Webinars feature expert physicians in their field, and I'm very excited for today's presentation. The American Society for Gastrointestinal Endoscopy appreciates your participation in tonight's event, Advanced Endoscopy Fellowship. My name is Marilyn Amador, and I will be the facilitator for this presentation. Before we get started, just a few housekeeping items. We want to make this session interactive, so feel free to ask questions at any time by clicking the Q&A feature on the bottom of your screen. Once you click on that feature, you can type in your question and hit Return to Submit Messages. Please note that this presentation is being recorded and will be posted within two business days on GILeap, ASG's online learning platform. You will have ongoing access to the recording in GILeap as part of your registration. Now, it is my pleasure to introduce our GI fellow moderators. Shifa Omar is an Advanced Endoscopy Fellow at the University of Chicago. Prior to this, she completed an Advanced Pancreatology Fellowship at the Mayo Clinic and serves on the ASG Training Committee. Nicholas McDonnell is currently a third-year GI Fellow at the University of Minnesota and the incoming Advanced Endoscopy Fellow at Thomas Jefferson University. Judy True is an Advanced Endoscopy Fellow at the University of North Carolina. She completed her General GI Fellowship at Loyola University. She currently serves on the ASG Medical Simulation Education Technology Committee. I will now hand over the presentation to our GI fellow moderators. Thank you, Marilyn, for organizing this important event for our future Advanced Endoscopists. We are so excited for this special end-all hangout so that we can share an overview of the Advanced Endoscopy Fellowship, the application process, and more importantly, insights from a few of our Advanced Endoscopy Fellowship program directors. Our course director for tonight is Dr. Uzma Siddiqui. Dr. Siddiqui is a professor of medicine at the University of Chicago and serves as a director of the Center for Endoscopic Research and Therapeutics, CERT, and the Advanced Endoscopy Training Program. She is currently on the ASGE's Advanced Endoscopy Committee and co-director along with Drs. Vinay Chandra Chakra and Jonathan Cohen of this year's ASGE postgraduate course at DDW. I have the privilege of introducing two of our faculty members as well. Dr. Fukami is a professor of medicine at the Mayo Clinic in Scottsdale and director of therapeutic endoscopy and Advanced Endoscopy Fellowship there. He's the current chair of the ASGE ESD Special Interest Group and he serves as a member of the International Committee for the Japanese Gastroenterological Endoscopy Society. And then Nareem Shariah is a professor of medicine at the Division of Gastroenterology and Hepatology and the director of interventional endoscopy at Weill Cornell Medicine where she oversees the interventional group as well as the Advanced Endoscopy Training Program at the New York Presbyterian and Greenberg Pavilion and David H. Koch Center. And I'll pass it over to Dr. Umar. Hello, everyone. It gives me great pleasure to introduce Dr. Vinay Chandrasekhar. He's currently Associate Professor of Medicine and Program Director for the Advanced Endoscopy Fellowship at the Mayo Clinic in Rochester, specializing in gastroenterology with advanced training in complex endoscopic procedures. He's also a director of the Pancreas Group there. Thank you. I again welcome everyone for joining us today for the first ASG ENDO Hangout for 2023. We'll be discussing Advanced Endoscopy Fellowship, match, tips and tricks. Thank you again for the moderators and the panelists for joining us today. These are the disclosures of the moderators and presenters today. So why Advanced Endoscopy Fellowship? Why do a fourth year Advanced Endoscopy Fellowship? The reason we're all here today. This fourth year is basically the foundation of learning advanced endoscopic skills, developing, becoming proficient in majority of the advanced endoscopic skills, including ERCP, US, paratherapy, internal stenting and tissue resection techniques. Most programs will cover these in the ASG match, would include these skillset, like I've discussed, as much as we'd like to think that Advanced Endoscopy Fellowship is about training in endoscopy, it's more than that. It's also learning the cognitive aspects of these procedures and non-technical skills in providing highly complex care to these patients and taking care of their procedures. Lastly, other things to note, the other major component of the Advanced Endoscopy Fellowship is learning how to provide multidisciplinary care, working in a collaborative environment with oncology, radiology, interventional radiology and surgery, and also learning how to manage adverse events associated with these highly complex procedures. A major, most of these fellowship programs are in large volume centers with a large referral base. And it is an opportunity, not only to just experience better and better endoscopy, but also get introduced to further niches in advanced endoscopy, like third space and pediatrics, and develop focus in that. Another major component of advanced endoscopy training is preparing yourself to become a lifelong learner. As we know, advanced endoscopy is an emerging, is a very evolving field, rapidly emerging new procedures, new skillset coming on the horizon all the time. The Advanced Endoscopy Fellowship prepares you to adapt to all new skills, working with your mentors and attendings. You recognize resources, whether it's with industry or societies like ASGE, to prepare yourself for the next step, for the next new skill, and how better to provide new techniques and care for your patients. So how do you apply for an Advanced Endoscopy Fellowship in the United States? It's through the ASG Match. Quick overview of the match, how we've been doing for the last four years. So the last four years between 2019 to 2022, the number of programs have gradually increased from 65 to 76. How's the match rate been for applicants? Well, the number of applicants has been, has seen minimal variation over the last four years. The number of programs have increased, and the good news is the match rate has also increased for applicants. It is important to mention when talking about the Advanced Endoscopy Fellowship match, it's a procedural field, and just like most procedural specialties and competitive specialties, women are under representative in Advanced Endoscopy. In the year 2020, 63 applicants matched in Advanced Endoscopy. There were only 10 female applicants matching into Advanced Endoscopy. In 2021, the number of total applicants matching was 69. Again, only 10 female applicants matched into Advanced Endoscopy. In 2022, we've seen some increase in the female applicants that matched into Advanced Endoscopy. That's 21 out of 78 applicants matching, a 27% or a 10% increase, which is all good news, but there's still like a long road to go. Timeline for the match. This is the 2023 schedule. It's available on the ASG website, but I think anyone who's interested in applying should mark the calendar for these dates. January 11th is when the applicants will have access to website. Deadline for applying is February 24th. Programs start offering interviews in March. Applicants rank order list is due in June. Program rank order list is due on June 23rd, and then match results are on July 10th. Moving on to the components of the Advanced Endoscopy Fellowship application. I'll pass on to Nick McDonald to take over. Wonderful, so I'm gonna talk with you guys a little bit about the components, and a lot of this you may know, but it would be a great chance to hear a little bit more from our panel and just kind of cover some of the basics. So the personal statement, you know, you guys have written a lot now between medical school and residency and fellowship. For Advanced Fellowship, this is really, I think, the chance to tell your story. Like sitting down with you all, you know, everyone's got a really interesting and good story of why they want to be an Advanced Endoscopist, and this is your chance to tell that to the program directors. Ideally, I think you should convey kind of who you are and why you want to do this, and kind of show the interviews why they should want to interview you for their program. If possible, some things I think that are helpful is trying to avoid some of the common tropes that you see kind of reused in program, personal list statements, because program directors read an awful lot of these, and then try to keep this concise at about a page or so, if possible. If you have things that you really want to highlight or talk about that don't show up on your CV, this is a great place to talk about that and some of your interests too. I'm kind of curious to see from the panel, what to you guys makes a good personal statement, or what do you hope to see in the personal statements that really stand out for the applicants? And then maybe a little bit about pitfalls that they should avoid. Well, I mean, I'll start. You know, as you mentioned, we read a lot of personal statements in a short time span. And so keeping it concise is important. I'd say the one thing that I like to see is if you don't want to see a rehash of your CV, but if there is something on your resume that you want to highlight or accentuate and talk more about, that's very helpful. But for me, some of the more compelling reasons as to why you as an individual are interested in advanced endoscopy are things that I really want to see in a personal statement. It's a personal statement because I want to know as you as a person, what you want to highlight about yourself and what really got you interested in the field. And so I do think that that's a highlight. And, you know, some people have really fantastic life stories and it's very easy for them to craft it. Others, you know, things may seem mundane. My personal interest in advanced endoscopy to me seemed mundane. So it takes a little bit of work to craft, to make it interesting, to make it pop on a one piece page of paper. And so I think you have to spend some time in crafting the statement and not look at it as an afterthought. Awesome. Thank you, Dr. Trimshaker. Let me chime in. And Vinay said it really eloquently. And, you know, we see, we read a lot of personal statements and frequently there's a rehash of what they did, what they published, which is not really interesting to us. We can see that in CV. So most important thing is this, why you want to do the additional one year, not making money already, but you want to be tortured again, one year being in the training. But that really attract me to get the patient, get to know more about the patient. I mean, more about the person. And get this story, connect the dots together. You as a human, why you get interested in this field? And is there any motivation? Just to describe what motivates you and what make you happy during the day in the endoscopy room? So those are the things that I want to read about you. So that's my two cents. I'll just add that, you know, I agree with what Norio and Vinay have already said, but definitely keep it concise. When they say keep it to one page, but then you think that means put it at seven font so you can jam in more. I mean, I won't even read it at that point. And just maybe just telling us how you came to the decision to go into advanced endoscopy and a little bit of your thought process can definitely add to your application. Oh, can I just, I thought about it. We're not saying don't put your accomplishment in personal statement. You can. You publish this one because of this and that, that's great. I mean, if there's a backside story to it, just put it in, but don't list your publications. Wonderful. So another core part of the application is letter of recommendation. I think this is something that applicants really tend to stress about. And I think the common theme from last year was just really like, these are important, but don't stress. Letters in general are going to be from people that support you and want you to be there. And a lot of letters in this letter like glowing kind of read the same. And so you're in general going to want a letter from a couple of advanced endoscopists that know you and your GI fellowship program director. If you don't have all of those or enough of those you can consider a gastroenterologist who knows you, certainly people that you're doing research with and those may overlap with some of the advanced endoscopists but those are important people to think about getting letters from. As far as when to ask the ASG submission from the timeline Dr. Omar shared with us is February 24th. So it's coming up in about a month and a half or so but this is a good time to start thinking about asking faculty for letters because it's going to take them time. They're busy with all the holiday season and ideally to have them ready to go for your application submission. And for the panel to you guys, what makes a good letter? What advice would you give to a fellow that's trying to figure out who to get a good letter from and any other advice you'd have for them? I would start with make sure the person you asked to write the letter knows that you're going to get an email from the ASGE because we have, if you're writing the letter, you have to upload it to the ASGE match website. So sometimes I may disregard an email unless I know it's coming. So make sure you do that. And like you said, remind your faculty to do that letter. And if it's not submitted within two weeks of the deadline, harass them a little bit more at that point. I would say when you're choosing the people who are writing your letters, they should definitely know you. When I'm reading a letter, it means a lot when that person has interacted with the fellow on a regular basis. They've seen them in clinical rotation. So they know how they manage patients kind of on the clinical side. And also it helps if they've seen you scope and they can mention, this fellow is above where they should be for a second year or they're on par. Those are kind of things I look at because for advanced endoscopy, you only have one year. So not only do you have to manage the patients clinically on the wards, but you also have to be able to scope. So I like to see both of those things mentioned in the letters, if possible. I guess I can just add that it really is persevere. And sometimes you get asked by a lot of people and I always tell people, just remind me if you don't hear back from me and that's okay. And you should have that kind of relationship where it's okay and you shouldn't feel shy by sending a reminder email. I mean, we get so many emails from so many different aspects that sending a reminder email is okay. And even sort of saying, do you want me to highlight three things on my CV or the research that I did with you or something like that. It's not gonna be taken in a bad way, especially if the person that's writing it knows how competitive is advanced can be. And yeah, it's great if you can scope, but if you can't scope that well, I wouldn't, it shouldn't deter you, but just know that you have an extra year to get better at it. So it's not the be all or end all of everything. Osma can be a little harsher. Especially with her seven font. Yeah, I would add that, you know, it's not, you have three letters. And so it's also okay to have, you know, someone who may know you for your research endeavors and hasn't seen you scope, but the other two do comment on your clinical and endoscopic technique and your skillset. So I do, I think a lot of people stress, well, you know, it's advanced endoscopy, but you know, this is my program director. He doesn't know how I scope, but he knows about my scholarly accomplishments. Well, yes, you want your program director to write a strong letter for you. I definitely do agree that you want people who know you and can comment on you personally as well. That goes a long way. I think that, you know, in a big division like mine, one of the challenges for applicants is they don't get to work necessarily daily with the advanced endoscopists in an endoscopy, in the endoscopy suite. They may send them consults or, you know, have a patient that they're referring for EUS or CP. So if you're interested in advanced endoscopy, don't be shy to get to know the advanced endoscopists. I think most advanced endoscopists welcome having their own fellows come in and yeah, your first year fellow, second year fellow, you know, come and watch the case that you're sending for an EUS or an ERCP. Now, for those of you who are applying this year and haven't done so, it may be a little too late, but it's never too late when you're preparing for your advanced endoscopy fellowship. Get to know those folks. The reason that's important is because if there's a potential applicant from Cornell, from Chicago, from Mayo in Scottsdale, we know each other, we're gonna shoot each other emails, we're gonna text each other and say, hey, you know, Uzma, I see this fellow that's applying, you know, can you tell me about this person? So you have to keep in mind that advanced endoscopy is actually a very tight-knit community. We do know each other, maybe not all very personally, but professionally, and we reach out to each other. And so having a relationship with an advanced endoscopist who may not even write your letter of recommendation, but they may be approached by another institution is key. So you wanna make as many connections with the advanced endoscopist at your own institution, even if they're not writing letters for you. That's just another tidbit I'd like to say. I think that's a great point because if someone from Cornell applies and they tell me they love advanced endoscopy and they've never talked or approached REAM, I would find that odd, you know? So I 100% agree because to me, that shows that you were interested in advanced endoscopy enough to make that extra effort. Absolutely. We talk behind the scenes, so we get to know you without being asked to write a letter. So one thing I would add is that when you ask for a letter, just to describe, just to remind the mentor that you're applying for the advanced endoscopy fellow because of what, you know, you have to know the backside story to put into the letter and get to know you with the motivation really helps writing out the letter. If we just ask to write a letter, it's like, sure, I can write a letter with the standard format, but it's gonna be very, very tasteless letter of recommendation. We can see it's a formatted, we can feel that not much thoughts in this letter. So just when you ask the letter, just talk a little more in depth. I want to get to know you and because I want you to write a letter about me. So that's a personal thing is really important. Wonderful. Well, thank you all so much. A couple of questions from the audience. What are your opinions on like, how many is too many? Is four letters too many, five letters, are those okay? And then what are your thoughts on getting a letter from a general gastroenterologist who knows them well? I think four is okay. Five might be pushing it a little bit, but I don't think there's anything wrong with having one or two extra letters, to be honest. I agree, but five is too many to read through. Three would be great. I think just to add to Dr. Fukami's point, when I requested my letters, I shared, besides like, you know, what I want to do, I shared my personal statement and CV with my attendings as well. I think this just gives them a bit of a background about you, even if they know you well, everyone's busy, you know? Yeah, I agree, because you can use that in the letter because we're all very original is how we write our letters. I mean, it's always very helpful. I think a general gastroenterologist is fine, especially if it's like either your program director or someone you scope well with, because at the end of the day, they can tell if you scope, they can tell that you have interests, they can say like, in my experience, this person X, Y, Z is really good or has demonstrated an aptitude or is very interested in endoscopy, et cetera. So it's always good. It's always good to ask from people that know you. It will help if you have an advanced person write you a letter as well from your institution, because like Uzma said, it's a red flag if they don't know you at all. But I do agree with what everyone else is saying. I mean, the program director can give you a lot of insight on how the applicant works with their other fellows and other attendings in different rotations and you get a different perspective and it doesn't have to be advanced endoscopist writing those letters, but you just want the best picture of you presented. And I guess someone wrote in the Q&A that the ASG portal only allows four letters. So that's perfect. You can't do more. Wonderful. Thank you guys for all your input. And I think we can go to the next slide, please. So a lot of people ask about kind of niche, like what am I supposed to do? What am I supposed to say in interviews? And again, I think this is something important not to stress about during the interview trail. There's a lot of areas of focus within advanced endoscopy and these are kind of growing as the techniques and technology expand, things like endopariatrics and third space endoscopy and many more. I think it's okay to talk about if you have an interest or passion in this that you want to bring up on the interview, but it's also okay if you don't know or you're still figuring that out or don't have an interest in more kind of general advanced endoscopy. I think if you're going to mention this, it's important to kind of tailor that to what the program has to offer. If you're interviewing at a program that, you know, doesn't do any endopariatrics and you're talking about how the only thing you want to do is endopariatrics, then that may be a tougher sell. And then there's some things to think about. There's some programs that actually offer advanced like years that are dedicated to a specific thing. So for example, there's bariatrics years at Cornell or Brigham and as well as dedicated third space or luminal time at Mayo Clinic in Arizona and University of Florida in Gainesville can give you some dedicated time as well. Maybe for Dr. Fukami, Dr. Shryo, what are some of your thoughts about kind of these dedicated years and advice that you'd give to an applicant that's maybe thinking about doing one of those years? Reem, do you want to go first? No, you go first. Okay. Well, I think this is important. If you have a specific interest, interventional U.S. is probably offered in most of the institution if you go to the advanced endoscopy fellowship. But third space, endopariatrics, you have to have a bariatric program. So not all the programs offer the training or exposure. And to get into the endopariatrics, you have to have specific interest and you have to dedicate some time. So my thought is usually just to give up some of the component of training to dedicate to the endopariatrics. So you might have to scale back on advanced ERCP, just basic ERCP plus EUS and endopariatrics if you want to do in one year. So we opened up the dedicated luminal intervention program starting this year, I mean last year, July, to dedicate luminal intervention for one year without ERCP. So some program offer one and a half year program, just combine them. We started to offer one year dedicated program. So you have to see what type of training can program tailor your training to those interests. And if you're asking for it, you might have to drop off some of the training because you cannot learn everything in one year unless you're a superhero. Reem? I agree. I mean, generally we're hearing more and more that programs are starting to either offer more two years or separate programs for different subsections. I think whatever your focus may be, if you're particularly interested in just one thing, then if there is a program that offers that one thing, then do it. If you're not a hundred percent sure, then go to a program that really offers everything, but know at the end, you're not going to be, at the end of one year, you're not going to be like that amazing at everything. You might be great at some things, but not everything. And that will come as your first year attendingship. Nothing is still over once you finished fellowship. You could still continue to learn. For me and maybe some other people here, I learned poem more as an attending and Norio came and proctored us for our first poem in ESD. So that also happens, that also comes afterwards. So I wouldn't just think, oh my God, if I'm not learning everything, this is the be-all or end-all or everything. We, for instance, often a specific endobariatric fellowship, but in that you're also learning with endocrine and with surgery, et cetera, et cetera. So it's not just purely endoscopy. And at the end of our year, some fellows come out competent with third space. Some are not as interested, so they don't do it as much. And we have multiple attending, so they get to pick and choose where they want to go. But just be careful as to your expectations at the end of the year is important and what you may end up wanting to do. I agree with you sort of saying, Nick, that don't feel stressed that you have to say you're interested in one thing. I mean, I always ask that just out of curiosity, reminding people that endobariatrics didn't exist when I was applying. So it may be you can say that I'm interested in X, Y, and Z, but I want to learn everything because I'm interested in this at the moment, but I haven't done everything else. But the disease process is exciting for me. And the disease process is like, I think, a keyword that makes people think that you're not just interested in scoping. So that gives you extra bonus points, whether it's true or not. Now, every applicant's going to tell us they're interested in the disease process. And then you know they're lying. But then I know they logged on to the webinar, so I'll give them credit. That's a nicer point. Genius. And I think one more comment, like part of the reason that you want to do an advanced endoscopy fellowship is sometimes to get exposure to other niches. Like I can say for myself, like in my general GI fellowship, my exposure was mostly pancreatic artery endoscopy and similarly in my pancreatology year. But when you go to a large center for advanced endoscopy fellowship, you actually learn, see new things, like for me, first time seeing an ESD was at UChicago. And you sometimes develop your niche during your advanced endoscopy fellowship as well. Sure. So a common question is kind of, where do I apply? How do I pick programs to apply to? I think some of the important things are to think about the really the big decisions. Do you have kind of geographic or regional either ties or areas that you really need to be? And then there are other considerations for your family and others as far as like geographic area. And then as the panelists had kind of mentioned, what specific goals do you have? What are you trying to get out of training and try to find a program that can match that? For the faculty, what would you recommend for an applicant trying to find programs to apply to? And then any advice you'd give to somebody that maybe has like restrictions or kind of limitations in where they can apply to? I mean, this is such a personal decision. When people ask for advice, it's basically we're reflecting back and helping them talk through it. What's more important to them? What's their value? Is it being close to family? Is it being in a major city? Is it going to a program that they don't care if they're in Rochester, Minnesota, and they want to learn EUS or CP? So everyone has a different value system and what's important to them. And then once you are able to elicit what they think is most important to them, then you can guide them, okay, based on your set of values, I think these are the programs that I think that are a good match for you or you should strongly consider. I struggle with, you know, someone has a specific geographic location that they want to end up in. I struggle with how to advise people and I'll tell you why. One is clearly make connections with the endoscopy groups there. If you can make connections at a meeting, you know, reach out to them well in advance of the advanced endoscopy match. The one thing that is a struggle, and I don't know how real it is, and Reem and Uzman in particular can comment on this, is that one of the things that I've seen or heard, and I don't know if it's true or not, is that if a fellow wants to be in New York City or Chicago and they go to one of the programs there, they may run into people saying, well, you know, we don't want to train the competition. There may be non-compete clauses. There may be some discouragement for institutions training people that want to be in that region and then be competition. Now, I know every program's different, but I know in highly desired metropolitan areas that that's something that I struggle how to advise people, so I'd turn it to them to see how they advise their own fellows on that. I mean, I think these questions that are being asked are the right ones, and as Renee said, you have to decide for yourself what means the most. As far as the big cities, you know, I'm always interested in hearing, you know, what are the fellows' long-term plans, where would they like to end up, and I think for the applicants, it's sometimes helpful to know, okay, if I train at UChicago and they're looking to hire someone in the next two years, that I would potentially have a job there, you know, and so for an applicant, that might be something attractive. I can't say one way or the other if I really think, all right, I'm going to train my competition or not because, I don't know, I don't think it comes into play as much in my mind because there's always competition in Chicago and New York, so even if I don't train you, every fellow in New York, it seems, has ended up in the suburbs of Chicago right now, so, you know, they're going to all end up, I mean, a lot are going to end up in the big cities, so for me, the more people I know, you know, I'm still going to get referrals from those advanced trained people, depending on where they end up, if their hospital system can't handle certain types of patients, they're still going to send it to me, so I think having a relationship with the big centers, no matter where you end up in that area, is helpful. I agree, I've heard as well with people saying, oh, I'm not, I'm going to train you, but you can't stay here with certain institutions. I think for us, the biggest thing would be, what are your long-term plans and where do you want to end up, because for us, we're aiming to train academicians and, you know, it doesn't always work out that way, but if, but it's always, for us, it's always better if it does, because it's sort of, you know, a continuation of the program in some respects, but I think it's good to be honest, you have to realize that some places don't want to keep people there, and you have to know that there are non-competes that get given to fellows, but I think it's very important that you ask why that is the case, and if you get an offer elsewhere that's better than the offer that they'll offer you, that it shouldn't matter, and I think they should honor that. Sometimes it's just a cookie-cutter thing as part of the contract, but I hate non-competes. I think it's the bane of a lot of people, but it's important that you have that conversation if it happens. Awesome, thank you for the great answers, and I think we can go to the next slide. Nick, I'll just make one more comment about, you know, I think whoever, when you're applying to programs, you should be very clear about your long-term goals. Like Dr. Shourya said that, you know, she's looking for applicants who want to stay in academics, and if you're someone who's, you know, who's very clinically oriented and just wants to provide patient care, there are a lot of programs for advanced endoscopy out there that will cater to your goals as well, so you should keep that in mind. I think, sorry, I'm speaking. No, go ahead. Lastly, one of my mentors, when I was applying advice, like, you know, if you, if the specific location you're applying to is if the specific location or state you want to be in the country, let's say, like, you know, I want to be in Illinois or New York, then try to interview to as many programs in New York during your advanced endoscopy fellowship, because that's also an opportunity for you to make connections for future. That's a good point, and one of the questions in the Q&A came up, if my career interests are 50% general GI and 50% advanced, you know, does this make my application weak? Is it okay to be honest about this? I mean, I think it is okay to be honest about it. How different program directors will take that information may be varied, but it's probably better to know, you know, what, again, what your long-term goals are. If it's a very hardcore academic research-oriented program, and you say you want to do 50% general GI in private practice and 50% advanced, you know, probably that's not the place for you, but honesty is probably the best for the whole process. Oh, and Shifa, do you want to mention, there were a couple questions also in the Q&A about international applicants or applicants on visas, because you've had to deal, you know, you're on a visa, and you've gone through the process. Yeah, of course, yeah, so currently the ASG match, like there are certain programs that would offer your visa sponsorship that includes J1, H1, and there are other programs that unfortunately cannot do that, just based on how it's been set up within their organization or academic institute, and this number continues to change, and it has actually, there are more and more programs that would be taking up visas. The year I applied, there were 14 programs, and I think we should have a final list for this year by January 11th, as programs are still listing themselves. Yeah, and for international applicants, you know, we've taken those as well. The key thing there, though, is that you have to have already taken steps one through three, and I think there's the English language exam, TOEFL or something, you have to take all those in order to get a license. For our program, you have to get a license in Illinois to be able to, and then privileges at the hospital to be able to scope, so we take international applicants, but you have to take all the USMLE exams up before you apply. Yeah, that's a good point. We also advise the international applicants when they apply, we ask them whether you have USMLE or not. If there's, if they haven't taken, we cannot really consider because they have to have a state license. The other question, actually, the person was asking after the training, whether a J-1 waiver is easy or not. Shifa, do you have information? I have several information about that, too. If you want to go first, then that's fine, too, Dr. Fukami. Okay, so we had two J-1 person who went on to do the J-1 waiver, and one is one VA system, the other went to the Georgia, one of the very small Georgia University, I think they changed the name, but anyway, one of the academic institution, they supported the J-1 waiver, so it's possible, but they were really proactive. They searched those information even before coming into the program, and they started the process, and most recent J-1 waiver was actually granted already in August, when they started the program. Shifa? Yeah, I've kind of had a similar experience. I think if you're on J-1 visa, it's definitely a little bit more challenging for you, but if you just have to be proactive, you need to start very early on. What I did personally was I introduced myself, I kept connections with my, during my, even with people that I've interviewed with during my advanced endoscopy fellowship, and then I introduced myself during conferences, and get your name out there. You just have to start early. I think it has worked out pretty well for me so far, and if anyone needs any personal advice, you know, they can reach out to me anytime about this. Awesome, thanks for the excellent discussion. One last thing that I want to add about the J-1 visa stuff is, in my experience, and the applicants I'm familiar with, I have not actually, I know from my own, our own program in University of Chicago, we previously had multiple applicants on J-1 visas. No one has ever had difficult, has not been able to find a job. There's always a job. It may not be the perfect fit, so you have to keep that in mind. Awesome, so after you kind of thought about the big things for what you're looking for in programs, it, you can kind of narrow down where you may want to apply to. So the ASG provides like a, on the website, a program search that has really detailed information about all the programs linked to their website, and it's a really good resource to find more information. When you're actually kind of going through the interviews, which Dr. Tru and Dr. Moore talked about a little bit, you can kind of get the gut feel or vibe of the program and feel if you think it's going to be a good fit for you. A lot of applicants have found it helpful to talk with the current Advanced Endoscopy Fellow, and many of the programs will provide you the opportunity to during the interview day, but programs are also pretty responsive that if it's something that you want to do, they're generally pretty happy to put you in contact with their Advanced Endoscopy Fellow. And then I think in general advice, if you apply broadly, like the panelists have mentioned, it's a small field and, you know, there's, there's only so many programs, but make sure you're applying to places that you actually think would potentially fit your needs or your goals. And with that, for the panel, do you guys have, I know you talked about this a little bit, but for kind of finding that gut feel or things that they should be thinking about that we haven't covered so far for applicants choosing a program? I will say I think it's hard getting that gut feel on Zoom for both the program faculty and the applicants. And I think this year I'm going to do in-person interviews because I just think it's a better assessment of compatibility. And I, you know, it's a chance for the applicant to actually see the program and the staff in action. So hopefully COVID will, will be kept at bay long enough so that we can do that. But I don't know for you guys applying, you know, on Zoom interviews, what you thought about that. I think it's really hard to gauge people. I generally, like our, the people that we were interested in, we would ask them to, you know, you can't technically ask them to come and call, but it's always really important if you're interested in the program and you like it, then find a way to say, Hey, I'm going to be in New York for X, Y, and Z. Can I come and see the place? And you know, that just gives you that extra edge. If it's on Zoom, I think on Zoom applications, it's been easier for a lot of applicants because you can widely apply and it's cheaper. You don't have to fly out to many places unless it was most paying for it. And so I think just showing an I think just showing an extra email, an extra thing like meet at DDW, whatever it is, let's, let's go have some coffee. Cause I think the match that we have to put in our thing is after DDW usually is. So there's always a chance to have a chat then, or have a coffee then, or come, they can come see you after a talk or a panel or, or whatever. And that gives you the extra sense that, Oh yeah, they're really interested. No, they're not interested. Like I had someone who I said, let's meet up there. And I didn't hear from them and I was like, okay, well, we clearly know where they're ranking us. And so I, I, you know, I don't want to say what I did, but there you go. I think it Reem and Norio and Vinay, I find it a little bit hard because with all the zoom interviews, now every applicant says yes to almost every single interview. And it's a little, it's definitely harder for me to gauge, you know, their actual interest. Obviously some do make the extra effort. Shifa definitely did. So, but, but in general, I think it is harder to gauge because they say yes to every interview. So it's not like they're choosing to just come to visit you as one of their top choices. Yeah, absolutely. I mean, the zoom meeting interview made so much easier for the applicants to say yes, which is great. I mean, they don't have to spend money time. It's just really much easier for everyone, but it is more difficult to get the really personal feel. And I'm sure Vinay is the same way, but may actually discouraged to bring the people, especially selective applicants to visit the institution. So either all zoom or in person, but the mayor decided to advise all zoom for the duration of time. But we're coming back to the question, right? Where do I apply? Now that's really difficult. And you have to know what type of training you're going to be offered, but you really have to have some sense of teachers, you know, trainers. You have to spend every day with them person, and you have to have a good everyday endoscopy and you have to, you know, go home smiling. And you have to know the day look like. The city may affect your mood and family, you know, just your wife. I mean, your partner is really unhappy with the location. It's not going to go. So you have to really talk to your important person where you can go and then narrow down the location and then select the institution. I think that's what I can say. And I think this match, just like any other match before it only list a program that you would be happy to go to. Like there's no point in putting a program on your list. I still remember for residency and people crying. And I'm like, why did you put that program on your list? If you were going to have a meltdown, if you match there, you know, so you may interview at 20 programs and only list seven, you know, so. Awesome. Well, thank you guys for the excellent discussion again. And with that, I'll turn it over to Dr. True and Dr. Mark. Oh, and one extra thing. Did we go over just things about the CV? Because one tip for the applicants, if you list all your abstracts under publications, I just, that's a pet peeve. It's super annoying. And there's like 30 abstracts as a publication and never a paper out of them that I just have to sift through to realize that this is fake news. You should just list them as abstracts. Great point. I'm going to address a few questions related to the application that are in the Q&A. I think this is a very good question. And it comes across often. If you've experienced with ERCP and EUS during general GI fellowship, should you mention that during your advanced endoscopy fellowship interviews? How does that affect? I'm sure you're going to hear multiple different replies. To me, that doesn't really steer me in either way, because if you learn the bad habit, it's very hard to correct it. And it's rather not to have any experience so that we can just start fresh. But in some way, some physicians really prefer some background training so that you don't have to start over. To me, it doesn't really matter. Rather, it's a fresh start. It's better for me. Others? I agree. Sorry, go ahead. You go, Reem. I know. I was going to say I agree. And it's exactly for the same things you said. Also, I remember I could pass the side-viewing scope. I had very little experience with ERCP before I came in. A lot of fellowships that have a fourth year, they may not get that hands-on experience that they want. And so we're expecting that you might get a little bit experience to no experience, and either is OK. You can always tell us. Yeah, I completely agree. I had done zero ERCP and zero EUS when I started my advanced endoscopy fellowship. Now, I do think there's a lot that you can learn without touching the scope. You can walk into your advanced endoscopy fellowship and understand cognitive aspects of ERCP, EUS without having passed a scope. And you could still be so far ahead compared to the average incoming advanced endoscopy fellow just because you have that fundamental knowledge base. Now, you may not know how to do what you want to do, but you know what you're supposed to be doing, or you know the cognitive steps of, OK, after I do a synchrotomy, I need to do this or that. So I think there's a lot that you can achieve by learning about it, watching, and shadowing without having touched the scope. That comment is spot on because I agree with what everyone's saying. Every single fellow is different. And I think if you at least have a basic understanding of what an EUS or an ERCP is, and cholangitis or pancreatic cancer patient with jaundice, and just understanding the basic concepts ahead of time, then you definitely have a leg up. Now, if you happen to know some equipment and have passed the side-viewing scope, I don't think necessarily that will hurt you because it is just one year. And I find fellows who have never even seen an ERCP, you're going to struggle in the beginning. And you have to be OK with that because some fellows come in, and you're the most amazing person at doing a colonoscopy. You're the superstar. And now you know nothing about ERCP. And that's a hit to the ego. But that's fine. You'll get there. But it's just you have to have that realistic expectation coming into a new a new procedure. And one thing that I'm going to add that I'll be really impressed if you tell me that you're so interested in EUS that you went to radiology. You used to watch the trans-abdominal ultrasound, like 50 of them. It's like, oh, you did great, rather than 250 ERCPs. That's a great point. Another question in the chat is that what do advanced endoscopy program directors prefer in terms of applicants? Do you prefer if they write fresh out of fellowship? Or sometimes people decide about doing advanced endoscopy later after a few years of being independent attending. Is there a preference, or it does not really matter? Yeah, I saw that question. And the person also who asked the question said, for personal reasons, I had to be a GI attending for a year. And I think that's totally fine. I think you explain, you describe some of that in your personal statement. And you can say everyone has their own story. But really, why did you decide to do advanced endoscopy? Some people, it's because of family issues. Some people decide later in their training or career that they want to pursue it. For me, the main thing, and Rima said this before, is my mission and my goal is to train individuals who are interested in remaining in academic medicine, whether they have a passion towards education, research, or some other real critical, vital element that's critical to advanced endoscopy in an academic mission. That's what we're really interested about. I could care less if you're fresh out of fellowship, one year out, two years out, but if you're really passionate and you have that background. So if you're two years out, the onus is on you a little bit more to say, hey, despite that I published, I furthered my career, I advanced my career, even though I wasn't pursuing advanced endoscopy. And we've definitely taken fellows who've been a couple of years out practicing in academic medicine. So I think that your story and your reasoning for pursuing advanced endoscopy is really more critical than where you are in your stage of your career. I think another point, this is mostly for a question from the standpoint of international applicants, that if they're applying from elsewhere, how much does it affect you? Like practice of endoscopy in Mexico or South Asia, maybe completely different. Does that impact your decision-making? And then you may not necessarily know their mentors. How do you decide then? I think all those are factors. So if they're coming from an international institution, ideally I would want to know who their mentors are so I can obviously touch base with them as to their clinical performance. It often might be attractive to a program director that someone is already an independent attending, whether international or within the US. So they have some, some, again, hopefully ability to manage patients prior to coming into the fellowship. But again, I don't know if it matters that much. We're still going to do the same thing. We're going to vet them. We're going to talk to their mentors. And we're going to base our decision on kind of the individual applying and the interaction we have with them during the application process. The international applicants, they tend to be sometimes farther along in their careers and their institutions are funding them to come to the US for a year or two of training. And then they go back to their institution to apply what they've learned. So there may be varying levels of experience in those applicants in particular. So I was going to also add to the point before about, you know, having a gap year, so to speak, and in terms of a hospitalist or another career, I think whatever it may be, as long as you have a good story as to why that is, if you don't have a story, make one up so that it makes sense of why you've had that trajectory. It's always important to have those things of why and it fills in your gap. I mean, we've seen people who've gone into hospitalists and then applied to GI or did a liver transplant year and then did GI and then an advanced year. And as long as you can make up a story as to why that is and it makes sense, that's really important. And for international, I mean, it's a small world. And so if we don't know them or their mentors, we know someone who knows someone who knows their people. So we'll always understand where people come from and we're a diverse background as well. We've all been trained in various different aspects. Go to the interview. Yeah, okay. So the interview process, I think we touched upon a little bit. I'll let Dr. Tru take over. Thank you. Yeah, we did start talking about the interview process. That was a great segue in terms of talking about whether or not it's in person, virtual. It sounds like there may be some hybrid options. Before I move on from that topic, or that sub topic, I was wondering if any of the other faculty have any more comments about how they're doing interviews. I know there were some comments already, but any additional comments about the interview? I would appreciate if no one asked me how many native papillas they're going to see in the year. I do not even know what you're trying to accomplish with that question. Every papilla is native and new for you. You're learning ERCP. So when that question is asked, it's been, it's like a thing, I think. I know, but that just means that you're like a robot. Someone told you to ask that. Do you even know why you're asking that question? And I just think it's stupid. But every time I got asked that, I just was like, I don't know the numbers. I have no idea how many we see or don't see. We see a lot of complex cases. Is it native? If someone macerated it and didn't get in and now you have to get, I mean, I don't know, but it's stupid. I think Uzma's point is it's really important to talk to the advanced endoscopy fellow and reserve some of those questions for the advanced endoscopy fellow, right? Because that's the type of stuff you talk, you can talk with a fellow level. They'll still tell us. But I think the interview should be to get to know the program and the people in it. Like, and obviously you want to know on average, which it is on the match website in terms of cases that you're going to see what's the hands-on experience versus just kind of observing. And sometimes that may be more discernible from the advanced fellows there, but just these random questions that clearly you may or may not have any background in for understanding of that someone told you, you should ask that. It's just, I don't know. I find it very off-putting. Literally everyone knows I didn't ask that question. Wait, what'd you say Reem? Like other questions are off-putting to you. That's the one I remember from, especially this last cycle that I don't know why people kept asking that. Oh, the other question I know that's off-putting, sorry. I got another one. So are there going to be any major changes between now and when I apply? Like, are you going to be leaving? Because the last person I will tell my personal plans for my career to are the applicants for an advanced endoscopy fellowship. I can tell you that. So it's just, I mean, I get where you're going. You want to know if you're interviewing with me, will I be there to train you in two years? I mean, usually we don't know maybe that far in advance. If a job opportunity came up, I may take it. You never know in the year and a half, but it's just, it's very interesting because we're not good friends. So I'm not going to tell you every secret going on at the institution. Along those same lines, are there any red flags that you can pick up, especially with virtual I know that's more difficult but any other one. Yes. So, I was interviewing this applicant, and they did not have any kind of background other than their apartment which was a complete shambles, and I could not listen to them talk because I'm thinking my god like this place is a mess and she is showing it to me. And I'm just like, I mean, that's very off putting to. Well, my house is pretty pretty dirty I guess I don't care but you should have a background. Oh, you should, but to me it's like a really blurry camera, it's like you cannot see it clearly, I hate it. Why can't you just choose a better computer, or just wipe it off your finger was on so many times. She must be the same person. Clearly not one of the 10 people that match and I'm joking. The other thing and it's really hard and this is just zoom, zoom, so to speak, is know where your camera is. There's a green thing that was taught me. But basically if you look at the green dot, that's where the camera is so especially when you're interviewing. It's it's eye contact right so you don't want to be looking there, there, and that's just one of those things that helps with the zoom interview just to make it a little bit easier it sucks in zoom interviews suck but this is the best way out of it and just make sure that you're looking at the, at the, I was gonna say patient at the. Thank you. So, along the same lines of comment on any red flags. Oh yes, that's right. Oh, I mean, for me. We're making an effort to get to know the applicant, and some I've had a couple of times where applicants just seem disengaged, or just kind of aloof. And so right there to me that's a bit of a red flag now I fully acknowledge zoom may not be the best platform to convey that but I really think that you need to come in with a lot of energy enthusiasm. If you're if you're naturally quiet that's fine you can have quiet confidence, but being engaged. Like you said, making eye contact, you know, answering questions. Now, you don't have to make up questions just to just just to show interest, that is a pet peeve where they're like, I think I already know the answer to this but I'm going to ask you the question anyway. You don't need to fake a question, just to show interest we, we still know that you have, you're interested you will know that you're interested by follow up by, by, you know, the your interactions with the panelists throughout the day. And so there are other ways to show interest you don't have to make up a question just to show that you're interested. Vinay just reminded me of important point that at the end of the interview you see so many people and you run out of questions right he's come back to me at that the last interview is that do you have any questions like, Oh no, I don't have. So that off putting, it's like, you don't want to ask me any questions. I mean, you can ask any personal question what do you like to do, I mean what what enjoy your location I mean you get to know the person right. No question means you're not interested in so try to make some, you know, interesting conversation this is like, you know, dating. Yeah, it's not like you're interviewing to be some kind of math professor where we need you to solve a problem and ask specific robotic like questions we just want to get to know you a little bit. That's right. I agree speed dating I guess. Yeah. Sorry, it was my you go ahead. No, I was gonna say the thing about being aloof, like, and as you said you know we're taking time out of our day to meet you. I mean you could put on a nice shirt and not be in the workroom where 50 people are walking in and out I mean just find an empty room and put a jacket on with pajama bottoms I don't care but you know present yourself that is a life lesson. You can never be faulted for, you know, presenting yourself well. And on that initial impression. Yeah, I think that applicants want to show you that he or she is working so hard. We're all working hard. I will say that you know the objectives of the interview are slightly different between the applicant and and the programs. We're looking at applicants, you know, we're looking to see who are we going to work with eight hours 10 hours 12 hours a day, day after day after day and still walk out with a smile on our face, and not want to, you know, be at each other's throats. So compatibility is a very big thing. And that should be a big thing for you too as well and I think some applicants don't understand that that. Yeah, this program may do a lot of your CP and us but I really didn't get along with it with the faculty well maybe you shouldn't go to that program because you're going to be with them. And for me that's that's surprisingly one of the highest things that that I probably got my gut feel or gut reaction is, you know, can I can I work with this person for 10 hours 12 hours a day, day after day after day, because there's some people that you know you just can't you're just not compatible. And so you should be thinking that way as well during your interview. I think that's a great point and I think that, you know, knowing yourself for picking places where you're applying to knowing yourself during the interview and the most importantly brings us to the rank list I think this is extremely important, because you need to know what you want out of the fellowship. During that year in order to really create a rank list that reflects you. And so at the end of the day, what is going to be important for you. Is it going to be exposure to the subspecialties, is it. If you don't know then are you know maybe list higher programs that have exposure to it also then you can experience everything. You know, research mentorship location, and a lot of people end up going, you know, can make their rank list based on gut feeling and I think that's really important. Dr. Umar can you advance to the next slide. Like me, I was very much type A. And so I initially made a rank list based on my gut feeling. And then I did kind of a weighted variable scoring sheet where I tried to score my programs, compare it to what I based on my gut and then maybe really rethink So this is just an ideas to use you definitely don't have to use this, but it helps me at least delineate the rank list a little bit more for for myself. And then at the end of the day, you can find out what works for you. Next slide. And then overall tips for finalizing the rank list. I think that a lot of the programs can be very different from each other. So that's why it's important to know what's important to you. And then at the end of the day, I think what's important is the vibe. Exactly what Dr. Chandra Trigger said is that you're going to be spending a lot of time with the group and it can be a very small group depending on where you are. And so you need to make sure that that feeling is good. And so some tips that I have put together for the rank list is Start off with a draft, make sure you get it in early. I think that talking to people is really important. Your family, your partner, any faculty or mentors and recent advanced fellows only because they, it's a small world. People know each other and they know what the programs may be like. They may know what advanced fellows who graduated there from experienced and sometimes well actually a lot of the times I reached out to the fellows after the interview again because what they say during those group interviews may be different from what they say to you one on one. And then make their notes, compare it to your rank list and see what's important to you. I had very opinionated mentors, which is great. But they may have said things I didn't, you know, agree with that I didn't agree with just because it wasn't important to me or they mentioned things that were important to me and I never really thought about it. So I think it's important to make this early. Talk to people early. Don't say, hey, my rank list is due tomorrow. Can you like sit down with me because that's not a good thing either. And to put that on your mentor and then try not to make last minute changes. I think we've already been through rank lists before, but making those last minute changes can be regretful. Now that I went through my my tips of the rank list. I wanted to open it up for both the faculty and obviously actually just Dr. Umar and Dr. McDonald as well since they recently went through the match. Like myself and any additional tips for candidates. Judy, go back to your checklist there that you had. What does that mean? Mentorship times two? Oh, yes. So these are my weighted scores. So if I were just to put a score, it would actually tabulate how important that was to me because sometimes research is a little bit more important than volume and things like that. Oh, I was nuts. Wow. That's amazing. But but it helped me kind of at least organize between programs that were very similar to. And so this was something that someone had taught me to do and suggested and I picked it up and I thought it was wonderful. Just because I was a little overwhelmed with with how much I loved every place. So it helped me really delineate. And so it helped me. It may not help you as much, but it's something to try. No, no, no. I was just saying, I'm just a I want to know where we ranked. And then I think it's a general GI part is important because I forget. I forget. I forgot to mention, like some fellowships have funding where the advanced fellow has to either do clinic or GI attending or scoping sessions. You know, add in. Yeah. The other thing I would add in there is call schedule. Maybe, but I think it's it's great. Yep. So this list is going to make you realize what's most important for you. I was surprised to see there's no time three. It's a little more important. That's true. Right. But this is, you know, reflection on the what's what's important for you. So that's a good thing to do. And one thing is, I tell my fellows that the general GI practice is not. I mean, if you're doing an inpatient attending, that's a different story. But general endoscopy, EGD colonoscopy on your own is important to learn the technique, learn how to do it. And, you know, coming back and just doing a bad EGD, I'm going to smack you. I agree with that. I think so. For the most part, I think there are some programs that you don't have to do general GI at all. I think the most common thing you hear is half day a week of general GI. I would have to say those are my favorite days. Because I get to read my own room and actually feel like I'm doing something right compared to US and ERCPs. But but at the end of the day, it's it varies a lot, too, whenever you interview at these places, because there are some places that don't have general GI. And it depends if you love it. And I think it makes you a strong gastroenterologist, but it all comes down to your opinion. And that's that's what counts. I think Nick, since you're just talking about it, I'm going to ask you a question. Yeah, I was gonna say, I totally agree. I think the sheet and like the other panelists talked about, really, it's kind of getting at a gut feel of like, what's important to you. And so whether you do a more formal method, like a sheet, or you kind of go off of gut feel, I think just really sitting down and then critically thinking about what, like, what things are important to you, like, what's important to you as a gastroenterologist. And so whether you do a more formal method, like a sheet, or you kind of go off of gut feel, I think just really sitting down and then critically thinking about what, like, what things are important to you, what are you trying to get out of fellowship, and then what programs really like align with what you're after the most, because every program has some really wonderful stuff and like good things. And so you got to figure out what, but what are the things that you really, really need, and then just kind of make your rank list according to that, and where you think you'd be happy. I think those are important. So next, you've matched. So that's great news. You'll hear in July, first week of July, I think if that's still the match date. Now what? And so this is a great question, I think, for faculty with regards to how can our candidates best prepare for their advanced year? I'll start. And I think as time has gone on, I've shifted and realized it's not really a one-year, it's a one-year technical hands-on fellowship, but your fellowship, your advanced endoscopy fellowship planning starts when you match. And I'm not strict like that, but I, you know, I reach out to the applicants and I tell them, look, great, we're happy to have you. Let's touch base in a couple of months and just see how things are going. You know, I can, I start counseling and providing advice and guidance. What I've started doing in the past couple of years is I actually reach out to them and say, look, we have a research expectation to our advanced fellowship, and I want you to start thinking about your research projects and your research mentors six months in advance, so that when you walk in the door to your advanced fellowship on July 1, you already have an IRB and a research plan in place. That way you're not wasting your first two or three months trying to figure out a research plan, but you already have that ready to go the day you walk in. And you can put all of that behind you and you can focus on endoscopy in July and August, saying that I've already got my research plan figured out, I just need to implement it. That way, you know, you're maximizing your endoscopy time, you're maximizing your time during your advanced fellowship for research and helping to, that kind of makes you a little bit more competitive for when you're looking for a job, that you have, you know, you have a research project, you've got your endoscopy training. It just keeps you a little bit further along. So I, my philosophy has changed quite a bit in that, you know, a lot of pre-planning before July 1 really helps and goes a long way for your academic and your clinical knowledge base. Okay, let me go next then. So, for, once you match, when you start the fellowship in July, it's going to be really hectic four months. July come in and get to know the institution, get to know attending, get to know each other's habit and preference. And then you're going to be learning the system. Then you have to prepare for the projects, you have to pick up the projects and start running with, and then you have to pass the board. And then you have to submit the project, which is, which happens within four months. So it's always, always, it's really nice to have a preparation like Dr. Chandra Sekara said. I would like the fellows to think about what they can do. Maybe ask what kind of project we have just in advance several months before and kind of have some idea what they want to do. That's number one. And second, don't bring any remaining project to the advanced fellowship. One of the fellow couldn't take on the project for a while because still writing a paper from the last institution. So they couldn't just convert to the advanced endoscopy fellows. So those are the two things I would suggest. Try to be proactive. And it's going to be super hectic first four months. And then the holiday season hits, everybody's happy. And then it's January, it's already half of the training is gone. It's going to be really hectic. I want to point it out. And I advise matched fellow, when I call them personally, that try to see, as I said, try to go to the radiology. Try to read the ultrasound images. Understand the ultrasound. That's really the most difficult part, just get in. You have to learn the maneuvers and you have to learn the system, the machine, as well as images, the fundamentals. And those are the things, the EOS training comes really late to be matured. So if you have that idea and knowledge, I think that's going to give you a really nice head start. And then focus on the ERCP when you come in. I can go next. I think for me, when you come in as an advanced endoscopy fellow, I think you just need to understand that it's a privilege to do these procedures on our patients. And the procedure is the last step in the process. I need to know that you understand why we're doing it. You've communicated with the team and the patient and their family. We've done it together. You've reviewed the imaging. You know what the referral is for. And then the last step is the procedure. If you think you're just going to dabble in and out of the room, do the procedure, then disappear and no follow-up or just pick and choose what you want to do, for me, that's not a good fellow. It's a whole process and, you know, it is definitely a privilege to work and scope these patients. And you need to understand that the procedure for me is probably the least important part. Thank you for touching on that. It segues perfectly into our last slide is what makes a good advanced endoscopy fellow. You made some great points right there. Does anybody else have any other comments? I think Reem has a comment. I do. I was like finding my mute button. I really think know your patient. It's such a thing not to know your patient and who you're scoping is really important. And it always impresses me when they know the history, they know what was done in the past, even though they weren't there. It just, it gives me that extra look. They put in the effort. I know I'm running 10 minutes late or an hour or two. I'm going to give them that extra time on the scope because if they do their bit, then I'll be more likely to do mine as well. And then like Mowini used to always ask me if the gallbladder was in or out. And if I got that wrong, he'd take the scope from me. So that was one other thing that he always asked that. So it's just really know your patients. And the next day, even if you don't necessarily need to follow up on the inpatients there, just knowing what happened overnight is always good. Because at the end of the day, you're wanting to be a good doctor. You're not just a mechanic. And so you need to be that full spectrum of everything. And you want to be the extension of your attending, so to speak, and they want to be able to trust you. And they'll only be able to trust you if you spout out good information and Judy's list. I was going to say, my thing is, have you looked at the images? Because if you tell me you just read the report, forget it. So Shif is laughing. So I agree with it was my dream and wanted to comment. One thing is self practice, trying to be proactive and reading. And if we ask questions, then just bring the answer back. And don't forget about, you know, the reading about it. You have to build up the knowledge every day. So I want everybody to just keep reading and just be curious about disease process. Why would do this? Is there any better way? And that make you a better endoscopist in the end. Yeah, I think sometimes, to your point, Norio, you know, the fellows, they want to memorize what you're saying, what you're doing. And, you know, advanced endoscopy is not something you can just memorize and then do it the same way the next time, you know, it's definitely an evolution and you have to kind of take in the information that you're getting daily, but then you have to do your own research. And you have to kind of come up with your own way of doing things and understand why someone may do something one way, but you're going to potentially do it a different way. But it's not something that you can just expect your attendings to tell you every single possible thing you need to know in that one year. It's just not feasible. You know, I think what makes a good, the question was what makes a good advanced endoscopy fellow and it, you know, it's being humble, coming to work, ready to learn, knowing your patients, following up on your patients, following through. I think these are all, these are all surrogates for wanting to be better at what you do, being a lifelong learner. And what said before is what you learn in your advanced endoscopy fellowship is if you're a, if you're a true advanced endoscopist and you want to keep, keep moving with the field, what you learn during your advanced endoscopy fellowship isn't what you're going to be doing in 20 years. There's going to be new techniques, there's going to be new devices, there's new platforms, and you need to, you're learning how to be a student, a lifelong student in endoscopy and adapt with time. So I think that's really, if you, if you embody all of those, all of the advice that we've given you, it's a reflection of being a lifelong learner to be a good endoscopist in 2050, you know. Thank you everybody for your comments. I think we're close to wrapping up. Any final questions and comments from our faculty? Or not questions, comments from our faculty? I think, Judy, before we do that, that was, yeah I agree, that was, that was great. We just want to make sure that we've answered all the questions in the Q&A box. I think there's, there are quite a few questions about job search and I, and how like you know doing an advanced year affects your ability to find a good job. I think we kind of touched upon it briefly that if you're, if you're, if you're bound by location, reach out to places earlier. And if you really want to be an advanced endoscopist, I think these, these things are very secondary. I don't, and I'm sure the program directors can comment on it, I don't know anyone who's ever graduated from advanced endoscopy fellowship does not have a job, they may not have the perfect job, but they do always find a job somewhere. I think, I think you're more, to me there was one question, if you would be less marketable for a private practice job, but you know, the more procedures and techniques, you are able to do. I think the more marketable you are, whether you'll be able to utilize all of those skills in the job that you end up taking, that's a different story but again, I don't think it would hinder you from getting a job by any means. There's one question I think it's, it's a great question. What is the reason why our panelists decided to do an advanced endoscopy fellowship? Oh God, that could take years. That's a question during the interview. Yes, yes, we don't want to give it away yet. Better than the native canola. I was gonna say the disease process. Oh, that's genius. I'm going to use that in any other job interviews I have. That I, I sort of answered but I think it's important like how would you track your progression. I think it's really important that you sort of, there are different fellows fellowships that have like certain milestones that you should achieve at each third of the year we have that. But I think throughout the year, it's important to have that sort of 360 feedback, sort of saying is there anything I should improve on. It's been three months, where do you think I should do, should I read more should I go work on whatever more and that's really important because that will improve, improve you and and your mentor as well. Yeah, any critiques or, you know, just trying to help you get prepared for when you finished, and you're going to be in attending on your own. There was, I don't know Reem you're always particular about this but there was one question about being a female applicant in the whole process. I do not see gender and our answer would probably be, you know, just put your best self forward and you have to be as good as anyone of any gender, race, ethnicity, whatever you know you still just want to be the best applicant out there. Again, I think there's more and more women going into the field. So, I don't think I would treat it any differently. And obviously Reem you can speak to work life balance but if you want to do advanced endoscopy, it is time consuming, it is stressful, and every individual has to just figure out what kind of sacrifices they want to make to be successful in their advanced endoscopy career, or if it's for them. Yeah, I agree, agree completely and don't, don't use, I think this also for general GI fellowship as well. I mean, don't use buzzwords without knowing what they mean and I'm going to leave it at that because I've said it before and don't like like whatever it may be that that that year. Don't use it if you don't have the science to back it up just, I think it really comes across just sell yourself in the best way possible know your story. Know the disease process and you'll get your good fellowship. And we can end here. I'm joking. Thank you. Okay. Thank you everyone for your time. It was a great discussion. Thank you for joining us. Good luck everyone. Thank you. Good luck. Good luck. Thank you. Good luck. So thank you again to all our moderators and panelists for tonight's presentation. Before we close out I just want to let the audience know to make sure to check out our upcoming ASG education events registration is open. registration will be limited. So I advise you to register early and sign up registration will be open in February. At the conclusion of this course, you will receive a short survey and we would appreciate your feedback. As a final reminder ASG membership for fellows is only $25 a year. If you haven't joined yet please contact our membership team or go to our website, make sure to sign up. Thank you again for everyone for an excellent presentation and thank you to our audience for making the session interactive. We hope this information has been useful to you. And with that, I will conclude our presentation. Have a good night. Thank you everyone.

Advanced Endoscopy Fellowship

ASGE

application process

interview tips

personal statements

letters of recommendation

endobariatrics

third-space endoscopy

selecting programs

virtual interviews

career goals

job prospects