We've got about 20 minutes left for you guys to ask any questions. One thing we did have in this course that we've taken out, and I'm going to just make a plug for another course that ASG is running as a full-day course on the thing you don't get in your training, is what you're going to do next after this year is over. What job you're going to get, what direction you're going to go, and that can be valuable. It's valuable enough that we've started offering a full-day course. I'm not sure when it's coming up, but maybe Ed can ... Senior fellow. Senior fellow. It happened. Happened already. And it was great. Okay. I was there, but it was really good. Were you there? Oh, that was in Austin? Yeah. Yeah, Austin. The fact that it was in Austin, it was really good. Had people from all different types of practices. I learned a lot. This is the time to give your feedback, et cetera. I don't know. Do you want to start us off? We've got about 15, 20 minutes left. I think, resoundingly, the faculty in the room will tell you that the first year out is the hardest year of your entire career. And I think the biggest reason for that- Let's go to another case. I just wanted to say thank you. All right. sitting over your shoulder, grabbing your scope for you, telling you what to do. Oftentimes, you're out there alone. But I think to counter that point, you're going to come out very well-trained. And you just have to trust your own abilities and stay within your comfort zone when you're starting out. You've formed a network of mentors already, right? When we start with internal medicine, we're paired off with a single mentor. And you think that you need to stay one-to-one with your mentor. But now, you have mentors that can help you with research, that can help you with contract negotiation. And so keep in contact with those people and call them in the event that you need them, even if it's during or within a case. And you'll hear your attendings' voices kind of rattling around as you're doing things. Depending upon where you end up, you really have to search your soul. We all say during fellowship interviews, I want to be in academic practice. I want to publish. I want to work with learners. You may not want to do that anymore. And that's OK, right? And also know that it's not black and white. There are hybrid practices where you may be affiliated with a learning institution or you may be doing research, but you're a private practice model. And I think we're also biased regarding that dichotomy that private practice doctors are just rolling up in their BMWs, scoping a few patients, and then leaving. But no, you're probably honestly working. You're working for that money that you're getting paid for. I would say take this time now not only to think about those things, but think about what's important in your life, right? Do you want to be near family? Is there a geographic area of the country that you want to be in? Do you have a friend that's scoping at an institution? Do you want to be near that resource? And educate yourself regarding your finances, right? There's tons of things for physicians and health care providers where you can educate yourself. The White Coat Investor is a great resource. If you have student loans, that is a huge impact on your finances moving forward. And public student loan forgiveness does happen, regardless of what you may have read. But you have to be at a non-for-profit institution. And so studentloanplanner.com, which is Travis Hornsby's website, and I'm not getting paid by any of these people, that's a really good resource for student loans, too. There's podcasts. There's books. I would say at least educate yourself with one of those things. Before you start, this is the only time period until you retire when you're not going to get called on vacation, like Dr. Chuck was talking about, by surgeons, by oncologists, by other GI providers to help out. You're not going to have an inbox that's piling up. All of our emails right now are crazy high, because we're sitting hanging out with you guys. So before you start your job, travel. Take a couple of months off, if your contracts allow, because that's the time in your life when you're going to have total freedom. And then reconnect with family and friends, these people that you've neglected for the last seven years that you haven't seen. You're a normal human being again. You get to do the things that are fun and enjoyable. So start to think about those things that you used to do before you joined the medical pathway. So I guess that's the gist. And then go back to being abnormal. Well, you're always a little abnormal in this field, right? I have a comment, and then I have a question for the faculty also. Comment-wise, I think I speak for all the faculty that we really enjoyed working with you guys. We're really proud of the work you guys have done. The videos have been outstanding. We kind of give you guys all the constructive criticism, but fundamentally, we're all very proud of the work you guys have done. You guys are the next generation of pioneers in endoscopy, in video making, in storytelling. And do us all a favor and pay it forward as you guys go through your careers. I think that was the best advice given to me. It's like, all the stuff we teach you, pay it forward, because that's how mentorship works. A question for the faculty. There was a really good question that was posed to me that I kind of know my answer to this, but I want to see what other people think. And that is, when you guys record videos, do you get consent, or do you tell the patient? No. We have a sense and true consent for all professional conference teaching and education purposes. As a competitive statement, we have a form. We have each patient. In the institution, we record each and every case we do. No matter whether you want to do it or not, we just record all the cases, unless you explicitly want not to record it. But we record. So when it comes in, we do ask, is it OK to take the video for what an XYZ purpose is? I'll ask a follow-up question to that. If you walk into a case and you know the patient's kind of apprehensive and you know that this may be a risk to you, is a video discoverable? So yes, any part of the patient processing, including the video, email, send, all that is deeply discoverable, yes. I think that brings up a bigger question. With these new cloud services, they are always recording. Every single procedure that you're doing at any time is now on a cloud. And the question becomes is, if there was a complication, an adverse event, now legally do they have the ability to go to that cloud, find out what happened in that procedure, and review those cases? And I think as these modalities of video recording grow, I think these questions are going to become important. I think when you perform a procedure, you take photos. So these do not need consent, pretty much. But we do have a consent for obtaining video that is embedded in the procedure consent. Like, if you agree to get a video, some people say yes, some people say no. So at where I am, we have it in the consent form, but not for getting regular photos during procedure, because it's a part of the report. But not all patients would like, patients I think who would like to get a video recording of the procedure would say yes, and they can get a copy, and vice versa. But regarding recording, it's the patient's choice. Like, do you agree to recording your procedure, yes or no? So it's in the consent. So it is in our consent form. I admit that we don't tell patients about this particular instance associated with the video recording. I'll just say that radiology is a little bit ahead of us, because their CT scans, MRI scans, all that stuff is actually on whatever server they have. It's available for any physician or expert to look at. Often, there's discrepancies in interpretation regarding CAT scans or MRI scans. And I think we need to meet that standard as well. And I suspect that in the next couple of years that endoscopic video recording is going to be standard, and that it is going to be available to anybody who wants to review a video to figure out where we can actually do something better. And this is part of quality and endoscopy. It's not to be punitive. It's designed to make our system work better. It's designed to find systematic ways of doing endoscopy, standardized ways of doing endoscopy that's going to improve the quality of care for our patients. So I think we're going to be moving in that direction. From an ethical standpoint, from what I remember, last time I looked at ICMJE, the international whatever of editors, case reports, and I think it's up to six, the ethics was that because they're educational and supposedly retrospective that they don't fall into guidelines where you're supposed to consent people for just doing a case report. But anything more than that, and the discussion when you read it is on ethics of how many and what purpose, and did you think you were going to do research and publish before or after, and just the burden that would exist. So those are exempt from at least those guidelines and ethical decisions. The legal part, I think, is interesting. But I think if you are video recording, that should be discoverable. And that's responsible. That's part of the whole procedure. Regarding most of you, I mean, you guys are doing a great job, getting great training here in the US. But if you happen to be citizens of another nation and doing this like I was in the past, I think considering coming back to your native country is a very valid option. I know there might be limitations on income. There might be limitation of availability of certain technologies. But believe me, you'll be able to make a difference there. So this is something that you have to keep in mind, of course, if you are. That's what I did. And I spent about 18 years there. And I do not regret it. I ended up coming to the US for different reasons related to what is happening in my country. But if you happen to be in a country which is politically stable, you will be able to make a bigger difference there. How many of you already started looking at jobs and or have been on interviews yet? Or and how many of you are, you know, this difference between academics and practice or is sort of a, like Schaefer says, there's a whole blend. But how many of you are going, thinking of academics, practice? How many of you know what you're doing or are going into community practice? And how many don't know? That's good. Do you guys have any burning questions? I have a quick question. So I've heard that once you're out of academics, it's hard to come back into academics. Is that kind of true? Or it is just variable on what you do outside academics? Not true. I was in private practice for a year and a half. So I've been in academics after that. I don't know if you guys have all heard of Bennett Roth, you know, the Rothnet. Roth was in private practice in LA for many years before he went back into academics and joined the faculty at UCLA. Also, the president of the ASGE, there have been plenty of private practice people in a few years. So it doesn't limit when you turn to an academic faculty. And vice versa. People stay in academic for years and then they join private practice. It's whatever makes you happy. You may not know till you do it. You may want that Rolls Royce, but you don't want to be on call at three hospitals. You had a question over there. Thank you very much. We know that, I would say, the bulk of the training is being hands on in the endoscopy suite and just to master all of these great skills. But what are your advice when it comes to the resources that we can go and read about, like the advanced endoscopy field? Like, would it be a books, or like the guidelines, or like a combination between them? So just like I was interested to hear from our mentors. Good question. I think I can start a little bit first. So before we forget, we also want you guys to go up to the ASG website. They came up with an EOS guidelines recently and adverse events management. So look that up. The training committee came up with a lot of the core curriculum on third space. They're on POM, balloon, resections, et cetera. So make sure you make yourself aware. I personally, I read all the journals and I subscribe to a couple of websites. That allows me to highlight at least 30, 40 journals related to pancreatic ability stuff. So I get everything notified via that. And plus, also, all the societies, they send out these short email blasts on what are the journal scan. Like ASG has journal scan, which gives you all the pertinent articles that got published in variety of top to GI journals. So I subscribe to those, and that's how I get my information. For advanced endoscopy, yes, there are a lot of books available. Everybody has their favorites. You have Haas. You have, I think, Bhutani book. And then there is ERCP, a few ERCP's books that you can refer to before you start. I think also the guidelines are useful, and it kind of depends on what the clinical question is. Like you heard the presentation yesterday on the pain in the pancreas area. Sometimes the European guidelines are the most accurate of books. And Dr. Dragunov has a book on third space endoscopy, a five hour, but it's a really good resource for building up your base. There's also the ABCs of EUS, and there's a free EUS app if you want to get the visual spatial component down in a little more of a solid way. I think those are helpful. I always read GIE, every single one, cover to cover, just to stay current prospective. And there are ASGE teaching videos. If you go on the teaching video library, they are on interventional EUS, and a lot of third space teaching videos, and then on necrosis, necrosectomy. So they are excellent 60 to 90 minutes long videos if your program can put some money on it and buy those for you. How many of you are ASGE members? I hope training members might be required for the course. But just to put in a plug, if you join ASGE and as training members, you have access to G.I. Leap and the quality of what's going on in G.I. Leap. We used to tell you to read the CVAC textbook because a lot of us knew Mike and trained with him, but textbooks are now getting outdated and having the format of things that you can access on the web, just like you do up to date. Looking at video and education and lectures is valuable, and it will keep growing and keep educating. ASGE, for the EUS training that they're doing in people out of community, have put together a web-based syllabus, which I think is terrific. We can convince the people who have copyright, if that becomes accessible, is again going to be a great teaching tool. And those tools will grow. So subscribe to G.I. now. They'll give you access to a lot of that information. Also, sometimes learning is not being fed to you, like you're now seven years post-graduate training. Sometimes you have to ask your mentors. Do you recommend an article that's relevant for the duration of the course? I think asking is helpful. And now you know us, so. Any questions you have, we all love to answer questions. Very accessible. So you can email or call Dr. Chuck any time, day or night, and he can answer all your questions, if you want. So thanks for coming. It's 12 noon. The time flies by, but this was terrific, always fun. Any last words? Are we going to choose a first prize, or do we have a first prize, or are we going to forego the video? Yeah, group C, the first presenter. If you can see me, I'll send you an e-gift card for Amazon. You can buy everything. Who was group C? Is that supposed to be anonymous? It was anonymous, but I'm sure you know who you were. Do we want to? You want to stand up? Don't be shy. Thank you.

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