This is fun, and especially for those of you who are just starting out, Ashley asked me to just sort of talk about what you might have to look forward to as you embark on your career in therapeutic endoscopy, and I think most of the people in this room will be able to tell you what they enjoy, just my disclosures, which is part of the fun that you do get to work with some of these companies and get to create and invent. But you have to be careful as you go in, you know, you have to have that balance. You need companies, any idea that you come to, you could cure cancer and it's not gonna mean a thing unless someone can make money off of it. And so you do need those commercial partners to take your cure and get it out in the community, but you also have to be careful that you don't get directed so much that, you know, realize when you're using the term Axios or FTRD that there's a reason for that branding. So I loved this when David Letterman came up with the top ten and what generation are we in now? I guess I'm showing my generation, but you may not remember the top ten, but my top ten reasons for choosing a career in academic endoscopy started, you know, when I started I couldn't decide whether I wanted to be a surgeon or whether I wanted to think, and the great thing about GI in general is you get to do both. You also get to collaborate with engineers, you get to collaborate with your colleagues, any ideas that you come with, it's fun to be in a group and think of how do you challenge this, how do you do this, and that's what's been happening the last day and a half as we see cases that others present. You know, it's kind of cool to get a few numbers and be able to say you have a patent, even if the patent doesn't go anywhere, but it does look good. Still trying to get rich, I'm not giving up my job, but someday maybe, but seriously, you know, last evening we just sat outside and people, I never knew Vivek knew so much about cars, but you come to these courses and you give up your weekends because it gives you an opportunity to make some great friends in this society and as you go along. We do, even though we're doing endoscopy, we advance our knowledge and get to learn something about gastrointestinal diseases. We were playing yesterday when we were in there with the courses and working with different, you know, you go back to being a child because you've got just better toys. We really do advance our knowledge as technology goes on. There's new stuff happening, there's constantly something that you're learning and applying to your practice, but the other thing we do as we come up with, you know, GJs or putting a Vesco's here and taking out full thickness things, we're making our patients better and better, but I think my biggest reason the top 10 is just there's a joy in what we do that you never lose after so many years. There's always something new, I never regret going in to do a day when I've got, you know, even challenging cases. Sometimes the night before you're a little bit worried, you may not sleep, but there is a joy when you're successful. If you are going to go into, you know, academics gives you a chance to do different things that talk about three different shields, three different methods, but we break it down. You got to excel in endoscopy and taking care of patients. It can't just be the endoscopy, it's got to be the whole patients that you're taking care of. You got to also, you know, all these people who are here, they're excellent teachers. You know, I was at the station yesterday where I started and the model wasn't there, there was no endoscope, we were trying to teach liver biopsy, and I just stood there where Vivek just said, no problem, and he just started discussing it and just showed people how to do simple stuff like doing a liver biopsy or work with a needle. So you've got to have that skill to verbalize and be able to teach people how to do endoscopy. And then the third thing is if you want to advance your field, you've got to excel in coming up with new ideas and doing research or studying what you're doing. How many of you are thinking of going into academics endoscopy? So the one thing that no one ever teaches you is once you go in, what promotion is and what tenure is, and I'm not sure, I still understand it even though I've been promoted. When you start looking for jobs, it's important to try to understand, each institution has this archaic process that makes no sense, but you do want to try to understand it and set your career goals at the beginning to figure out how you get promoted, what service do you have to do, what teaching do you have to do, and tenure is not provided mostly to clinical faculty, and that's fine, you have to, they're different tracks, they're there for reasons, we're not going to be able to do what's required of the tenure process because tenure becomes expensive for academic institutions, but every institution is going to ask you to achieve some degree of excellence, and you're going to demand it of yourself, that's why you're in here, and participating in events like this, being part of teaching courses, coming to, you know, constantly upgrading your knowledge is part of how you develop that excellence, and then giving that knowledge to others, and wherever you are academically, there's going to be, you're going to have to publish, and promotion committees are going to want you to do research publication. You've spent like eight, nine years now not writing a thing or writing acronyms like HPI and NAD, and you've forgotten how to write English, it's going to be hard to go back and learn how to write in English again and express and verbalize you, but that's a very valuable skill, and you'll have to re-energize some neurons that have been lost or have been dormant for a while. For clinical care, there's always a yin or yang, you know, everyone was talking about the number of cases, and it's a labor-intensive field. When you start, people are going to be coming up to you and saying, can you do this case, so-and-so's not present, can you help out, even though it's not your time. Don't, you know, always be available. Don't say no, because I've got to go here or go there. Try to help people as much as you can, but you have to balance that. You don't want to say no, but you want to protect your time for doing research, you want to protect your time for your family, so it's a constant struggle, it's a balance that you have to learn how to achieve. Take on, you know, those difficult cases that are a challenge, but also know there's someone with you who can help you if you need to or know when to back out. I mean, the biggest learning in that case that Vivek showed this morning is knowing when to stop. You know, know your limitations, know how far you can go, don't feel you have to succeed everywhere, there are other alternatives, there are other people who can help. You know, you've got to be available for your patients, that's the most important thing, it's not the endoscopy you do, but you've also got to have time for your family to keep that balance. So, you know, don't get tunnel vision and get so into doing endoscopy that you don't make time for other things in your life. To be clinically excellent, you know, you're already on the path where you're getting the proper training. Train in what you're going to do. If you don't, you know, if you're not going to do ESD, then don't. If you're going to do ESD, then get enough training so you can do it well. Maintain your skills, choose your institution where you can practice what you're training and what you want to learn, and continue to come to courses, read, watch, and learn from other people so you stay well. And if you're going into academics, you know, develop a niche for yourself. Some of it will come naturally, but become really good at one thing in your field that complements what your partners are going to do wherever you learn to practice. You can't be good at everything, so find what you're good at and develop that and use that as your basis for your academic enhancement. And then, you know, the fun part of this is there's something new that someone else develops, and you have to go learn from them or come to courses and learn, watch things and learn. That's what keeps you young and energized, and there's always something happening even after so many decades. Then comes teaching. If you're going to teach well, you first have to learn how to do it yourself. You know, once you've gotten mastery like that last video showed, the reason he was able to express it so well, as Bill said, is because he is a master. He understands what he was trying to do, so he was able to express it so well. But when you get that mastery, then you start to be able to teach it. And teaching, when you're teaching someone, you're actually learning yourself. You know, being at this course for all of us, we're a little better at what we do because we tried to express it and explain what we're practicing. Remember, right now, you get focused, but there's someone standing behind you who's sort of itching when you're doing something that they're not most comfortable with, but they bite their tongues and they stay patient so you learn from—they don't want you to make a total mistake, but they want you to struggle, and their patience is what allows you to teach. When you become the teacher, you have to remember the patience that they had and be able to let the fellow give them a little bit of a leash, but know when to get them to stop. And teaching takes time. When you've got a busy schedule and you've got so many cases to do, and the fellow walks in the room, you have to give the time and you have to be able to delay it and catch up at some other time. It does require patience, it requires time, and it does require effort, but it's rewarding when you see your trainees improve. Teaching also, if you want to be really a good teacher, you have to innovate, so it's not these three silos of patient care and teaching. They all overlap. If you want to do good patient care, you have to be a good teacher. If you want to be a good teacher, you have to be a good researcher. And this is sort of what Dr. Raju was, I think, trying to—you know, challenge your students, expect more, really push them, but be prepared that they may disappoint you at times. So Mike Sivak was my mentor, as he was a mentor of several other people here. Mike was the guy who wrote the original textbook of endoscopy. He was around to do a lot of the novel things that we now take for granted, and he became the youngest ASG president. He was a leader in terms of developing ERCP in this country. Sclerotherapy was the first guy, first one to do electronic endoscopy in this country, one of the first to do US, was the GIE editor for eight years. If you ever do come to Cleveland, we have a Dittrick Museum where the ASG endoscopy archives, if you want to see the lamplighter scopes or rigid or semi-flexible scopes, come. We'll be happy to take you there, and also started one of the first, what now have become a standard advanced endoscopy fellowships. When it was started, people used to say, why do you have to do an extra year? And there was a big controversy. But look at all the trainees that came out of this program. Jacques Vendam was one of the first, Mimi Canto, Deepak Agarwal is now at UT Austin leading it, people who've gone abroad, and then some of the people who are in this room and have stayed within our program. So he's fostered a large number of people who have progressed and continue to expand the knowledge and the love of endoscopy. So Mike was the ultimate teacher, and there's some phrases that have gone from him to others to, Sagarika still uses some of them, but when you have the urge to push, do anything but push. Position, position, position. Fast is better than slow. When you dance, do you look at your feet? And all colons have personalities. I still use this and love this. But Alan Barkin wrote this, is if you're a teacher, you have to have some degree of mentoring potential. You have to have a vision and give feedback to others. You have to energize your mentees. You have to invest in in them and open doorways for your mentees. Challenge them and also counsel them as far as their career goes. But the mentees that you will have also have some obligations. They have to have a respect and interest in that relationship, and sometimes you will be disappointed, but for every nine that disappoint you, the tenth that ends up being a superstar will really energize you. Be a willing recipient who assumes, if you are the mentee, then you have to assume the responsibilities. And taking responsibility, it's a two-way relationship that the mentor also benefits, and the benefit the mentor gets is when the mentee actually improves and goes out and becomes independent. You know, watching that growth is what the mentor gets as a reward. And then finally, the third part is you'll be starting a research career. You're already starting a research career. And what I do is find, you know, it's not that you want to take your mentor's ideas, but find your own ideas. Whatever gets you passionate, whatever clinical challenge you encounter in practice, that's what's going to tell you what to develop. It really has to be a question that excites you. Research is time-consuming, and you're not going to do it just for doing it. It has to be an inner drive because that question, you want to answer that question. But, you know, we really don't learn how to ask questions or answer them. We don't understand epidemiology and statistics when they teach it during medical school because it makes no sense. But when you get a question that you're trying to answer, and then you start to figure out how do we answer it, and you go to your epidemiologist and statistician, and they tell you how to do it, then it starts making sense, then it starts getting applied, and you have to have someone you collaborate with. You will have to get funding in this day and age, but get help, write grants, small foundation grants to ASGE, ACG, local institutional grants will help you get funded. But in the end, you know, when you do your research, you have to share it, and you'll have to, your mentor will help you, but you're going to have to learn how to write it and publish it. So for writing grants, you know, again, identify exciting questions, develop the right study design, find those funds, go to workshops, institutions have it, your societies have it, and find someone to mentor you who's good at writing those grants so you can get those funds so you can pursue your questions. And finally, just like submitting that video, which I know all of you are going to do, publish, publish, publish. Go back to writing regularly. There's an inertia and there's a fear of writing. You just have to overcome it. Write concisely, less words are always better than more. If you've got anything new, you have to communicate it, otherwise no one will understand it. Ask for help, and you'll get criticized, you'll get rejected, but that which doesn't kill you just makes you stronger. So if you are going into academics, it really does become your calling, and it becomes your life. But as you contribute to your chosen profession, I think all of us who attended this, you know, you go home with a sense of gratification because of what we've done in the last couple days. It goes without saying, you have to provide the best care to your patients, you have to teach, you have to pass on the knowledge you get, get your new ideas, you know, you do need to advance the field. And to success as a researcher, find a mentor and write it, publish it, so we can learn what you're doing. Thanks.

career in therapeutic endoscopy

balance with commercial partners

independence in decision-making

collaborative environment

continuous learning

academic promotion process