP, most of us know what we are going to do. We're going to cannulate the duct and we're going to cut, for example. And so you really know what you're going to do ahead of time, so try and plan ahead. There's also a lot of AI applications that can help you, and scribes as well that can be offered, depending on where you end up going. So before you leave, tip number two, take copies of everything you may forget. So protocols, all your templates that you've started to work on, patient education handouts. If you are planning on doing, for example, EMR and you like the settings, what you're using now in your fellowship, take all these settings with you. If you have preferences to specific snares or biopsy forceps, or if you're going to be an advanced endoscopist, wires or sphincter tomes or whatever, just keep those, track them and keep them with you so that you remember and take them to your new job. If you do plan on performing rare procedures, especially in advanced endoscopy, for example, like EUS guided gastroenterostomy, how many of these are you going to do? They're relatively rare. So just keep track of how you did them, write notes, take videos if you can, and that will really help you up front. Before you start your new job, try to connect with your future employer and your partners just to get a better understanding about the leadership structure. If they want you to do specific procedures or they want you to, for example, interpret manometry, this would be a good time for you to sort of refine and work on your skills. So when you arrive, meet your partners that you're going to be working with, introduce yourself, tell them a little bit about your background and your training and what your interests are, meet the support staff, and I'll talk about that in a little bit. Please don't make your first call to the colorectal surgeon during the middle of a perforation. It's better off to meet them, you know, ahead of time and get to know them. Same thing with IR and radiology, and again, share your expertise with them. And learn about what they like to do. For example, at our institution, one of our surgical oncologists has an interest with pancreatic neuroendocrine tumors. So now I know that this is the person to go to to send these type of referrals to him. So I think it's really important to also learn about them. And then if you do decide on introducing new protocols or new procedures, it's important to make sure that everyone is on the same page. So there's many skills, products, procedures, or protocols that you may want to bring into your program. So you have to make sure that there's alignment with like key stakeholders, subspecialty programs as well. You have to think about financial implications to this program that you want to introduce and what the outreach or marketing, you know, things you're going to be able to do and how you're going to develop the program and train the staff. So I'll give you an example. We wanted to start a bariatric endoscopy in our program, and I'll tell you, it's one of the most difficult because of the financial implications. So we first started off by doing grand rounds and medicine grand rounds and endocrine grand rounds. My wife is an endocrinologist, so I got to, you know, easy there. And so we presented the data. We spoke to the surgeons, and then we went through the division, Department of Medicine, and then the most difficult is just trying to get insurance approvals, and we were able to do that. And a lot of this, you may need to reach out to local mentors within your program or external mentors. And in this situation, there wasn't anyone at our institution that did bariatric endoscopy, so we had to reach out to other institutions to help us out as well. So building your practice, I'm going to briefly discuss this. Dr. Martin is going to be talking about this a little bit more, or building your brand. Sorry, he's going to be talking about that a little bit more. But it really, it's establishing a referral base, professional networking, regional involvement, and being involved in national societies. So when you do arrive, introduce yourself not only to your partners, but to the local health care community. They're going to be really important people to refer cases to you. You can do this both on introductory meetings, for example. You can just set up a phone call, Zoom, or during grand rounds on educational platforms as well. And again, share your expertise and establish yourself as a potential referring physician, depending on what your subspecialty is going to be. And focus your efforts on specialists that have shared mutual patients. So for example, in interventional endoscopy, it's going to be general surgeons or surgical oncologists, which, you know, so instead of just spreading out and networking with multiple people, just focusing is going to be important. And talk to your institution's marketing team about how you can promote yourself, whether it's in printed or online materials, which can really help you. And then maintain the continuity of these relationships. I think it's very important that, you know, referring entrusts you in his or her patient. So make sure that you reach out to them and, you know, and let them know how everything went with the patient. And then establish yourself in one of the GI societies. I think it's very important. It does help you build your practice because, first of all, it allows you to connect with colleagues and at the same time, you know, many patients move from one state to another. So this could be an opportunity where you can have extra referrals. And then whether we like it or not, in the modern era of medicine, social media has really become an important part of health care for multiple reasons. And I'll go over that in the next couple of slides. So building your brand is tip number five. Build your reputation as being a safe GI physician or endoscopist. Have a niche, whether it's clinical, academic. Be available. You know, whenever I have to call a surgical oncologist or a general surgeon, they always answer the phone. So in at least an interventional endoscopy, we try to have that same idea. So they reach out to me any time. And just being available to referring physicians is very, very important. Communicate your findings back to them. And then educate referring teams. I know that we don't like the polyp that was biopsied and tattooed and hot-snared and then now you have to do an EMR. So sometimes once you get these referrals, it's OK. Reach out to the referring, let him or her know that everything went well. And then just let them know that perhaps in the future, let's not biopsy and do all that stuff. And then keep learning and staying up to date. It's very difficult in your first year to stay up to date, because you're just learning the logistics of getting around. So some of the things that I do is I try to attend at least one conference or course a year. I have all the journals that I enjoy reading. My journals are focused more on interventional endoscopy. And so I keep those on my office desk. I like the printed copies. And I just read through abstracts of all of them. And then I personally review interventional articles myself. There's plenty of educational platforms with ASGE, such as ASGE GI Leap, ACG. All these are excellent opportunities for you to also stay up to date. And then podcasts. I was just telling Dr. Adler, his podcast is almost an airplane podcast. I always listen to it when I'm on the airplane. There's plenty of other podcasts there that is very educational. Not only do they talk about specific articles, but some just talk about GI in general and medicine in general. And then, again, social media is another aspect where you can keep yourself up to date and allows you to really go advance your medical education throughout the first year. So there's plenty of groups that you can follow. Almost every journal has a social media page which you can follow and get the most up-to-date articles that's been published. The Emory Digest, there you go. So Emory is, many institutions have, they summarize some of the articles. I think in a very nice format, which is handy with you all the time. And then at the midst of COVID, when things have been affected and we couldn't really attend conferences, there are many social media groups that created what we call tutorials. You get expert opinions. Not necessarily things that can be put in guidelines, but you get to hear what other people are doing in their procedures and how they're taking care of their patients. It also allows you to promote your practice or your division. It allows you to collaborate and establish mentorship and really spreads your work. So if you have a publication, it allows you to do that. It is a double-edged sword. You have to be obviously very, very professional and then definitely don't display any patient information in there because you can get into trouble. Team building. I think this is one of the most important assets when you do first start your first job in the clinic. It's mostly APPs and the billing team, schedulers, and coordinators. If you're in an endoscopy, it involves nurses, nurse managers, and technicians that are with you in the procedure. And so it's very important to be able to have a good relationship with them, be professional and collegial with all your team. It's important to set expectations to what you expect from them, but also be able to receive their feedback as well is very important. And you should invest in your team because the more they're engaged, the more they're going to be involved and want to work and help you take care of the patient. There are many opportunities to invest in your team within ASGE and other GI societies as well. So consider investing in their education as well. So for example, if you're planning on removing a large polyp, this is typically what we do. Or if you're planning a complex procedure, review obviously the patient's chart ahead of time. Talk with anesthesia in a colonoscopy for removing large polyps. It may not be a big deal, but if you are planning on putting a stent in someone that has gastric outlet obstruction, you may want to let anesthesia know that perhaps general anesthesia is the way to go. And then talk with your nurses and the technicians about what type of scope you want to use, what are tools you're going to use for plan A, because hopefully everything goes well. But in case it doesn't, you also have to have plan B, tools for plan B available. And talk to them about the plan. Again, most of us know exactly what we're going to be doing. So talk to them about what you want to do. And if you are doing a procedure that involves special equipment, you can partner with industry to help guide you through some of these procedures. And then have a backup mentor, especially if it's a complex case and you're doing it for the first time, either within your practice or on the phone or in person. And then at the end of the procedure, obviously thank your team. Most people believe that mentorship ends with fellowship. It really doesn't. I have mentors here. And so as an attending physician and even 10, 15 years after you graduate from fellowship, you're going to need mentorship. So stay in touch with your current mentors. And then you can seek out mentorship within your division or outside your department. For example, if you are an interventional endoscopist, you can partner with a surgical oncologist. He or she can be a mentor. IBD, same thing. Colorectal surgery is another example for that. And then you can network, obviously, in regional and national conferences. And then peer mentors. So your current fellows now, you can be co-mentors for each other. One of my co-fellows who was an interventional same year as I, I'm in touch with him. Every week, we sort of share ideas and cases together. So I think that's a good way to seek out mentorship. Now tip number eight is to find your niche. And I think we're going to be talking about that today as well. So there are plenty of opportunities in advanced fellowships, whether it's an interventional GI, transplant, hepatology, IBD, motility. These are all opportunities to be able to find your niche. There are some available without advanced fellowships. So you can attend courses or through mentorship with specific type of procedures or areas that you're interested in. And then you can also partner with industry. And then there's non-clinical niches, such as research or medical education or leadership. And there are also plenty of opportunities within our major societies for leadership training as well. I think it's also important to have a research focus because it allows you to identify specific mentors and a good collaborative team to help you work. And it allows you to invest your time in evaluating opportunities that may be presented to you. Because as fellows, most of you are probably doing a project in transplant, hepatology, and one in IBD and one interventional. But once you're out into practice, you really want to try and focus your research interest. Many institutions will provide you with startup funds with the expectation that after that you need to have your own funds. And you can get this by awards within your institution or at a national society level. And planning is very, very important. If you don't wish to have a physician scientist career, there is plenty of opportunities in medical education or quality. Or you can simply share interesting cases or videos. Don't buy the Porsche at your first paycheck. Maybe wait a couple of years. Because I think it's very important to manage your finances early on. Because once you get busy, it's very hard to go back. And so I think it's very important to manage your finances early. Discuss retirement plans, loan forgiveness options, and investing opportunities. And I would consider having a financial planner that doesn't necessarily sell insurance but really helps you manage your finances. Work life balance is also important. So it's important to clarify what productivity expectations are early. You should take time off, exercise, stay healthy. Don't be afraid to ask help. It's completely normal. You're not expected to know everything. And you're never alone. We're all one phone call away. I remember I was 12 hours overseas and my advanced fellow called me. It was 1 a.m. my time. He was in the middle of an E.U.S. rendezvous procedure and so he insisted that I help him. I obviously was very happy to help him. We put on the FaceTime and I helped him throughout that case. The time difference was significant but we're always available. We're always ready to help you. This is a very nice article that I read in AGA which is really when you do have time I encourage you to go through it. Remember have fun and take care of your patients. This is our outpatient endoscopy team and our inpatient interventional team during colorectal cancer awareness month. Have fun and good luck. Thank you.

gastroenterology

fellowship tips

time management

mentorship

professional networks

work-life balance