Welcome to ASGE Endo Hangout for GI Fellows. These webinars feature expert physicians in their field, and I am 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 Michael DeLutri, and I will be the facilitator for this presentation. Before we get started, a few housekeeping notes. 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 the message. Please note that this presentation is being recorded and will be posted to GI Leap, ASGE's online learning platform. You will have ongoing access to the recording in GI Leap as part of your registration. Now it is my pleasure to introduce our GI Fellow moderator, Michelle Bayliss, from St. Louis University. I will now hand over this presentation to her. Thank you so much for the introduction. Again, my name is Michelle Bayliss. I am a third year Chief GI Fellow at St. Louis University currently, and a future Advanced Endoscopy Fellow at Washington University in St. Louis. It's such a pleasure to be here to moderate this special EndoHangout session for our future Advanced Endoscopy Fellowship applicants. I myself remember going through the application not too long ago and found this session to be very helpful, especially the part where you get to ask the content experts questions along the way, so be sure to utilize this opportunity to ask questions. Today we'll be touching a little bit on some match data, the various components of the application, a little bit about time and fellowship, and even a little bit about post-fellowship. So without further ado, it is my privilege to introduce our course director and some of our panelists tonight. Our course director for tonight is Dr. Praveen Chahal. Dr. Chahal is the Director of the Therapeutic Endoscopy Training Program at Cleveland Clinic in Cleveland, Ohio. I would also like to introduce one of our panelists tonight, Dr. Robert Seelock, who is the Program Director of the Advanced Endoscopy Program and Associate Professor of Medicine at Baylor College of Medicine in Houston, Texas. We also have Dr. Emily Jonica, who is an Assistant Professor of Medicine at Oregon Health and Science University in Portland, Oregon, and Dr. Shifa Umar, an Interventional Endoscopist and Assistant Professor of Medicine at Baylor College of Medicine in Houston, Texas. I will now pass it over to Dr. Umar, who will introduce the rest of our panelists and get our session started. I would like to introduce Dr. Girapinio, who is the Director of Bariatric Endoscopy at Brigham and Women's Hospital, and Dr. Sachdev, who is Program Director for Endoscopy Fellowship at Arizona Center for Digestive Health. Once again, thank you, ASG, for hosting this Endo Hangout, and thank you for esteemed panelists for joining us and our audience. The first and foremost question which arises when we're discussing Advanced Endoscopy Fellowship is, why Advanced Endoscopy Fellowship? Advanced Endoscopy Fellowship provides optimal training for advanced endoscopic procedures. Most training programs currently provide training in ERCP, EUS, Barrett's therapy, stenting, tissue resection techniques, and now we're also seeing more emerging programs with training in bariatric endoscopy and third space techniques. Why is Advanced Endoscopy Fellowship important? Because advanced endoscopy is not just about technical skills, but also mastering non-technical skills, including working in multidisciplinary groups, communicating with referring doctors, and anticipating and predicting adverse endoscopic complications and managing them adequately. Most importantly, in my opinion, and I'm sure we can have some input from the panelists, what really Advanced Endoscopy Fellowship prepares you is it builds the aptitude to learn and adapt to any new emerging skills and puts you at the hub of innovation. Moving on to ASG Advanced Endoscopy Fellowship match, the topic under discussion today. To start with, I would like to share some ASG match fellowship statistics with all the audience here today. As you can see for the past few years, the number of programs in the match have increased, whereas the number of applicants has remained the same. And overall, the match application rate has also increased, which kind of is good news for the applicants right now today that if they're looking to apply for Advanced Endoscopy Fellowship, they're likely to succeed more than a few years back. It is also important to highlight when talking about any sort of procedural field, including the Advanced Endoscopy Fellowship match, that the number of female applicants matching into the fellowship programs has almost doubled over the past few years, and this number continues to increase. When considering Advanced Endoscopy Fellowship, we have to all go through ASG Fellowship application match, and the most important thing would be to review the competence of the application. Now I'd request Dr. Ballas to go over the competence of the application. Thank you, Dr. Umar, for sharing this data. I'll now be going over the various components of the application, starting with the timeline for the application and the match. So this is the 2024 schedule. It's available on the ASGE website, so anyone interested in applying should definitely mark their calendar with some of these dates. I've highlighted with the arrow here February 23rd, which is the most important upcoming deadline, which is the deadline for application submission. Programs then start offering interviews in March, and applicant rank order lists are due June 19th. Program lists are due shortly after, June 21st. And then the big day, which is the match day, the match results data is released on July 8th. So the key components of the advanced endoscopy application is pretty straightforward, similar to past applications. It includes a personal statement, up to four letters of recommendation, a CV, which will need to be uploaded, and then some other documents that you might want to start getting ready to upload or request, such as medical school transcripts and diplomas, USMLE scores, certificates of residency completion, and other documents, as well as a photo, which is optional but encouraged. And then other components of the application cycle include the interviews and the rank list. And I'll be covering some of the basics of each component. Many of you may already be familiar with this information, but this is also a great chance to hear from our panelists. So starting with the personal statement, if you've reached this point in your career, chances are you've already written many personal statements. And this is really your chance to tell your story, to convey who you are, and share why you want to be an advanced endoscopist. It might help you to maybe brainstorm ahead of time some relevant anecdotes before you get started, think about what are your compelling reasons that inspired you to pursue this next step in your training, and write down maybe moments that you feel affirmed your interest in the specialty, because those will really make your personal statement more personal. And as you do so, you can also reflect on what are your goals for your training, and what are your goals beyond your training, and perhaps create an outline of the points you really want to convey. Here are some general do's and don'ts to keep in mind for your personal statement, but before I go through them, I'd like to direct some questions to the panelists. So whoever wants to take this question, I'm curious as to what you look for in a personal statement, or what you feel makes a good personal statement in your opinion. I'll just jump in if that's okay. So I think the personal statement is kind of a necessary evil. I have to read a lot of them, we all do, and I think it can hurt you if you do a lot of the don'ts. If there's a lot of cliches, there's a lot of spelling mistakes, then I think that definitely will hurt you. And you know, if you have a memorable story, it's always helpful. But a lot of times what I end up reading on these is, you know, someone was living somewhere and their grandmother got sick, and they got cancer, and that inspired them to be a GI. I think that becomes cliche, but at one point in time, it was a really great story to tell. And so I think really just, I use it to see if someone is relatively normal. And I don't put a lot of weight in a personal statement, I read every single one of them. But at the same time, I don't make decisions personally on who we're bringing in or not based off of the personal statement personally. It's a lot of personals. I think one of the things that's helpful with the personal statement is identifying things that you can't necessarily garner from the CV. Like if there was a gap between their fellowship training and when they're applying for fellowship, what did they do during that time period? And was there some decision that motivated them or some experience to subsequently apply for advanced endoscopy fellowship? Had they done a liver transplant hepatology fellowship? And then, you know, what was the story behind that by making the transition into advanced endoscopy? So some of those small details that you can't necessarily pick out from the CV. Yeah. And then another thing that I find helpful is that I feel like for the past few years, there are more and more applicants who might kind of sub-specialize or kind of have that some goal in mind that they might want to specialize in interventional EUS or third space. And when they put that in into the personal statement, sometimes I read through to get that sense before I meet that applicant during the interview. Not that it helps or hurts your application, but I pick up on that information from the personal statement. Great. I think I'll make one comment. Personally, when I'm reading the personal statement for me, it's just a little bit of a sneak peek into the personality. So most of the CV, that's an objective data. Personal statement may give me a little bit idea about who you are as a person and how we are weaving your story. That's how I see that. Does anyone have an opinion on whether, you know, if there is an area of potentially perceived weakness in the application, do you think the personal statement is a good place to address that? And if so, how do you suggest this should be approached? Yes. Personal statements is the right place to discuss that a little bit more. You know, as Mankaval mentioned, that if there's a gap, oftentimes we see applications coming in from people who are practicing gastroenterologists, either in private practice or academic, and now they're choosing to do that after five, six years. So we are interested in reading the story. Why now? Or if they are making that transition, they started with a D32 basic science track, and now they want totally made a 180 switch and want to be an advanced endoscopist. We need to hear the story behind that transition. Great. So just some of the things on the list under don'ts, they're, you know, pretty straightforward. Using things like cliches, obviously plagiarism, exaggeration, or inauthenticity, which can be easily detected during the interview, you know, you're writing something that's not really consistent with who you are. The fourth item is don't tell show, meaning don't go listing all the great qualities that you possess. But if you have maybe a story that can demonstrate those qualities, you might want to include it in that way. Failing in grammar errors, as was mentioned, and waiting until the last minute can, you know, especially if you know that you're, you know, writing is not your forte, you might want to avoid that. And then one big thing is avoid restating things that are already on your CV. You know, the programs already have your CV, and they're able to read the list of items on your CV. But if maybe there's a pertinent backstory to a specific item on your CV, or if you want to elaborate further and feel like it really ties into why you want to be an advanced endoscopist, then that could be, you know, a place to highlight that. The do's are also, you know, pretty straightforward. Tell your story. And in order to tell your story, take some time to reflect on your why. Highlight any unique strengths you might have. Like Dr. Girapino mentioned, if you have a specific niche that you're passionate about, and as part of your goals, a personal statement might be a good place to mention that. Talk about any specific career goals you might have. Definitely get feedback and proofread, because sometimes, you know, you might think you're coming off a certain way, but someone reads it and can, you know, tell you how to make certain adjustments to get your idea across better. And try to limit the personal statement to one page. I think, you know, program directors have enough material to go through, and most people are able, you know, to get their story across of why you want to do advanced endoscopy to one page, and there's no need to kind of make it longer than that. Keep it concise. So another core component of the application is the letters of recommendation. This is another aspect of the application that can be stressful. Applicants often wonder, you know, who they need to ask, when to ask, how many letters to ask for. So, you know, I'll start by turning it over to our panelists. One of the questions that I had when I was applying, and that, you know, I commonly get from current applicants is, how important is it to have your letters of recommendation come from advanced endoscopists versus, you know, other people you may have worked with who might know you better? For our program, I mean, it's definitely best if you can get a really strong recommendation letter from an advanced endoscopist who knows you well. So you want both. So the earlier you know that you want to do advanced endoscopy, you should try to get yourself to work more closely, clinically or academically, with an advanced endoscopist, and then try to work hard, impress them, and try to get a letter from them. I think that is the best bet if you can plan for that. But if not, I think getting a very strong letter from someone who knows you well definitely is better than getting a letter from some advanced endoscopist who will write a generic letter for you. Right. So the application allows for up to four letters. Is there a certain, you know, when you're advising, you know, future applicants, do you say, you know, get one letter from your program director, two from an advanced endoscopist? Is there a certain breakdown that you recommend? I think that it's a good one, like one from the program director, and that one hopefully will comment on all of your clinical skills, and then two from advanced endoscopist. Hopefully you get to do lots of scoping with the two advanced endoscopists, and they can comment on your hand skill. And then one research mentor letter, ideally from an advanced endoscopist, but if not someone who can comment on your research skill. I think one comment I would like to make is, especially from applicants who are applying from program that does not have an advanced endoscopy fellowship or advanced endoscopist, it's absolutely okay, I think, not to have a letter because you don't have an advanced endoscopy program. I think what matters more is the person who is writing a letter for you knows you really well, what your strengths are, and it's not just some generic letter. So I think that carries more weight, and obviously from your program director who can summarize your achievements nicely in the letter. I just wanted to add, I agree completely with that, because a lot of people are going to come from programs that don't have advanced endoscopists, but if you can find one, that's great, because advanced endoscopy is such a small community. Most of us would know somebody writing your letter, and that goes a long way too, but if you don't have an advanced endoscopist in your program, don't stress about it, just get, like Dr. Chahal said, get somebody who knows you really well. I just have a follow-up question to this. When talking about generic letters and personalized letters, what makes a letter personalized? Is it a story that you can share about your mentee, or are there certain words that stand out for you? I remember reading a letter one time where the letter writer knew something very specific to that applicant. They talked about their previous career before they were a gastroenterologist. So that to me was personal. What I find out to be non-personal is when I see a lot of people write the same thing, he or she is in the top 10% of all fellows I've ever trained. The number of people who are in the top 10% of how many people that person has trained is far more than 10%. So when they put those kind of numbers in there, to me, that's impersonal. It's helpful, but impersonal, so. I think I used the term generic. See a person who has known you, you have worked with that person. I think Dr. Chahal, we may have lost. I think in the meantime, I can quickly ask a question that's live in the chat. Is it a red flag if an applicant requests four letters, but only three letters are uploaded the submission deadline? Anyone can answer that. It's not a red flag, but it's strange. So it means you either didn't ask the person in advance, or they didn't care enough to write the letter. So just make sure the people that you're asking are responsible enough and you can rely on them. Is there maybe a certain number of letters that you recommend asking for all four letters or is three good enough? I feel like three is fine as long as they are very personal and know you well. I would not stretch or sweat to try to get the fourth one just for the sake of getting the fourth one. And I think some attendings might ask you to draft a letter for you if that's the case. I would think of something that is personal, like let's say if you scope with that attending, something that you think is impressive, like put some of those in, not just like write your CV into the letter. Like all of those little stories can be helpful for the attending to mention that in the letter. So I've listed some, you know, I mean, Dr. Chahal is back with us. It's okay, guys. I don't know why I'm having connectivity issues today. But yeah. Good to have you back. I was just, you know, going over some of the tips for letters of recommendation. So asking early, you know, everyone's busy, especially advanced endoscopists. So you want to give your faculty enough time to, you know, really be able to reflect and write something personal about you. So with the submission deadline being the 23rd of February, now might be a good time to start thinking about who you want to ask and maybe asking if you haven't already. We talked a little bit about selecting your letter writers. It sounds like, you know, having a letter from an advanced endoscopist would be great, but especially important to have someone who really knows you and make it a personal letter. I think in terms of requests, you know, asking in person first is more personal, but it's good to always follow it up with a formal, you know, email request or a thank you email for them agreeing to write your letter. That can kind of formalize the request and serve as a first, you know, reminder for them. Providing guidance is something that I've done along the way in my application cycles. Sending the letter writer your CV, reminding them of any shared experiences or impactful experiences that you had together, maybe sending your personal statement, or if you want specific qualities highlighted in that letter, be open with them and let them know, you know, what you're hoping to get out of the letter. I think both sides kind of appreciate it. As far as a reminder, don't wait until the deadline to ask about, you know, where's my letter? Maybe give it two or three weeks and at that time maybe send an email kindly reaffirming your appreciation that they agreed to write you a letter and include the application deadline in there. Ask if there's anything else you can provide to help move things along. And don't forget to thank your writers that are taking time out of their days to write you a letter and support you in your future endeavors. And don't forget to keep them updated on your journey and on your interviews. It looks like we have another question from the panel. It says for first-year fellows who are just learning the basics of endoscopy and are unsure about their aptitude for advanced endoscopy, what things can help them determine whether advanced endoscopy will be a good fit for them? Okay, great. So actually it's a good question for me. I'm just over a year out from my first attending year, so I'm still not too far removed from you guys as fellows. But I would say when I think about determining your interest in advanced endoscopy, it's not so much, in my opinion, about your aptitude and your skill level especially as a first-year fellow in terms of being able to scope, but more thinking about what really excites you about fellowship and thinking about, you know, when you're doing endoscopy, is that the setting when you feel really energized? Do you feel like you have the capacity for longer procedures? Because many of these procedures are more complex, so it's almost in a way sort of like a surgical field in a way. And do you feel comfortable being able to do longer procedures? Do you get gratitude from being able to participate in complex care of patients in multidisciplinary settings? There's a lot of that within this field. So just kind of paying attention early on, what setting really excites you? Is it more clinic? Is it more long-term care with patients? Or do you really get energized by endoscopy? I think those are all great points. Your skills will continue to get better as you progress through your fellowship. And even though you may be struggling in your mind during your first six months, you know, we always tend to overemphasize our weaknesses. And by the time you reach, you know, your fourth year, you're more than likely be ready to jump into that fellowship. So don't let those early struggles deter you. But yeah, I think it's certainly what motivates you. I mean, for me, I always thought, well, if I didn't do a first year, I felt like I might've been missing out on something. And so that's, that's kind of, you know, where my passion lied during my general fellowship. And I think the other thing is that maybe not emphasized enough is what is your risk tolerance, you know, or your tolerance for risk, because complications will occur. And oftentimes those complications do occur more common, although they're still, they don't happen a lot, but compared to general procedures versus advanced procedures, you will encounter more complications. And so, you know, are you willing to take on, you know, those complications when they do arise? And I would also just add one more thing that you will be on call much more frequently than your general GI colleagues. Because you will be taking, you know, ERCP call, which is oftentimes, no matter which practice setup you're in, whether private or academic, invariably leads to more call weeks. So you have to be sticking around in town. I would say one of the benefits though, especially if you're in a big academic center, is that they do separate out general GI fellowship, general GI service from advanced endoscopy service or from interventional service. And so, at least in my experience, I've found that the work-life balance is actually very reasonable. Obviously, it depends where you end up. But I also don't want to deter a lot of, especially female applicants. A lot of women, early women fellows will ask me, you know, is it really that bad lifestyle and you're working there super late every day? And it really depends on the program, obviously, where you end up or your position, how busy of a practice it is, and whether it's all interventional or whether there's a mix with general GI. So I just don't want to discourage some people if they're worried about work-life balance, because you can certainly find a position that fits you and your goals. I think, yeah, that's I think a good statement. It's not too long of hours, but then again, there are a lot of programs where the day stretches to 9 p.m. I think a lot of places as an advanced endoscopist, you do do general GI. At our place, we do cover general GI on-call service, which is, I think, very common when you talk to advanced endoscopy colleagues across the country. So I think even if you go through a third year, you will be doing general GI at a lot of places in some form or fashion, both inpatient or outpatient. They're all great points to keep in mind. So moving along through the application, the next section is the CV. So the ASGE application includes uploading a copy of your CV, as opposed to previous application systems where you input the information. So it might be a good time to start working on a document of your CV if you don't already have one. Here are just some broad categories to think about that you might want to include in your CV. Obviously, you have your background information and your education, any leadership or awards that you've received, any teaching experiences or involvement in societies or committees. I'll highlight the publication section, whereas in past applications, published abstracts and manuscripts would be lumped under the same category. Since you are uploading a copy of your own CV, try to separate manuscripts from abstracts to save the program directors from having to search the abstracts and see what's been published and what's translated to a manuscript. Try to keep them in separate categories, as advice that I've received in the past, and I'm not sure what the panelists think about that. So what are some key components of the CV that our panelists, that you look for when considering a candidate? Is there a place that your eyes go first on the CV when you're scanning it, or places that you feel should be elaborated upon more? So when you're working on your CV, I think because it's, I suggest that, at least that's what I did when I was preparing for my application, is that because it's, there's no format like the prior ERAS applications, like Michelle highlighted for internal medicine residency or during your fellowship, have your CV reviewed by, by, I suggest, several mentors. Make sure it's very clear and coherent. All titles are pretty clear. One of the advice, and I think Michelle highlighted that on, is that make sure to separate abstracts from published manuscripts, because most of the advanced endoscopy fellowship programs are at high volume academic centers, and the people reviewing your application are well versed in all sorts of publication, and they can easily tell that apart. And do highlight any sort of leadership committee involvement that sets you apart, specifically if you had any sort of awards in publishing advanced endoscopy videos. This is one thing that came up during my interviews, that if you had any experience of making videos as you learn and grow slowly in advanced endoscopy, that's, that's a large part of, large part of what advanced endoscopy is, how they share their skills and expertises by making videos. I would like to request if any of the other panelists have any other input on what their eyes goes to, go to first, like what is the first thing when you look at the CV, what is the first thing you look for? And everyone can give, like, you know, one, one thing that, that's important to them. One thing I, I look at is kind of like a combination of education training and publications, because I feel like if the applicant comes from a program with, let's say, very productive advanced endoscopy public publishing attendings, then you kind of correlate that to the number of publications versus someone who comes from a program that might not even have advanced endoscopy, then the way you interpret the number of publications and research experience should be different. So it's not just an absolute number of your research experience. Some people may not have the same opportunity getting to work with advanced endoscopy mentors, but may have seek out, like, other mentors, and then they might have more publications. So all of those combo kind of look in combination. And then I would go into the publications and kind of look at the title of their prior publications to kind of gain some insight in terms of, like, how long have they been interested in this field? And then that kind of, like, built the story with their personal statement. Obviously, with a CV, I think everything you do is extremely important. Personally, for me, I know I'm going to spend a year with you as my fellow. And so for me, I'm looking at the biography, the hobbies, the education. I try to get a sense of who you are as a person through your letters of your recommendation and your CV. At this point, my personal opinion is at this point with 150 or 125 applicants, many people are very similar on paper in terms of academic achievements. You know, you've gotten to this point, GI is not easy to get into. You've done a lot of work to get where you are today. And so I really want to see also outside of your academic achievements, which, again, are extremely important. But I want to try to get a sense, like, are you somebody that I'm going to enjoy staying at the hospital with till 6, 7, 8, 9 p.m. or long call weekend? So I'm trying to understand who you are. So that's where my eyes go is what on the CV gives me an idea of who you are as a person. I agree with Manka. Well, you know, basically, you know, everybody is highly talented with strong work ethics. You have worked hard. That's why you are in the GI fellowship. You're looking for somebody who is reliable, who is conscientious, who will be working hard, is passionate about the field. So as Pichai mentioned, we are looking at the, you know, when I'm looking at the publications, sometimes you see a lot of publications, but they may be just all videos. And then how do we set them apart? You know, what is the publication content? You have somebody who really has worked on, you know, registries, which requires a lot of work. Somebody has published 10 videos. So, you know, you give some context into, you know, what kind of work you have done that tells us an idea how many midnight oils you have burned, you know, you were up gleaming through the patient's records. And then obviously adding letter of recommendation. And then finally, who you are as a person outside. Then I think when we are trying to gauge, we try to match, you know, this is just a little bit of an insight when we as a PD look into this with the virtual platform. There are, you know, there are a lot of applicants, and then you guys interview at a lot of places as well. So you probably already have in your mind, what are the geographical locations you're looking at, either for personal reason or family reason. For example, somebody in California, they studied, they grew up there, their families there, they're interviewing at our place in Cleveland, Ohio. Then the big question I need as a, you know, interviewer is, are you really interested in coming up for a year to Cleveland to train with us? So just try to get a little bit of an insight about those possibilities. Yes, these are all great points. And leads us into our next slide, which is going over where to apply. So this can be somewhat of a challenging decision. Obviously, there are only so many programs out there. So you do want to apply broadly, but you don't want to apply randomly. So really take the time to research the programs ahead of time. You can do so on the ASGE program search that shows you what procedures a program offers with links to the websites. Think about what geographical ties you might have, any family considerations that you wanted to take into account. Is there a specific niche that you're passionate about that you wish to pursue? And does the program offer you that training? Definitely feel empowered to reach out to current or past advanced endoscopy fellows to ask questions about the training, the environment, see if it fits, you know, what you're looking for in a training program and if it aligns with your goals. And at the end of the day, make sure you're only applying to the programs that you would truly want to join and those that align with your goals. You don't want to rank a place where you would be unhappy if you ended up. So that's definitely my biggest piece of advice. So this is the ASGE program search that I was referencing. You can find it on the ASGE website. You can see that, you know, you can search by procedures offered that you wish to learn, by location. And as you go through it, you can also link to the website and find out more information there. So question maybe to Dr. Seelock, what would you recommend for applicants who have maybe geographic or other limitations and when applying for advanced endoscopy fellowship? Yeah, I mean, if you're limited geographically, I mean, apply to all those programs in your geographical area. I think the other thing is that you'll want to reach out to the programs probably, you know, directly. It doesn't hurt and specifically tell them that, you know, hey, for whatever reason, I'm applying only to these, you know, X number of programs and this is the reason why. And I think it shows to those programs that you're certainly, you know, more motivated to come to their particular program, you know, for geographic limitations. And maybe to Dr. Girapino, you know, since at your program, there are separate tracks offered, bariatric track and for people who have interest in other subspecialties of advanced endoscopy, how do you feel like that should play into the application cycle? Do you feel like, you know, they should apply for and learn ERCP first, followed by, you know, trying to refine their skills in the other subspecialties? Or do you think going, you know, on a bariatric track directly is something that you would advise? Yeah, it's very tricky. And a lot of fellows ask this question. So I think at the end, it depends on each fellow. If you truly, truly want to do just bariatric endoscopy, I mean, I would encourage people to just apply for bariatric endoscopy separately from EUS ERCP. But if you see yourself doing kind of like a combination of both, then the question would be, would you have to talk kind of one-on-one if you should go for bariatric first and then EUS ERCP or EUS ERCP first, or like vice versa. The caveat is that right now there are only two programs in the country who offer a dedicated bariatric endoscopy fellowship. And both of our programs, including ours, we interview six months before we start, while for advanced endoscopy, you apply 18 months before you start. So we just have to kind of talk and see what is best. From my personal experience, I do bariatric and then EUS ERCP. I thought that was a good sequence because I feel like once you get the ERCP in, your learning curve is like this, and you want to keep doing ERCP at a high frequency and high volume after you finish your ERCP year. While for suturing, at least at our program, you get 300 suturing cases within one year, you kind of get over that hump, you get over that very steep learning curve, so you can do less frequent number during your ERCP year. So that's usually my recommendation if you have, if you're very fortunate like me to like pick what sequence you want to learn. Okay, so at your institution, the bariatric endoscopy is offered in third year or second, correct? Yeah, so in the past, if you are internal fellow at our program, you can do bariatric endoscopy during your third year GI fellowship, but we do offer it to fellows who graduated third year fellowship from outside programs. For example, two years ago, Rasha, he completed his GI fellowship at UH and then he wanted to do both bariatric endoscopy and EUS ERCP. So we had to talk a lot about what sequence, how to apply, and then he ended up doing bariatric with us. And then during the bariatric year, he applied for EUS ERCP or yeah, and then he got into the EUS ERCP year with us as well. Okay. I think similar, a similar question for Dr. Seelock as well. Baylor is like a huge hub for third space endoscopy. How do you address this when you see applicants who were asking like, do you think we'll feel, we'll be competent in POM and ESD after advanced year? Yeah, I mean, I can, I can really only speak to our program because I can really only speak to our program. You know, Mohamed Othman and Salman Jawed are here, who do a lot of third space endoscopy. What we tell applicants is, is that you will get exposure during your one year, but we won't train you to competency in third space endoscopy. The emphasis of our program is still EUS and ERCP, but we're certainly, you know, you'll be in the room and get some, you know, early experience with third space endoscopy. I know Dr. Othman has talked, was starting a third space, you know, training year. But I think potentially one of the hurdles for, you know, multiple programs is, is funding it, you know, it always comes down to funding. And that's kind of one of the limitations that they face. But yeah, I think, I don't know if anybody has any experience with programs that, and to my knowledge, I'm not necessarily sure if there's programs that are solely dedicated for third space endoscopy. And, you know, the program that comes to mind is the one with Dr. Dragunov in Florida, where it's still, you know, EUS, ERCP, and then it's an additional six months of, of third space, you know, thereafter. I believe Nouriel Fukami at Mayo Arizona had pioneered kind of like a dedicated third space endoscopy fellowship. And this is a separate fellowship from EUS, ERCP, similar to our bariatric fellowship. For that program, I believe you go through the ASGE match, right Shifa? Yes. Yes. Dr. Pena, just like in last year's endo hangout, and you should have access to it online. Dr. Fukami was invited. And yes, there's a Luminal Fellowship Program that's separate from Pen Cradle Buildery. Feel free to review that Endo Hangout on GILeap. A question for Dr. Sachdev, how do you feel when, if there's an applicant who's based in Arizona and wishes to apply for a program, interviews with you, and is also considering to stay there? Is this something that's welcomed? And I know like there's certain programs that do not necessarily welcome competition or will have applicants signed on competes. What are your thoughts about that? So actually our program, we never actually had a fellow sign in on compete, but we would have what I call a handshake agreement. And the issue for a lot of programs is volume. You know, where there are more and more people moving into cities. So I can just use Phoenix as an example. When we started our program, you know, our volume for ERCP and EOS was probably close to a thousand of each procedure a year. At that time, there was only two or three advanced endoscopists in the greater Phoenix area outside of Mayo and the University of Arizona in Tucson. And as the volume grew, we started to see, or as the people moving to town came in, we started to see our volumes decline. So we made the decision just to ask our fellows, we said, listen, if you come here, we are going to ask you to not actually sign and not compete, but give me a handshake agreement that you won't compete against us unless we hire you. What happened after that is our practice was acquired by a private equity and they actually formalized it. And anybody joined the practice, irrespective of whether they were a fellow or a attending, had to sign a non-compete, you know, in their contracts. It's tricky because like Arizona is a state that doesn't recognize non-competes and we have it there. And I've always told every fellow that we're never going to sue you or come after you. It's just more that we don't want, you know, more competition in the area. So, you know, we support it, but I get it. You know, it's tough because people have to live somewhere and you have to work somewhere. And so, you know, like I was never going to be in a situation where I was going to sue a fellow or go after them or anything at all. And we always made that clear. It's just, you know, we just hope that you won't compete against us. That's how it turned out. So. I wanted to go back to the third space and just give an example of what has happened, at least with one of our fellow graduates. She, Tara Kahanian, had done her advanced year here and was, you know, at the incompetent USCRCP, had gotten some exposure to third space and then eventually became a faculty member and chose to work where Muhammad is working. And then through her employment and ongoing interaction and basically, you know, an informal extension of her fellowship, even though she was faculty, is now competent and does quite well in third space endoscopy. So that's another avenue, if that's a particular interest, is becoming a subsequent faculty member with a program that has an established, you know, third space, you know, program. And I think that the flip side to that is you're absolutely right, Dr. Sivak, is somebody who has some USCRCP experience under their belt during the General GI Fellowship. If they're coming off really, you know, no experience whatsoever, then it's virtually impossible to learn USCRCP and then, you know, bariatric or third space in one year. But if you come up with some USCRCP number, what is that number? The entire panel will give you a different answer, but most everybody would agree more than 150, 200 range or so you're very comfortable with USCRCP. Then you can spend time learning resection or bariatric during your advanced year. Yeah, totally, Dr. Shahal. We, for the past five years, we had two fellows who came in with more than 150 ERCPs that they got during their GI fellowship. They were able to get more comfortable one person with endobariatrics during their fourth year USCRCP year, and another person was able to pick up third space to get comfortable, and then you keep learning on your job after that. I think that's the benefit of, you know, if you're going to a bigger advanced program is you have the ability to kind of tailor your fellowship, particularly during the latter, you know, six months into, you know, specific areas that you're even more interested in. Just a follow-up question in the chat box, Dr. Bellis, before we move on about where to apply. There's a question about visa sponsorships. So just to review this previous slide, if you go to the ASG website and look up programs, they do list if they sponsor J-1, H-1, or no visas. Dr. Bellis, you can take over. Yeah, I mean, we've touched on the niche segment already. To be honest, this is something that I myself found stressful at the time that I was going through interviews, and I know many applicants do as well. It's a question that, you know, is coming at a lot of interviews, and as much as I wanted to have a definitive answer at that time, I did not. But just, you know, letting our future applicants know that it's okay to not know. Don't stress if you're not sure. The areas of focus that I'm referencing include endovariatrics, third space, interventional EOS, which is offered at most programs. So sometimes you might be asked, you know, what is your specific area of interest within advanced endoscopy? And it's okay to start thinking about it, but it's also okay not to know. But if you do have a specific interest or passion, make sure that it's matched by what the program can offer you, and that program search can be a good resource for that, as well as reaching out to the current and past fellows to see what they've been able to accomplish at that program. A question for the panelists. If you're interviewing an applicant and they're sharing that, you know, we are passionate about third space, endovariatrics, do you typically try to, like, gauge their passion by, like, looking at publications or who they have worked with? Or this is something that, you know, this is something, okay, I, you've gotten, you enjoy doing it and you've seen it and you want to be more involved with, is it okay to say that without having, like, a solid background? Emily or Pichai, you want to take that? I would say, I would say it's okay, in the same way it's okay to not know, you know, exactly what your long-term goals are going to be, but obviously it's ideal to have some experience because experience, whether it's hands-on experience or publications or working with a mentor in a particular niche, but if it's something that is still pretty early, that in terms of what you've been exposed to, I wouldn't shy away from expressing your interest in it. Yeah, I agree with Dr. Jahnica, where it is nice if you had some experience working either on research or something clinical, let's say for bariatric endoscopy, and that's how you got really excited about it, but not uncommonly, a lot of people do not have access to that. And sometimes the applicants are very honest, which I love, that would be like, okay, we love the lectures, we learned about this field from going to DDW and that's how I got into it. And then they start maybe writing a chapter, like something very little, just to explore more, and that's why they want to dive into this niche. So maybe just something to show that you pursue your interest, but it doesn't have to be a lot. I think that will make us kind of like see that you're passionate about that field. But some people might go above and beyond, some people like really know, really sure, they might come in and say like, hey, I'm planning on taking like obesity medicine boards, all of those help, but not required. I think one suggestion that I can give is, yes, you can pick a niche, but probably spend some time talking to faculty members as to what your future is going to look like. For example, if somebody says they're just gonna do bariatric endoscopy and not learn EOS, ERCP, what kind of job would you be looking at? What kind of procedures would you be doing? Then you are looking for a backup if the patient needs edge procedure or need EOS, ERCP, gastric bypass patients. So think it through before you settle down and okay, this is all you're going to do and learn and spend rest of the time during the year and not rest of your life. And also what's the job market out there? I think that's just important, think of these things before you commit to a particular skillset. Yeah, believe it or not, like this year, we are interviewing our next bariatric endoscopy applicant for next year. And it is the first year that all applicants are not planning on doing EOS, ERCP year. All of them just want to do dedicated bariatric fellowship this year. So it is feasible, but like what Dr. Shahal was saying, right now, it's almost, especially in academic, it's almost impossible just to have like a dedicated bariatric job without doing general GI if you don't do EOS, ERCP, for example. So you need to know that going in. I just want to chime in on one thing about when you say you want to do a certain field, whether it's bariatrics or third space or whatnot, then you really need to know your audience. So for example, our program is a, well, I like to use the term general advanced endoscopy fellowship. We don't have a strong third space program. We don't have a third space program. We don't do a lot of endobariatrics, but if somebody on their application is applying to my program, and they talk about their personal statement, how all they want to do is be the next third space master, they're not getting an interview with me because I'm not going to be able to provide them what they want to be successful. So I think that, you know, you also have to, some people tend to have the personality trait where they over tell what they want to do without really knowing a lot about it. And I think you have to know yourself and you also have to know who you're applying to and what that program offers. And the resources that Dr. Bailey showed, looking to see what programs offer is very helpful. I think in follow-up to what Dr. Sajdev said, there's a question in the chat box that, if you're interviewing at an academic program, but your primary interest is to go into private practice following that, should you try, does that dissuade academic programs for considering you? Well, if you look at the data, more than 50% of advanced endoscopy graduates, they go into private practice. There are no academic jobs for all 75 graduates every year. So no, realistically, all of us in the academic world know that majority will be going into private practice or hybrid. Yeah, I think it's really important to really understand that because every single applicant will, not every single, but most applicants will tell you how they want to do a job in private, in academics. But we all know that it's, you're gonna end up in private. I'm in private. I never actually intended to, but that's just the way family responsibilities and everything came out. That's how I ended up where I was. So I think that it's foolish for program directors to assume that everybody's gonna go into academics, but it's also, the world is such that we have to have private practice interventions as well. Before we move on to interview and rank order list, another question that always comes up is how do program directors perceive gap years and other fellowships? Like if someone has been a general gastroenterologist for five years and now applying for advanced endoscopy, is this considered a negative or a positive? And if an applicant has done general fellowship and then like transplant or someone like me who's done a pancreatology fellowship, how do you perceive that? I think sometimes these gap years are necessary due to visa issues and your chance of matching in advanced endoscopy is higher if you can eventually get your green card just because more programs, it opens more programs up to you. I think what we look for is what did you do during that gap year? You're a general gastroenterologist, but did you make any effort to interact with the advanced people either at your facility that you're working at, whether it be academic or private, or did you make connections within the advanced endoscopy community more broadly? Did you do any academic activities during that gap year? So that's kind of what we look for. To add on to that, I think the why is the most important. Why do you wanna be an interventionist? If you didn't transplant hepatology fellowship and you come and say, I wanna be a third space endoscopist, the why of that is extremely important. But if you tell me you wanna be an endohepatologist, that makes a lot more sense. So I think the reason and why are you transitioning from what you did, and it could be a visa issue, which is perfectly okay, but what's the reason from going from A to B? So we'll move on to the interview section. There are so many things to talk about when it comes to the interview. So I thought we just try to answer some commonly asked questions. And one of the questions that comes up really early on in every cycle is, is there any comment on how interviews will be conducted this year? Last year, it seemed to be a hybrid of some programs doing virtual, others doing in-person or virtual, whereas some did in-person only. Is there a general consensus on how things are going to happen this year? Or is every program kind of making their own decisions regarding that? I think we are going to be virtual, but I do offer in-person. And anybody that we interview, if they're interested, I'm happy to arrange it for them. For our program, we receive GME funding. And so we have to comply with whatever GME tells us. And to my best of my knowledge, it's still virtual interviews. And so that's what we're planning to do. But if people are interested in doing a in-person look of our program, we would certainly help accommodate that as well. Is anybody doing in-person? How about you, Vijja, or? Yeah, I believe we're going to do virtual again, but similar. Virtual again? Yeah, where if the fellows want to come check out our program, we always welcome them. When I spoke with a few other programs across the country, I think everybody's sticking with virtual. Yeah. And then another question that comes up is, if you've determined after an interview that a program is going to be your top choice, what is the best time to reach out? And what's your advice on utilizing mentors and the timing of when you would want to know that information? I mean, personally, I feel like if you ask your mentor to reach out your number one program, I think that is helpful. But if your mentor is reaching out and say that you are my top program, I mean, that word is not helpful. So just pick one, the one that you want to rank number one and then ask your mentor. I think that's a fair game. Yeah, I agree. And maybe what do you think are some important questions to ask about a training program in general? Maybe Dr. Silak or Dr. Sasha. So, I mean, I think, so you're asking me what questions should you be asking about the training program in general? I mean, I feel like a good question is always going to be, you know, what are you going to become good at? You know, what are they going to make you, how are they going to help you become the best version of yourself as an advanced endoscopist? I think that's a question you need to ask yourself. And during the interview, you should be focusing a lot of your, because you're interviewing them as well as them interviewing you. So you're trying to see how are they going to, you know, maximize your potential. All right. I think volume is really important as well. It can be a little bit hard to gauge that during the interview, but talking to the current fellows is really helpful and getting a sense for how much, how quick the attendings are to take the scope away. Those were questions that I was sort of interested in and again, the variety of procedures, whether they're doing interventional EUS and other things that are aligned with your goals. But I think volume is really important, especially with COVID. There were bed shortages for a while. This might've been more relevant a couple of years ago, but it kind of affected patient volumes, inpatient cases. And so kind of gauging that from maybe the current fellows. You know, the volume and hands-on number of faculty that are there to teach, if you're looking for a third space or a section, do they have multidisciplinary programs set up? Do they have tumor boards? You know, that is a skillset that you will learn. It's not just the technical part. The cognitive part is also very important. What's your day-to-day? What is your week going to look like? What's your month going to look like? How many call weeks? Do you have clinic? Do you have inpatient service obligations? You know, are you covering the call? Are you taking ERCP call? If you do, what time of year? Are you allowed to travel? Do you have CME? Is the program set you up and open the doors for you? Does it have faculty who can do that? If you're looking to stick around in academics, will they be able to help you for a job in private practice? So I think those are some other things that I would be looking at. I think the others is, you know, you're applying a year and a half before you eventually become a fourth year. And, you know, a lot of things can happen in that year and a half. So asking the program, do you foresee any, you know, changes? I mean, just for us, for example, you know, we have two new ambulatory endoscopy centers at two different pavilions at our county hospital and at our now university hospital. And so, you know, for us, it's been, you know, a big, big growth and, you know, for the incoming, you know, fellow, this wasn't really even on his radar, but it does impact. Fortunately, it's an impact, you know, for the better because our volumes will just continue to go up. So it's also something else to inquire about. Yeah, that's a great point. Sometimes program, they add fellows as well. So for example, if you are signing up and you were supposed to be the only fellow and next thing you know, you join and you have one or a couple other fellows that you'll be sharing volume with. So I think it's important to know whether there'll be some out of match fellows as well in that program. I think another thing that is worth asking and hopefully it's discussed, you know, early on during the orientation, you know, prior to your interview for this specific program is how is the fourth year fellowship funded? For us, the ways that we funded the program, honestly, it seems like it changes every year, you know, in terms of what your clinical instructor responsibilities would be. But that can really, you know, impact your fourth year. Fortunately, you know, for us, we have GME funding, and so our fourth year fellow is not responsible for doing any clinical instructor activities now, which allows them to dedicate a lot, you know, solely to the fourth year. But hopefully that's disclosed early on. If it's not, you certainly want to inquire about that. Okay, so moving on to the rank list. So creating your rank list can be a really exciting process, but sometimes can be difficult. Some people approach it from the standpoint of going with their gut based on how each interview feels, and others like a more systematic approach. And so for that particular group of people, there are some great resources out there on how you can actually come up with a score for every place that you interviewed based on things that you're interested in. One of the resources is the Doximity article I've included up here, you can actually download the Excel sheet from this article, you can create categories of things that are important to you, and then weigh those categories. And then within those categories, create sub sections of, you know, different, you know, for example, no research equals zero, strong research equals two. And through the spreadsheet, you can plug in the things that are important to you and actually generate a score from each program. I'll also shout out to Dr. Judy True, who moderated this session previously, she shared her method, which is quite similar. And it's a matter of assigning weights to different categories of things that are important to you in a program, and generating a score that can maybe be combined with your gut feeling to help you generate your rank list. So I'll just leave it at that, just some piece of advice on the rank list for those who are interested. Maybe Dr. Janica, would you like to share how you came up with your rank list at the time of your interviews? Sure, that was definitely one of the trickiest I remember sitting down with my husband and then just just trying to hash it out, like really think about what are our priorities. We did end up doing a year separate. So he was in Denver, and I was in Seattle, and I will say that year goes by really fast. And so if you're able to be a little bit flexible, flexible about location, just remembering for most programs, it's only one year. So I wouldn't put as much pressure on that compared to some of the other important aspects. But just kind of going with your gut, like what felt good about the interview? What made you excited meeting different faculty? Did you click with anyone in particular, and again, just thinking how it will meet your goals and having making sure that there are faculty there again, who can really support you when you are doing your job search, because that's going to come up pretty quick as well. Once you're halfway through your fellowship, and so making sure that you have you'll have strong mentors who are willing to support you and getting a sense from the current fellows there to what their experience was with job search. So I think all of those things were important. I did apply to a lot of places, I remember, that were kind of geographically spread across the whole country. So it really just kind of was thinking about what cities would I want to live in? And what places did I really click with that and that will meet my goals? Thanks for sharing. Just some final tips when you make your rank list. Don't wait till the last minute, create a preliminary rank list, share that with your mentor with a family member, get their input on it and come back and revisit it. If you have any questions that were not answered during your interview that you really feel will help you make a more informed decision, reach out to, you know, current fellows or past fellows or faculty, and in the end, make sure to actually submit and not just shuffle things around until the last minute. You hear kind of horror stories about forgetting to hit submit in the end, so definitely make sure to verify you've completed that step. And I'll pass it on to Dr. Umar. Now that you've matched into advanced endoscopy, so what can you do to make the most of your year in training? Having recently graduated from advanced endoscopy fellowship, I can quickly reflect on things that really helped me out. So it begins from you found out you matched into advanced endoscopy. What can you do prior to starting your advanced year? First and foremost, I suggest even if you're not matched and you're interested in advanced procedure, try to spend as much time you can with advanced endoscopist and advanced endoscopy rooms. There are various ways of doing things, and the more you see, the better you learn, and in the end, you become like a hybrid version of everything you've seen at different institutions that you've trained in. I did that during when I was a general fellow, I also did it during my pancreatology year, I spent as much time I could in advanced room and with advanced endoscopist. If your institution allows, request clinic, outpatient clinic with your advanced endoscopist. I can reflect on my own story, I did a pancreatology fellowship prior to my advanced year, and that fellowship became the foundation of my decision making during my advanced year and to till date as a junior attending. Most fellows who progress from general GI fellowship to advanced year have to take their GI boards, typically in the fall of their advanced year. No matter where you go for advanced endoscopy fellowship, it will be a busy year, I highly suggest preparing for your boards beforehand, so you don't have to stress about it. Review guidelines, society guidelines from AGA, ACG, ASG on indications for endoscopic procedures and for surveillance and surgical referrals. I highly suggest going to the ASG website and reviewing the techno-tech assessments. They go over not only endoscopic techniques, but also equipment like biliary stents, pancreatic stents, enteral stents, RFA devices. This is a good overview to familiarize yourself with the various advanced endoscopy equipment available in the unit. Review video teaching resources, namely ASG has GILeap, which is free for fellows, has several educational videos including ERCP bundle sets and EUS sets that can be highly instructive in preparing you for these procedures. What can you do during your fourth year? Again, ASG has courses throughout the year, namely the fourth year fellows course, which I highly recommend. It is again free for fellows to attend and I highly encourage it as a resource for learning and training and even ASG has other courses throughout the year like suturing courses, EMR courses, which have subsided registration charges for fellows and some of them are still free for fellows in training. I was personally in Chicago, so I went to every single of these courses. Then throughout the year, you will come across several institutional courses and they have fellows grants. If you can attend them as your schedule allows during your third year or fourth year. These are not only just like great learning and educational environments, but also a great way to network because this is a smaller group of people. It's a great opportunity to discuss potential jobs, research collaborations, and like future opportunities for proctorship. Let's say if you are a program which does not have periatric endoscopy and you put a course and Dr. Girapinio is there, you can ask her like, hey, can you come proctor my first ESG when I'm ready? And then DAW and ACG also has hands-on workshops that are free for fellows as well. Lastly, I really emphasize on this. I know my program did that is like familiarize yourself with your industry reps in your unit. They are very eager to teach and always available. They're happy to go over equipment and even can set up animal labs for you. Let's say if you want to practice suturing or use of ESG knives, they're more than willing to do that. And for me, at least my reps in Chicago, when I was moving to Houston for this job, they also introduced me to the reps in Houston and helped me with this transition as a new attending. So briefly, just in the interest of time, life after fellowship. When you're thinking, I think we've highlighted that multiple times during today's ENDO Hangout that when you're thinking about advanced endoscopy, you really have to be clear about what's your vision for your life and what's your motivation. Because advanced endoscopy, and I'm sure the panelists will agree with me, it's not a profession. It's a lifestyle. These procedures and patients are very, very complex and require a certain level of commitment before the procedure and after the procedure. You will be losing your sleep on them. It is somewhat demanding, the calls, the schedules, and working with the... You're not just like an isolated physician. You're working with surgeons, radiation oncologists, radiologists, and whatnot. So pause and think, what sort of practice setting do you see yourself at? How much money do you want to make? Where do you and your family want to live? In short, just self-reflect on your several years of training and decide what you want from life. The route I took is I prepared my own manifestation list. When I was thinking about what I wanted next, what sort of a job I was looking for, I made a... I call it a manifestation list because this is how I manifested my job. I wanted to be at a place where I could have an academic niche, have teaching and training opportunities. Most of my family is outside of the United States, so I wanted to be closer to an international airport. I needed visa sponsorship. I was looking for a program where, as a junior faculty, I have an opportunity to grow. If I wanted to start to pick up a new skill or start a new procedure, they were supportive of that. That means not only just the GI division, but also your colleagues, like your surgical colleagues or interventional radiology or hepatology. For example, you want to start endohepatology, or you're someone who wants to do more international EUS or endobariatrics. You want to make sure that your surgical colleagues and IR and hepatology are on board. I wanted to be in a program where I'll have continued academic mentorship. I was looking for a program where the faculty is involved in national societies and there's representation. Lastly, but most importantly, where I could focus on clinical medicine without thinking about barriers for equipment purchase, experimenting new technology and reimbursement. This, in short, was my manifestation list. Now I'll open it to the panelists about sharing their experiences when they were looking for their careers or jobs after fellowship. I would just say one point, guys. I think define what is utopia for you. Well, first of all, there's no utopia. What are the things that you're willing to compromise? And what are the things that you think you don't want to compromise? In all probability, you will not be getting 100% that you were looking for. And all the items on your list, you will not be able to check off. What is the number? Is it 60%, 70%, 80% that you're OK with? Is that something that you have to figure that out on your own? A piece of advice I got from my mentors when I was trying to get ready for my fourth year was learning how to tech is as important as learning how to candlelight. So if you're at a program where there might be one room and it's occupied by the fourth year fellows, then one thing you can do is to go in and then offer your help to be a tech or learn from the nurse or the tech so you are more comfortable with the device. And then another piece of advice I got during the fourth year was that this is a very clinically heavy year. So your productivity from a research or academic standpoint might be less. You should really focus on clinical skills. So that's the mentality I had going into fourth year. And I echo that. I would really try to make the most of your third year of general fellowship. I actually felt like that was when I grew a lot and I was so happy that match was at the beginning of third year. So I had that entire year. All the interventional faculty really took me seriously and wanted to prepare me so that I would look good at my fourth year fellowship as well. So there was a lot of both internal and external motivation all around. And it was just a really good learning experience. And obviously, it's going to be different where you come from if you have opportunities to learn from interventional staff. But if you do have those opportunities, I would really try to do that to pursue that. And then I echo the importance of really learning, doing what you can, whether it's watching videos, learning equipment, just because then the more you build your confidence and your skills and your knowledge going into your fourth year, the sooner that the faculty there, especially if it's a new place, the sooner they'll earn your trust and they'll let you kind of jump in and then they'll be impressed by you. So you have one year and it'll go by really fast. And so the soonest that you can really embrace all of that and gain the trust from your attendings is really important. Yeah, I would agree that make the most of your third year because as Shifal was saying earlier, everything happens quickly. You're going to start your fellowship, your fourth year, and you might put things off because you're preparing for your boards. And as soon as the boards are done, it comes on to looking for your next job. And you always have something in the background. So the more you do in that third year to prepare for the fourth year so you can have focus mostly on your endoscopy and your learning in your fourth year is better for you. I think going back to your job, looking for jobs, mentorship is important. And it doesn't necessarily have to be academic mentorship if you're going into a private practice. Do they have somebody there that can help support you when you do get into trouble or you have a failed cannulation? I think it's important for me. I was fortunate in the fact that I had ongoing mentorship after I finished my fourth year. Honestly, the biggest time of growth for me as an endoscopist was not during my fourth year. It was during that subsequent year to two years is where I really learned, I think, the most. And I was fortunate to have people help me during those subsequent couple of years and really grow during that time. So I think that's important. I mean, some of these jobs you see, they're searching for a person with the US ERCP experience. And it looks enticing in the fact that you're going out and you're the sole guy in Amarillo, Texas. I grew up in Amarillo. But there's a downside to being the sole guy. You don't necessarily have somebody to come in the room and troubleshoot with you or give you additional ideas. So I think that's something else to look for. That's a fantastic point. That's one of the reasons I took the job. There was a, Dr. Das was my mentor for the first six months. I mean, I suffered after my fellowship from imposter syndrome. I didn't really think that I deserved to be where I was or that I was good enough at my procedures. But having a senior person there to kind of back you up and reaffirm that you know what you know is always, there's not words that can describe how helpful that is. So just to conclude, in the interest of time, I'm going to echo what Dr. Chahal said. There is nothing, nothing is 100%. Whether the advanced endoscopy fellowship program you match into may not be 100% of what you wanted, but the first job you'll end up, if you always have that the glass is half full approach, you'll always find some sort of satisfaction and contentment. Any concluding remarks from our panelists? I think I would like to say, Michelle just took a comment. Michelle introduced me as a course director, which I'm not. I think this was already set up. I think Shifah, you came up with that idea last year. So, but I'm just, but great to be part of this panel. So thank you so much. Yeah, and I just want to congratulate everyone on picking this field, such a satisfying field. I've enjoyed the process. To me personally, I think it was a great experience and I think it's the most fun interview and application process of all that we have done throughout our training career. So have fun. I'll just also echo, thank you for including me and anybody who's listening to the webinar or even today, feel free to email me if you have any questions that you were afraid to ask in this or you didn't want to ask in this forum. My email address is available on the ASGE website. So. Best of luck to everyone. And you may think it's your last personal statement, but I've subsequently wrote, I think, at least two personal statements as a faculty member for additional awards and everything. So you may not be done yet. Yes, it's certainly not going to be the last. That's true. This might be where Chet GBT helps, I don't know. Not that I'm advocating that, but. The same personal statements will become obsolete in five years, probably. But anyway, feel free, likewise, to reach out to me via email. We actually don't have an Advanced Endoscopy Fellowship at OHSU, but I'm very recently out from fellowship. So happy to answer any questions. No pressure. And all the best to everybody. Thank you, everyone. Good luck. Good luck for everyone applying. And thank you, Dr. Bellis, for that excellent moderation today. Thank you, everyone. Thank you to all of our content experts, our GI fellow moderator for tonight's excellent presentation. Before we close out, I want to let the audience know to check out our upcoming ASGE educational events and to register. You can visit the ASGE website for the complete lineup of 2024 ASGE events. Right now, here's a snapshot of it. We have more events coming, and we have more events on the site. Our next Endo Hangout session will be Protecting Yourself and Your Team, a session on ergonomics. And that'll take place on Thursday, February 8th, from 7 to 8.30 p.m. Central Time. Registration is open. At the conclusion of this webinar, you will receive a short survey, and we would appreciate your feedback. Your experience with these learning events is important to ASGE, and we want to make sure we offer interactive sessions that fit your educational needs. As a final reminder, ASGE membership for fellows is only $25 per year. If you haven't joined yet, please contact our membership team or go to our website to sign up. In closing, thank you again to our content experts and GI fellow moderator for this 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.

ASGE Endo Hangout

Advanced Endoscopy Fellowship

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technical skills

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personal statement

publications

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CV

selecting programs

work-life balance

career in Advanced Endoscopy