informal open panel discussion. All four of our panelists are gonna introduce themselves. We have a wide variety of practice types in phase and career, so they're gonna introduce themselves, tell you a little bit about where they're at, and give you kind of their top tip for how to make the most out of your fellowship. And then after that, you guys are free to answer, ask any questions you want to the panel. Again, just use your microphone so everyone in the room can hear you and the virtual audience can hear you. I'm starting. Whoever doesn't have food in their mouth. Good afternoon, all. I'm Kunal Jaju. I'm an interventional endoscopist at Brigham and Women's in Boston. I'm also the clinical director of the division, so I oversee clinical operations, both inpatient and outpatient. So happy to chat later if there's questions about different leadership pathways across careers. My one tip to get the most out of fellowship, I guess, would be if you get protected research time, make full use of it. I think that, you know, take the break, you know, whatever, the first couple of days after a long inpatient consult session, take the break. But try to take as much opportunity because it's very hard to get protected research time that you don't have to beg, borrow, plead for afterwards. So that'd be my tip. I'm Daniela. I'm an advanced fellow at Mayo Clinic right now. This is my second year. It's a two-year fellowship there. So I'm fresh out of fellowship. I think I have two major advices. One is you'll be busy, so I'm not gonna lie, you'll be busy. And I think to make the most of your time, the way I kind of studied throughout my fellowship is I didn't, you know, accumulate papers to read later. I kind of learned with each patient interaction. So, example, they called me for suspicion of colitical atheosis. So instead of, you know, saying I'll study this later, during that same, you know, I saw the patient and afterwards I just quickly went into the guidelines, read, you know, the highlight tables. And kind of when you have low suspicion, what do you do? When you have a high suspicion, should I go directly to ERCP, should I order an imaging? So that way, with each patient, I kind of like quickly read a guideline or up-to-date and kind of grab, you know, the important aspects of each patient. And that way, throughout the three years, you'll end up learning a lot. That's one advice I would give. The other thing is have a very good relationship with your consultants. So you're gonna be tired, you're gonna be, you know, at some point they may call you with four consults, you may get a little bit overwhelmed. So take it easy, never answer in a bad way, be very professional. And take that opportunity to learn yourself, teach your consultant in a very respectful way. And again, the relationship, it's very important because at the end of the day, if a consultant actually likes you, they'll be very nice with you. A particular experience I had is I was on call from a Friday night all the way through Saturday. And I didn't get any call that Friday night. I'm like, wow, I didn't get called. And then the next morning at 7 a.m., one of the hospitals calls me. And she said, you know, Daniela, I saw you were on call Friday through all Saturday. And I felt sorry for you, I really wanted you to rest. So I decided, you know, maybe I can wait until the morning, until I call you, I know you're responsive, you'll call me back. I mean, if I call you, you'll respond well. So I said, I'll wait, if anything comes up, I'll just call her later. So I ended up not being called, I guess because that hospital just liked me and wanted me to rest. So at the end of the day, it will pay back. So be nice, never respond in a condescending way, and that will help you out. Hi, everyone, apologize for my voice. I wish I had been partying in Chicago last night, apparently I was so passionate during Tools of the Trade that I lost my voice, and then this morning. My name's Maryam Naveed, I am a gastroenterologist at Advent Health in Orlando. It is actually a hybrid system. So we have our medical group, there are a lot of my colleagues who are in the private practice side, that they don't necessarily work with our fellows. And then we have core fellowship faculty as well. So a hybrid system, and I am the program director for the GI fellowship there. As far as my advice is concerned, a couple of things. I think number one, what I tell the fellows is that it is a privilege to be sitting where you are. There are a lot of your colleagues and friends who probably didn't match and didn't have a positive outcome. And the reason I say this is because three years, even though it feels very long, and each call and each inpatient rotation feels like an eternity, it really does go by in a blink of an eye. And I think all my colleagues here will attest to that. And of course, when you're faculty, you always have opportunities to go to other CME courses and do additional training. But I really miss being able to learn from others around me. And so frequently I'll ask my tech, be like, oh, so and so, what are they doing? Is there something cool that's out there? Or how is X, Y, and Z scoping? Because I miss that. I miss being able to step into another person's room and learn something from them. And yes, like I said, those opportunities are there as faculty, but then you have to like cancel your clinic, you have to go somewhere else. And so take advantage of the fact that you have that opportunity right now. And yes, of course, I'm not suggesting that you violate duty hours, but you know what? If you can stay and watch that one more scope, do it. If you can stay and do that one more thing. And I think the other thing in terms of taking advantage, you know, sometimes I'll have my fellows where say it's a double, and everyone is so focused on colonoscopy because they're like, yeah, endoscopy, I've mastered that. And they'll step out and they'll say, I'm gonna go see this patient. I really don't need to do the endoscopy, but I'll be back for the colonoscopy. And inadvertently what happens is that they have missed me treating an ulcer. And I've used bipolar cautery, I've injected, and they come back and the colonoscopy is like totally normal. And I'm like, look, every scope, every patient is a learning opportunity. And so don't take it for granted. And be a sponge, take in as much as you can. And by the end of the third year, you really then will be able to kind of put it all together and develop your preferences, your technique, and what you want to do. And I would say the other advice that I have, or two more really quick things. Number two, and even though I said, be a sponge, do everything, this is a really fun three years. And the fellows that you're with, and the people that you're sitting next to now, and who you meet at DDW, that is your network moving forward. There's so many people that I went to fellowship with, that I trained with. And it's not just friendship that's resulted from that, actually a lot of opportunities that result from that. Because then X, Y, and Z goes on, and never underestimate how well someone behind you is going to do. And so stay really humble, because that resident that you're giving a hard time, may match into GI fellowship, and maybe the next like advanced endoscopist leading something else. And they're gonna be like, that guy was a jerk to me. And you know what, I'm not gonna invite him. But the flip side is that you're kind, you're humble, and you meet someone, and down the road, they're like, hey, you were so helpful. I have this symposium. I am now the GI endoscopy director. Would you come and give a talk for us? So a lot of these networking, and it may not happen right away, gotta cultivate these relationships. And down the road, kind of rise together, that your co-fellow, or whoever you're sitting next to around you today, maybe the person who's reaching out to you and saying, hey, I'm directing the first year fellows course. Do you wanna come be faculty? So have fun as well, and enjoy this process. I certainly had a great time, and not that I wanna go back, but it was fun, so. My name's Judy Staub. I'm at the University of Utah. Oh, Utah people right there. And so I am a, I do pretty much all clinical work. I've been out of fellowship for, I'm starting my third year. So I also was very recently in your shoes, and can answer questions about what it's like to transition from fellowship to attending hood. But I see a mixture of general GI and IBD patients in my practice. And I guess a couple quick things that I would, little tips to give, I think, echoing some of the things that you said. One thing is, all of your attendings are gonna do things differently, which I think can be a little bit frustrating sometimes. But I would say that take each day as it comes with your attending, and just do things the way they're doing that day, and try to understand why they do that. Because I think it helps you grow as a whole person, endoscopically, clinically. And so taking little bits and pieces will come together for you. So I think that's one important thing. Another important thing I'd say is don't ignore clinic. So I think it's easy to get hyper-focused on endoscopy, but pay attention when you're in gen-GI clinic. That's become a big part of my life. And I think it's really important to know how to care for those patients. And yeah, so I think those are just a couple things to mention. Do you guys have any questions? Well, and I wanted to echo something else about the endoscopy part. So try to scope with as many attendings as you can. Every single attending will have a different kind of technique, a different tool that they can teach you. So try to scope with esophageal experts, advanced endoscopy. Everyone has a single, not even a single, maybe they have more than a single. You'll learn from each single attending. And at the end of the day, at the end of your third year fellowship, you'll realize that you've grabbed something of each one into your technique. So try to scope as much as you can, and as with many attendings as you can. Thank you. You don't have any questions? Yeah, open the floor to you guys if you have any. Surely guys, you guys are one month in. There must be some burning questions. You guys hypoglycemic? Are you waiting for the food to kick in? What's going on? Okay, there's one in the back. Recently finished fellowship. What was like the most fun part of fellowship for you? I wish you would start off. The recently finished fellowship, what was the most fun part? Honestly, I think the connections that you make. You'll make friends with your internal medicine colleagues, with your GI co-fellows. Even attendings, you may be reaching out later on. So I think it's more the, in my perspective, yes, GI is fun, but it's the human interactions that I think make a great deal of your fellowship. So again, get along with your co-fellows. Be nice to them, because you'll be in contact for the rest of your career. I think one really fun thing is you're finally doing the thing that you're gonna do, right? So everything you're doing feels that much more meaningful and awesome, and I think it's definitely like a fire hose three years, so you're kind of getting hammered, but loving it every step of the way. I think seeing yourself progress feels really nice, and I think endoscopy's kind of cool because of that. Like you can achieve these little goals, and I think that's just really, like how can that not be fun? Like you can see yourself get better, and I really love that about fellowship. I mean, and then that first year, when you're just like, oh, I really do know how to do this. The learning curve as a first-year attending is just amazing, and it's so different than anything else we knew, college, med school, residency, fellowship. The learning curve as a first-year attending is amazing, and you do that kind of look back like, oh, what am I supposed to do next in this situation? And then you wait, wait, I know what I'm supposed to do next in this situation, and the satisfaction of doing it correctly those first several times. Like you said, doing what you wanted to do this whole time, waited so long, made fun of all your med school classmates for going into surgical fellowships and then doing seven years of training yourself. Eight years training. From the virtual audience. So the question is, I guess you guys can each answer, how did you pick going into academics versus private practice? I can start. So I am, I'm 10 years out, and this is sort of advice in my journey, sort of combined in one, is throughout your, and many of you may already have done this, or may do this, I think it's super important as you're going through to learn to pivot. And what I mean by that is that, yes, you're finally a gastroenterologist, you're in, but of course there are a lot of opportunities even within GI. And for me, if you had asked me what I was going to do out of fellowship, the answer was very different than where I ended up. So I trained at a very academic center. So my medicine was at Duke, my fellowship was at UT Southwestern. And when I came into fellowship, I came in hell or high water, I'm doing advanced endoscopy. And all my mentors were advanced, my publications were advanced. I'm part of a two-physician family. And my husband, because he did his PhDs behind me in training. So when he matched, he matched elsewhere. So all of a sudden, I was faced with the decision where he was going, there was not an opportunity for an advanced position. So even though I had a fellowship position, I couldn't take it or I did not take it because where I was going, there was no faculty position. So I learned to pivot. And it just so happened that they were looking for an APD. And this is at Iowa. Now, I am like coming out of fellowship. And I thought, well, what's the worst they're gonna do? Say no and be like, okay, well, thank you so much for offering your services, but I don't think we need a young APD. But I asked and they said, okay, we'll give you a try. And that's really how I stepped into GME, again, at a university setting. And I was there for nearly five years. And after that, my husband applied for a position. I should tell my husband he's had way too many tries or too many opportunities here. But anyways, for him, what he was looking for was actually at Advent, which did not have a fellowship. It was purely private practice. And it was just not my calling. I knew from the start I wanted to stay in academics. But again, I had young kids and I said, okay, I'm going. And I did reach out to other programs around. And so I went, the pandemic happened. It was just a very interesting time. And then Advent came to me and said, will you start a fellowship? You have GME experience. It wasn't a lot, but I had experience. And so I really reached out to my mentors, all those people I was telling you, make those connections, your fellowship mentors, your PD, et cetera. Those are the people I called and I said, this is insane. I don't know how to start a fellowship. I understand how to run a well-oiled machine as APD, not been PD, and I've certainly never submitted paperwork. And I will tell you this, in your life, you'll have mentors and you guys can attest to this. You'll have mentors and people that you call who will make you feel okay about your decision. They'll say, it's fine, you're okay. You did the right thing. Yeah, you're okay with it? Great. And then you have some mentors where you call them and you're like, I'm a little bit afraid. And they'll be like, what do you mean? Roll up those sleeves, and you get in there. And you do what you're afraid to do. And you have to sometimes know which mentor to call. I really wanted to do this. For me, it just so happened that I wasn't very happy and satisfied in where I was in my career. And so I called the person who I know would say, would you stop being afraid? Roll up your sleeves. I got your back. And my entire fellowship, my PD, my mentors, and they were like, we'll help you. And I submitted an application to ACGME, and I started the fellowship. So now I'm back to academia. Now, that is my calling, and it doesn't have to be everyone else's. But the lesson here being that you can start off, and your path can be as squiggly as they come. But don't forget that sometimes you have to build your opportunities. And sometimes that network, that mentorship, I never thought I was going to call my PD. I mean, I'd call him socially, be like, how's it going? And this time I called, and I was like, hey, I need your help. I'm about to do this. Will you help me? And they were like, absolutely. And I still call them. So I hope that answers the question and also teaches you guys to be flexible. Life will take you in different directions, and sometimes you just have to go with it. Yeah, so for me, this is not a Utah recruitment session, but I did my residency and my fellowship at Utah. Just absolutely loved it. I mean, the people were people that were just like me. And then I did look around at different jobs in the area. And I think it took some digging deep to think about what the important things are. And I think private practice, there's different kinds of private practice, and they probably offer different things and have different call schedules and those sorts of things. But for me, the things that felt important were the sense of community, I think, that you get with academics was important to me. Continuing to learn with my peers and mentors that I had been with for a long time doesn't hurt that the call schedule is amazing. And then when you're attending, the fellows take your call. So the things that you're doing now I used to do and don't have to do anymore, which is nice. So I think there's just some lifestyle things about academics that were great. And I think there's also just a ton of great community and ongoing opportunities that it gives you. But I do think I'm sure there's private practices that allow for those things, too. So I think you just have to kind of investigate what's in your area that you want to live in and think about what's really important to you. I guess we don't have a good private practice representation to answer this question. But I've been in academics my whole career. I knew that I wanted to do interventional endoscopy, I think, starting my second year of GI fellowship. And for me, I think just the breadth and width of opportunities in academics, both clinically and academically, is just more than I think anybody could find anywhere else. And then just being able to train fellows every single day is very satisfying for me. So I didn't want to lose that in any way. I don't think I would enjoy GI if I weren't training fellows. There's one more question from the virtual audience. Maybe a couple you could answer. It just said, if we were interested in advanced endoscopy, when would you recommend starting to try and get involved in advanced procedures? Early as possible or after we feel comfortable with the basics? One year in, kind of. I'm supposed to be on this panel, I guess. I'm Eric's mom. I just added him up. Sorry. Sorry. Everybody hear me? I'm sorry. So I'm an interventional endoscopist. University of Chicago. I've been here as an interventional fellow in Colorado. This is a great question. I think expectations should be set on what you should be doing in general GI. I don't think you should be necessarily doing complex ERCP or doing an axios placement or anything like that or getting exposure on POM and ESD, high-level endoscopy procedures. I think it's fine to express a genuine interest, but you really should get the fundamentals of upper endoscopy and colonoscopy first. And then start saying, look, I want to learn how to pass a side viewer, for instance. Or once the attending has some downtime on a diagnostic US where things are not as high risk for a complication, say, hey, can you show me some of the stations and get your hands on what a scope looks like, like a therapeutic endoscope or echo endoscope or a radioscope or whatever. I don't think that's necessarily inappropriate to do during your general GI fellowship. I think, though, you shouldn't necessarily have to get a certain amount of numbers. I think you should get some basic fundamentals of what the scope is, get some exposure with passing a side viewer during your general GI. I think advanced endoscopist training, there should be zero expectation that you've got x amount of numbers already at all. But I know that's a long-winded kind of answer. I would say for the first couple of years, you really should be focusing on getting good scope control with upper endoscopy and colonoscopy first. Start doing that stuff late second year, third year, where you want to start getting some maneuverability with side viewers and whatnot. But your focus should be becoming the best general GI doctor first, and then kind of expanding upon that scope control that you've gained over the three years and maneuvering that towards a dedicated fourth year. Yeah, I would like to add something to that. So I totally agree. I think, especially on your first year, you're learning how to do an EDD, how to intubate the esophagus, how to reduce looping when you're doing colonoscopies. I do think, though, maybe during your first year, yes, doing an ERCP, it's not going to add much. Again, you need the basic skills to get there. But if you can join one of the advanced endoscopists to maybe a colonoscopy, I think it's nice because sometimes they have different tricks on how to reduce loops or how to describe lesions. It may still help you, but again, in a different setting, in a setting of a general endoscopy or maybe not too complex EMR where you can see how they handle the snare. So I think in those settings, maybe it may be very helpful just to get their insight on how they reduce the looping, how they describe the lesions, how they manage the snare, how do they inject. Again, it just may give you some further insight on how to use those instruments. Although most of your polyps are going to be small polyps, 80% of your colonoscopy is going to be removal of small polyps, just the management of this narrow injection may help you. And I'll just second the point about this is your time to become a great gastroenterologist. Then you can become a great advanced or interventional gastroenterologist because we can do a procedure on anybody. A really great consultant knows when you're not supposed to do the procedure, even if the team wants it or whatever. And until you have really the great basics of being a consultant for GI, then you'll be able to know what to do next in advanced endoscopy. That being said, if you want to lay the framework for applying for advanced endoscopy, again, think about your research time, think about other opportunities to expose yourself to advanced endoscopy, but become a great GI consultant first, and then work on the advanced stuff. Yeah. I would say, if you are thinking about doing a fourth year, or a lot of you are thinking about the fourth year, I would say by the end of your first year, you should have a pretty good understanding that I want to do a fourth year, enough exposure over my first year. And then have started the framework with developing the academic process or scientific process of developing a project, maintaining some documented evidence of interest in that. And then over the course of your second year, you can then expand upon that interest by doing a manuscript, presenting at conferences, and then building up your network within that specific field. And then, as the others were saying, it's totally fine to have this audible during that second, third year, where life takes you a different way. It just may take you down a non-traditional pathway. Maybe you go be a general GI doctor for a year or two, and then come back to your fourth year. I would say, at least how I feel it might be the most efficient is if, by the end of your first year, you really know I want to do some type of subspecialty within GI. And then from there, by the end of your first year, really start heading down that track. That way you can build up your CV and whatnot to make yourself a competitive applicant. Are there questions from the audience here? A question? I'm trying to turn this on. My button's not working. This one. Oh, this one's working. All right. So pivoting off that question, if you're not planning on doing an advanced fellowship, I think, obviously, the world of academia in general, even general GI, is becoming sort of subspecialized, especially in the research space. So did all of you kind of know, if you did general GI, what sort of research area you were focused on early on in fellowship? Or do any of you have kind of broad CVs sort of all over the place? And do you feel like that was a challenge in finding your academic job once you were graduating? No, I look, if you were to PubMed me, I look very confused. I had like one track and all this. I mean, I think that, especially when you're going through, like I said, even though in fellowship, I knew what I thought I wanted to do, and I did sort of work towards that. But if other opportunities came up where I had the opportunity to write a book chapter with someone or write a manuscript, it didn't really matter if it was with advanced or not, because it was an opportunity to learn how to do x, y, and z. And so I wouldn't be so selective where it's like, sorry, this is not about ERCP or poem, and I'm not interested. Because different, you will come across different mentors, even within research, and some who are so exquisitely productive, efficient, and you have something to learn from each person. And so I have liver, I have advanced, and I will, and this is an intentional plug for ASG. Nobody told me to say this, but I was involved in committee work very early on as a trainee. That was one of the things my mentors pushed me to do. And when I did join committees, it gave me an incredible opportunity to, at some point, be on one of the guidelines committee. So then I have guidelines across very different areas. And at no point, and again, when I went to apply then for my academic position, there were different points. It's not like where you're applying for GI, where someone's like, oh, you have research, and cardiology, and liver, and rheumatology. Are you sure you want to do GI? I was in GI. I was done. And so if anyone had a question, I would have said, look, this was me learning, and this was me having fun with research. And nobody ever really sort of shot me down. It was all about being productive and building a CV. I don't know. It was never a negative for me. Yeah. I mean, I think as long as you follow through with what you've started. I mean, sure, if some disaster happens and you have to switch because the lab PI moved to a different country or whatever, that's a different story. But I think that if you weren't sure, and you've committed to being in a project, and you finish that project, or make sure that the IRB is done and get whatever part of it that was assigned to you done, and then move on, I don't think anybody will fault you for that. I think a lot of unfinished projects, somebody will fault you for. And also, if you're going to have it on your CV, be ready to answer a question about it. I mean, to me, a big annoyance is if I'm going through somebody. And I don't try to pick out the most esoteric thing on their CV. But if it's something that they seem to be proud of or is part of what they're applying for or something that they've built on and they can't answer me about that project, then I'm not sure that there's a commitment there. So I think as long as you, I'd be more impressed by somebody who's applying to do ERCP in the US with us and has done an IBD project from thought through IRB through starting to written an abstract and maybe at least submitted a manuscript, that's fine if they realize that IBD wasn't for them and they wanted to do. I mean, I've had that happen. But that means more to me than something than dabbling a little bit here and there and not actually finishing anything. Because you may not have that. You may not have an advanced endoscopist at your place. Or you may not have, you want to do IBD, but you don't have somebody there. And you want to build your CV and absolutely. I don't mean start a project and be like, nah, I changed my mind. I don't mean that at all. But maybe you're doing what is available to you, whether you are interested in advanced or IBD or not, as long as you follow through and can speak to it. Yeah, I was just going to echo and say that I think there are some people that go into fellowship or whatever thing and they know exactly what they want to do. They know exactly what mentor they want to work with. And that's awesome. I would say that wasn't me. And I'm sure that's not a lot of people here. And I don't think that makes you less, I don't know, interested or any of those things. I think it's just important to have the support around you to gear you towards a mentor that I think some mentors are probably get papers published more efficiently. So I think just finding somebody that is helpful in that sense, knows how to publish papers with fellows, more so than the specific topic being something that's going to land your academic dream job, because that's probably not going to change things that much. So I think just having a mentor that finishes projects and taking things as they come, opportunities come up here and there. And you can try some things and find what interests you along the way. You don't have to know right off the bat. I would say that was not how it was for me. I wish it was, but it wasn't me. General GI can be sexy as well. And scary, by the way. General GI can scare you every day. So yeah, you don't have to do a cyst gastrostomy to be scared. You can hold your head up high and you decide you're going to be the master of bloating. Those aisles will clear for you at DDW. People will open up and say, here comes Dr. So-and-so. They figured out a cure for bloating. So by all means, whatever it is you want to do. And if you're not sure, stay in General GI. Like you were saying, do a year of something. Build your CV. Go back. But it's also OK to just be General GI and figure it out and realize what you want to do. And you don't have to do additional training. You could build a niche in whatever you want to do if you have support from your institution and an idea of what you like and don't like. But yes, General GI can be sexy. I want to say that. It's OK to stay right there. Right? Yeah. Yes. Borrowed enthusiasm doesn't go very far. So going to somebody because they definitely, I guess that's the best way to put it. Borrowed enthusiasm doesn't go very far. You start out and then you realize that you really weren't all that interested in the idea that somebody said was definitely going to end up in a paper or a study. Any time there's an obstacle, you won't be as motivated to overcome that obstacle for borrowed enthusiasm.

fellowship experience

gastroenterologist

research time

mentorship

networking

career development

medical field