I think we're just going to introduce ourselves first. So I'm Judy Staab. I went to medical school at MUSC in Charleston, South Carolina, then I did my residency fellowship training at the University of Utah. I chose to stay there on as faculty, and I'm finishing up my first year as a faculty member, so I can take questions about what that transition is like for sure. And I am doing mostly general GI with some focus in IBD. I'm Brianna Shin, I'm originally from Scranton, Pennsylvania, I did medical school at Geisinger, and then did internship, residency, fellowship, and then advanced fellowship all at Jefferson. And I'm about to start the big girl job in a week, don't remind me, and I'm going to Penn in Philadelphia. So I can kind of talk about, you know, a little closer to fellowship, just like the details about that, managing stress, and then also trying to just like focus your fellowship, and if you want to sub-specialize in something, specifically therapeutics, and kind of how to succeed in that. Looking for jobs, too. Hi everyone, I'm Lillian Wong, I'm currently a third year GI fellow at Mayo Rochester, I'm from outside of Philadelphia. I went to Temple for med school, and then Mayo for internal medicine residency. I've actually matched up BI for advanced endoscopy next year, so I can answer any questions about the advanced endoscopy fellowship, kind of make, or application process, and anything hopefully with fellowship in general, too. So I, if anybody has any questions, this might be a good time to do that first, yeah. Can you hear me? Yeah. Is it true that the number of spots for advanced fellowships are going to increase? Does some talk about it? That I'm not aware of. Do you know about that? That might be a better question for Dr. Byrne. Yes. In the coming years? Sorry, your question is the number of slots? Yes. You know, I don't really know the answer to that. I mean, there's new fellowship, advanced endoscopy fellowship programs all the time, so that's not run, like, the advanced endoscopy fellowship is not like an ACGME. Actually, you could probably answer this question a lot better. It's not an ACGME, you know, supported fellowship, you know, match. Like the match is run by the ASGE, and then there are a lot of programs that do advanced endoscopy fellowships, fourth years, that are outside of that ASGE match, so there's a lot of new programs all the time that are kind of going into the match or just getting advanced endoscopy fellowship candidates outside of the match. That's really the answer that we have right now. We have 65 programs that are kind of in the ASGE match. At this point, there are some programs outside the match. It really depends upon funding of the fellowship by institutions, but as you know, advanced endoscopy is growing, so we anticipate there will be more advanced endoscopy fellowships, but it's not a regulated number, so, you know, it will continue to grow at its own pace. Okay, thank you for being here. So looking back, now that we're starting, if you are interested in advanced, as I am, what do you recommend to do early? Should we contact programs early, focus on research, do an elective rotation? What would you have done better if you were in our spot? Sure. So I can just give a little bit of a backstory on my journey. It might resonate with you, and there's no right or wrong way to go about this journey, I guess I'd say, to preface, but for me, I always had an interest in surgery. I think probably a lot of you can relate to that, being in a procedural subspecialty now, all throughout medical school, I was really interested in that. I reached the end and just realized I wanted a little bit more mix of medicine and all that stuff, like probably all of you feel. I started my fellowship, and we have actually a pancreatic obiliary service, I started on that service, and I remember Dr. Kowalski specifically and his partner, Dr. Loren, kind of approached me and were like, we think you should consider this, and I was like, I think you're right. But I didn't want to commit so early on, I felt like I might get a lot of judgment from my peers or other attendings, I didn't want to commit all to that and then ignore other subspecialties and things like that within GI, but I did know I really liked it. I loved the innovation, I loved the procedures they were doing, I loved just anatomically dealing with the biliary tract and the pancreas and things like that, so I kind of just tried to stay open to all of general GI, do a good job of being a first-year fellow, getting those basics down and endoscopic skills, learning everything you need to learn. But on the side, I was absolutely pursuing research and therapeutics. Those three years fly by, and as most of you know, you do apply for therapeutics in your second year, so you only kind of have a year and a half to get everything ready to go to apply. So if you are interested, my advice would be pursue it. You know, again, have that balance so you're not neglecting other parts of GI, because you might end up switching, you never know, but I would recommend jumping in immediately, finding at least one, two mentors that you know are actually engaged and involved in research that you will have something productive come out of it. I think we do a lot of research that doesn't turn into publications or abstracts, things like that, so really try to focus your energy on research that will come out with something for you for your CV. In my mind, thinking about applications, I know what helped me. I had a first author publication in GIE, something I was very proud of that I did within a year and a half, so that was in publication when I applied, and that got a lot of people's attention. I also was the lead author on an oral publication every year at DDW, which was also a big deal and also a really good experience. So if you can aim to kind of be working on an abstract that you can take all the way from conception to presentation at DDW, whether it's a poster or an oral, and then turn that into a manuscript, you can do that in that timeline. That's pretty impressive, I think, in my eyes, because we all know how busy you are and everything you're juggling. But again, there's no right or wrong, and everyone has different type of research interests, so just do what's right for you and what the mentors you have are doing, but I would say don't slow down, keep your foot on the gas, try to do everything you can. As far as doing the procedures and such, that's something that's going to come later on, and I feel like, for me, it was just important to learn some of the concepts of therapeutic endoscopy in these first couple of years, learn how to manage these procedures pre and post, learn the anatomy, kind of get your feet wet with what we're doing. That endoscopic skill will come later in your third year and then in your fourth year, so don't stress out about knowing how to do an ERCP. I did not, and you do so much of it that fourth year. So really just try, again, to learn that general GI knowledge about it and then get involved in research. Yeah, I completely agree with everything Dr. Shin said. I think the most important part of being a successful endoscopy applicant is mentorship, finding the right mentor, personality-wise, interest-wise, someone who's going to help you achieve a feasible project, so something that interests you, one that fills an unmet need, a gap, something that will be meaningful, that can be published and presented at conferences, and one that's viable based on your timeline, because it is a quick one year before you have to start to apply. The other thing is, like Dr. Shin said, at my institution, we don't get really a lot of ERCP, EOS exposure during our first or second year, and so a lot of it is seeking out those opportunities, going to an endoscopy room, making sure that all the events and hospice know who you are, and so they let you watch procedures, you can start asking questions, talking to the techs and learning about the devices, and that's really helpful to learn kind of the cognitive clinical basis for the procedures, and really see, okay, you know, these are really cool procedures, they're really fun, but also you can start to see and appreciate the complications that can happen with these procedures and make sure, is it really right for you? I would piggyback on that and just say a big piece of advice I was given early on that has made a huge difference, and I've mentioned to some of you, like, have your hands in that scope every chance you get, even, like, before a procedure starts, like, pick up your scope, make sure everything's correct, test every button, learn how to set up your scope, because eventually one day you're going to be the attending, and you better know all your equipment inside out and backwards, and it's a great opportunity to build a relationship with your techs and your nurses, like, when you're just standing around before timeout, be like, hey, can you show me how to set this up? And not only will they recognize that as, wow, this person actually really cares, they'll feel a lot of respect that you're asking them to teach them, and that will pay dividends in the end. But then just, again, like, have your hands on the scope, know how to set it up, know your devices, and you'll kind of start to learn if you really do like therapeutics and all the device world and everything, but even in general GI, it's so important to know all these things in and out of the scope. Did that work? Okay. So Dr. Staub, now that you're kind of a year into practice, you know, we've already mentioned that there's only so many hours in the day and so many hours in the week. What do you wish you had spent more time doing during fellowship, and maybe one or two things that, like, you thought was a productive use of time that now you're like, I probably could have dialed that back a little bit? Yeah, that's a really good question. So obviously every fellowship is different. I think you get a different amount of, like, clinical experience. I think, for me, the surprising part was less the endoscopy and more, like, managing a clinic. So I think there's a lot, especially if you're doing general GI, like, you're going to see your IBS patients and you're suddenly be like, wait, do I even know how to manage IBS? Like I've been spending all this time, like, learning colonoscopy and learning, like, you know, how to do all these things. So I think I sort of wish that I, not that I, I'm glad about all the time I spent learning endoscopy, but I think everybody learns endoscopy, like, you're going to learn it, like, you just will. You're going to do so much of it. I kind of wish I had spent more time really paying attention in clinic and, like, asking lots of questions and, like, really figuring out how my attendings manage these seemingly simple things that end up, like, you're going to be in clinic by yourself being like, I feel like I'm doing too much, I'm doing too little, like, I'm not sure. So that has been surprising for me. I also think another valuable thing, interestingly, towards the end is watch your attendings do some scopes and, like, sometimes it's okay to just take a minute and just watch your attending do a colonoscopy. I did that a couple times my third year and just, I feel like, got a lot out of that. At first you're definitely not going to want to do that, but I think you can gain a lot by just watching and seeing what they're doing. And then I think another important thing as you're going along from an endoscopy side, you're going to do so much endoscopy, like, you're going to figure out, like, your way. But I have little tidbits in the back of my mind of, like, Dr. Byrne and Dr. Fang, you know, telling me to do things, not do things. But I think it's important to, as you're scoping with people, just do it the way that they do that day and just learn from them and take little bits and pieces from everybody and make your own way. But, yeah, I think the thing that's been surprising to me is that in clinic it feels a little bit more scary sometimes than in the endoscopy room. So just pay attention to all that stuff. It's not all about scoping. You've got to be a good clinician as well, so. Do you guys have any suggestions, I don't know if this is working, on reading material in our first year? Because, you know, we go from IM residency where we're learning for our boards, GI, but now we're becoming actual gastroenterologists. And so, you know, my program gives us DDSEP questions, but I don't know about reading material, what you suggest. I would suggest guidelines your first year. Yeah, that's all that's in my head is guidelines. We've become, GI is tough. We have so many societies, we're at one right now that, it's my favorite for obvious reasons, but it is important to know, understand these, well, I guess four, but there's different societies, but your guidelines are going to be everything, and that's a big part of studying for the boards. I got that advice, I don't know about you. Boards is all guidelines. Guidelines. Yeah. All guidelines. So I found that actually more helpful to go through that. No, I completely echo all of that. It's probably the most high-yield reading material and learning material, too. Hi, thank you all for being here. What were some of the most helpful resources and conferences or anything outside of your institution that you felt like was really worth your time doing in fellowship? Sorry, the question was, what are helpful resources outside of conferences? I try to go to, I mean, I don't know how your program sets it up with call and things like that. Our fellowship, all the first years get to go to ACG, which is awesome because you get to go bond with your first-year co-fellows, and then they have a post-grad course that's really good. And then same with DDW, their post-grad course is amazing. So those are great things to go to. Another good thing to do is meet your local device reps. That'll come with time as you're just in the endoscopy unit more, and again, I think that resonates with me because I went into therapeutics, but they are like a wealth of knowledge, and they have a lot of knowledge about conferences, different courses you can go do. Like, I did a Doug Rex colonoscopy EMR course this past year that was set up by Boston Scientific, and so you can, the more people you meet, the more doors will open. So when you're in there in the hospital, in the endoscopy unit, again, just introduce yourself, be open to meeting people and what they have to offer. But I can't think of any other courses I really did. Oh, I have a bunch. So sorry. There's a couple others that just come to mind, like the ACG does a second-year fellows course, so it's kind of similar to this, but designed for second-years, so that's a really good course. The ASGE also does a third-year fellows course, so more geared for, like, you know, when you're about to graduate. There's also, now post-COVID, there's a lot of great virtual things for you guys. So one of them is through the ASGE, which is the endo hangouts for fellows. So they do those once a month, and obviously they're all virtual, and you'll, there's different topics every month from, like, polypectomy, GI bleeding, all kinds of topics, and you'll have, like, experts in the field, and they'll do discussions and show videos, and then you'll have a chance to ask questions and things like that. So I would definitely recommend, you know, make sure you're a member of the ASGE, the ACG, the AGA, the ALSD, and then you'll get all these emails and invitations for all these different events, and a lot of them are kind of geared specifically towards fellows. Yeah, I'm glad you brought that up. That's completely what I did. Become a member of these societies. You get the emails, and then they'll pop, like, oh, I can join that. There's a good GI endo hangout for, like, applying to advance, like, you have, like, a lot of, like, the head people will come and answer all your questions, but that's, yeah, that's really good advice. I did that. Me too. Yeah. Looking back. For books, Dr. Byrne had told me about the Acing the Boards review books. I use those for board studying, and I kind of wish I had gotten them sooner. I think they're, if you're just looking for something just to kind of read, like, easily, all of those books are really easy to read and very, very high yield for boards, so might be something to check out, too. Any other questions? Regarding looking for jobs, is it good to go to certain forums, or what is the best way to find a job, or how did you manage? I know that sometimes they look for you, but what is the best way? I know that we have so many options. What do you recommend? Yeah, that's a good question. In my location, there's not a ton of groups, I would say, so you can literally just reach out to the groups and say, hey, I'm graduating, I'm interested, whatever, and that's one good way just to kind of set things up is just kind of identify some groups in your area. I mean, staying in academics is obviously, if you're staying at your own institution, then that's, I guess, pretty obvious, but there are, I think, a lot of ways, and I think they were mentioning earlier that there's a resource through ASG that they have job listings available, too, but you can really just contact practices. It's so different than, like, we've gone through our whole life in a matching process, and it's like, then all of a sudden, you reach this point where you're like, oh, I get to pick, and it's a little jarring. For me, I knew I wanted to stay in the Philadelphia area for family reasons, so I did, I just like cold email, I wrote up a cover letter and just kind of explained my background, what I want to do, why I want to be in academics, you know, blah, blah, blah, and I sent it out to the chief of every GI division in the area, and that's kind of how it goes, so it's not a bad idea just to, again, reach out, put yourself out there. If they don't know you're looking, they might, you know, especially in academics, they're not going to go find you, so that's what I do, kind of pick the areas you want to be in and reach out. You can start during your second year, I think it's probably a good time to kind of start thinking about it anyway, and hopefully your third year you're in touch. I started my beginning, like, this time last year, my fourth year, and it was a little early, everyone kept giving me the feedback, it's a little early, but again, it doesn't hurt to be on the earlier side, in my opinion. Okay, well, thank you, everyone, for your attention, and thank you to the panel, for your time.

gastroenterologists

fellowship

inflammatory bowel disease

advanced endoscopy fellowship

mentorship