Good evening, everyone, and welcome. I know some of us are still kind of coming in, but we'll, you know, as people join, they can tune in. So before I say too many words, let me just quickly introduce myself. So my name is Iman Boston. I'm currently a third year GI fellow at the University of Arkansas for Medical Sciences in Little Rock, Arkansas. And tonight, I'm going to serve as your moderator. And I want to thank you all for joining us for the ASGE Diversity and Inclusion Committee's Internal Medicine Interest Group panel titled Roadmap to Gastroenterology. So I assume that all of you here are interested in a future career in GI, but what you may or may not know already is really how competitive it competitive is to get into a fellowship program. So we're super excited to host this discussion that will hopefully give you some insight to best position yourself to successfully match into GI when that time comes for you. During this session, I'll have some questions from our panelists, but we'll also be taking questions from you in the audience. So if you will utilize that Q&A box at the bottom there, not the chat box, preferably, but the Q&A box. Don't be shy about asking anything you think might be helpful. We're happy to answer any questions you might have. You can even start adding questions now if you feel so inclined. In addition, I will have two requests for all of you as well. So before we get started, if you will please change your Zoom names to actually include what year you are. So MS1, MS2, MS3, that just helps us tailor our discussion. And then also we're just going to have a poll to sort of tell us who you are as well. If Michelle, will you go ahead and share that with them? Dr. Boston, can you see it? I can. Okay. Looks like a few more are still going, so we'll give it one more second. Okay. And let's see. Here are your results. All right. Awesome. So we have mostly people that completed medical school, which is totally fine. There'll be something here for you as well. And then the majority of the others are second or third years, a couple of fourth years, and then a couple of first years as well. So welcome everybody. Thank you for joining us. All right. So now before we get into our questions, let me just take a moment to introduce my panelists. We're going to start with Dr. Muhammad Bilal. He is an advanced endoscopist at the Minneapolis VA medical center. He's also an assistant professor of medicine and associate direct program director of the GI fellowship at the university of Minnesota. Dr. Earl Campbell is my next panelist. He's an advanced endoscopist who works for a private group down in Atlanta. Dr. Kenneth Obie is a general gastroenterologist. Who's a partner at Rome gastroenterology and associates in Rome, Georgia. Dr. Dimple Bokta is an advanced endoscopist who works at Kaiser Permanente also in the Atlanta, Georgia area. Dr. Shawnee Woolard. She is a general gastroenterologist at Emory in Atlanta. And then finally, Dr. Richard McLean is an advanced endoscopy fellow at the university of Southern California, which is in Los Angeles. Thank you all for being here. Now let's get to these questions. So Dr. Bilal, I think I want to start with you. Did you always know you wanted to go into GI? Yeah, that's a really, really good question. Thank you, Dr. Boston. And we're very excited to be here with all of you. I think that I knew that I always wanted to do internal medicine. So that part was easy for me because you know, I did not like surgery or doing procedures, which is ironic because now I do advanced endoscopy and I do procedures almost 80 to 90% of my, my time. So I think, so it was kind of like partly like I knew I wanted internal medicine and I wanted to stay in academics, which I knew that I wanted to develop a niche or focus. So I wanted to do a fellowship and I always loved, you know, GI hepatology, critical care, but I wasn't sure, like I was very impressed to see some of the first year medical students here. So I think that for those of you know, now that's fantastic. But if you're like me, it was undecided during residency and had some inclination. That's also, also totally fine as you'll hear from all panelists that we all have our sort of unique pathways and there is no one, one pathway pathway to success. But for me, it was mainly during residency that, that I got the final inspiration that I did want to pursue a career in GI and hepatology. Fantastic. Fantastic. Dr. McLean, what about you? For me? No, either. I came into medical school just knowing I wanted to be a doctor. Honestly, that was pretty much it. My path was with each subject I learned, I kind of ruled out what I didn't want to do. So when we did DERM, I was like, everything looks like the same rash. I clearly don't want to do DERM. When we got to GI, I thought GI was interesting. I didn't know that I loved it at that point. Kind of towards the end of medical school, when I got more to my clinical side, I really didn't want to do DERM. I didn't know that I loved it at that point. I realized I really loved procedures and I realized that surgery just wasn't the lifestyle for me. Probably the last thing that really tipped me over. So I graduated in 2016. I want to say in 2015 or 2014, there was a survey that came out looking at a bunch of physicians from different specialties. And it was measuring who really enjoyed their job. Who would do it again? How many people would become doctors again, things like that. And overwhelmingly gastroenterologists. Enjoyed their jobs, felt that they would do it again. And it was a huge, huge, huge discrepancy between the next place. So after that, I was like, well, this is clearly the route I have to go. So that's how I ended up here. But when I started, I had, I had no clue that this is where I would be. Gotcha, gotcha. Thank you. Dr. Willard, what made you choose gastroenterology as a career? Oh, Dr. Willard, you might be muted. Oh, we're having some issues with connection there. What about we can go to. Yeah, that's okay. Dr. Campbell, can you answer that question. Why do you. Yes. I can hear you. Okay. Yeah, for me when I went into, or I'm gonna say immediately when I started out but I'd say pretty early on to med school. I was pretty kind of the most part should they want to do internal medicine so it came down to which subspecialty so for me it was pulmonology, cardiology and gastroenterology so I had a feeling that I wanted to do. I knew I wanted to do something hands on, so it was going to be a procedural subspecialty of medicine. I thought my personality didn't necessarily fit well with the surgical field as well just a little bit more laid back than things tended to be in the OR. So for me, by the end of, I'd say, med school I was kind of on the fence between pulmonology and GI knew if I wanted to pulmonology doesn't do interventional pulmonology so when I started my intern year even when I met with my mentor. You know, I told him, you know, the one to get mentorship early in GI but I knew I was kind of on the fence between pulmonology and GI and then I think at the point when I finally decided about halfway through my intern year after doing the GI rotation for me. I'm someone that said get bored pretty easily. So, the thing about pulmonology versus GI and both those procedures like okay, we'll put all the knowledge is like you just have the lungs right with cardiology is just the heart. Right. So with GI like the fact you know you had so many organs within that organ system, right so there's so much variety. So many different procedures that you could do so you know you have esophageal disorders gastric disorders small bowel large intestine gallbladder liver pancreas so I felt that there was a lot of variety enough to keep me interested for the longevity of my career. So, I don't know if you got your audio working yet. If not, that's okay. Looks like still some issues. Okay. I'm Dr. Obi what I want to hear from you. What is the state of diversity within the field of GI and really how do you see it sort of evolving over time. Thank you. Can you hear me. Okay, perfect. So again, I want to thank the ASG and diversity and inclusion committee for having us today. What's the state of GI in terms of diversity. I think it's great. people matching for fellowships, it used to be predominantly male in GI but now I think it's almost even if not a little bit slightly in favor of females matching into fellowships for GI. Also, something very important is that a lot of the societies, the main GI societies have bought into the need and importance of, you know, acknowledging the importance of diversity, inclusion and equity. And so with that, all the different major GI societies have committees focused on this and basically what this committee is going to do is like this one, for example, is try to work on diversifying the field of GI and so how do we do that. A by bringing people along, letting people know early about GI. Whether it's at the med school level, high school level, or even the residency level, reaching out to people so they are aware of GI and they can kind of help diversify the field. We all know that physicians should reflect their patient population and so we have a lot of patients and a lot of health disparities within GI so it only makes sense that we have more and more underrepresented minorities within the field. Yeah, that's awesome. It's true. Dr. McLean, I'd like you to answer the same question. I second that. I think it is at a good place. I think there's definitely always going to be room for growth, right? I was looking at data, I want to say it was from AMA from 2018, I believe, and when they surveyed gastroenterologists about 11 to 12% identified as underrepresented minorities, which is not a huge number. So I think that we've seen a great uptick over the years because of all of the societies and all of the exposure and I think that's been wonderful. Myself, specifically, I've benefited from that. I've been at a training program where I interacted with black gastroenterologists and black interventionalists and I think that directly impacted my desire to become a part of this field. So I think it's great. I think there's still room to grow, for sure. And I think that, you know, things like this are exactly what we need to continue that exposure so that more people know about GI and how great of a field that it is. Sorry, did someone say something? No, okay. All right. So, Dr. Balal, this question is going to be sort of directed towards you. What are some of the most important steps that, you know, medical students who are interested in GI, you know, what steps can they take right now to sort of help guarantee a successful GI fellowship match? Yeah, that's a great question. And also, you know, it can be a very long-winded answer, but to sort of break it down into two simple factors, the way, you know, most programs approach about fellowship applicants and same principles will apply in residency is that you have some modifiable factors and then you have some non-modifiable factors. So your non-modifiable factors are, you know, where are you in med school? You know, are you in a school which has a robust, you know, research program? You know, some of you might be in school in the Caribbean. You know, some of you might be foreign medical graduates. Some of you might be in, you know, osteopathic medical schools. And what access and where are you doing your rotations? What kind of faculty you have on file? Where'd you go to, you know, undergrad? But then there are going to be some modifiable factors. And some of those are going to be your USMLE scores, you know, down the line is going to be one of the most important part of this is scholarship or scholarly work or research, which you'll have an opportunity to do from now on till you apply for GI fellowship. Then it's going to be your mentors or letter writers. And, you know, you want to have your letter writers who will sponsor for you, but then also networking. That is an opportunity that you have. And I really, you know, I'm admire, you know, all of you on the call today who've taken this upon so early on in your career to engage because, you know, through the various organizations and parts of interactive forums or opportunities and connections that you develop can open a lot of doors. A lot of opportunities. So I think thinking of all those things, volunteering, and, you know, especially if you know you're passionate about gastroenterology early on, you know, there is a colorectal awareness month, our societies have programs, more and more societies are now engaging with medical students, especially residents. And so I think, you know, when you guys start your residency, you know, start becoming members of our organizations, even as soon as now, today, tonight, you know, so that way you are informed because the first step of knowing about an opportunity is to know that the opportunity exists and how you're going to know the opportunity exists is through this. Social media is another platform of doing all these things. So I've been working on some of those on those modifiable factors early on. And again, this doesn't mean that, you know, for the next four years, all you think about is GI fellowship, you still got to enjoy life and do all these things, but having a clear and smart goal. So when you apply three years or four years from now, you're prepared and you're not panicked in the last few months. And I'm sure, you know, other, all other panelists will have have throughout the day about some experiences from their journey to share. Absolutely, absolutely. Are you able to hear me now? Yes. Okay. Not quite sure what happened. I apologize, but thank you for the question earlier, Dr. Boston. Do you mind if I just take two seconds? No, please. Absolutely. I know what everyone else said, I just also wanted to add that I really like the specifically the GI, the instant gratification that we often get as gastroenterologists. And so what I mean by that is, you know, obviously no one likes to be woken up in the middle of the night, right? But when I am woken up for a GI bleed or for a food impact, and actually going in and doing the endoscopy and relieving whatever the issue is, is very gratifying and very satisfying to me as a gastroenterologist. So that's kind of one of the other reasons I chose that along with the diversification, you can do hepatology, you can do advanced, you can do general GI, you can do IBD, lots of different career options and a very good lifestyle as well. So thank you. And I apologize for that again. No, that's okay. I'm glad that we got it working. And before actually I move on to the next question, I think we've had a few more people join since I gave my welcome. So I just wanted to just say once again, if you do have any questions throughout, please do put them in the Q&A box. We are monitoring that. And so we're happy to answer questions during the presentation or during the panel as well. So just so you all know. All right. So my next question, I want to start with Dr. Bhakta. What do you think is the most important part of like a GI fellowship application? Okay, great question. Also, thank you for putting this on and thank you for having me. I think Mohammed touched on a lot of the components that come into a fellowship application, modifiable, not modifiable. I like that you broke it down that way, because those are the components are going to go into an application. You're going to have to put in where you went to med school, where you're applying for internal medicine and where you end up going eventually. Those will all play a big role. Your board scores, all that, that you can't you're going to work towards and put on your application. But I think the biggest things that will be beneficial going into a fellowship or applying is mentors, because mentors also give you access to research. Right. So you have not only mentors for letter writers that become important for your application. They're also the ones who are going to be there to help guide you in research, give you some research opportunities, but also stimulate you into creating your own ideas or projects. So when you have those resources available, and that's why I think when you're choosing internal medicine programs, if you're really interested in G.I. fellowship starting off early in med school, I necessarily did not know that right off the bat. But I got lucky being at a program that had such a robust G.I. program and research. So then you can identify mentors quickly will help write those letters for you, but also give you those opportunities that you really need to get involved in research, academic projects, scholarship that then take you beyond just your small bubble of your residency to DDW, for example, or ACG to present your work. So that's where that networking comes into play beyond just your program. So I think those are the kind of the key features that will play into your application. Awesome. Thank you. And we do have I'm going to stop here for just a moment. We do have one question from one of our attendees, and I will sort of let whoever feels like most compelled to answer this question. How important are step complex scores and getting a fellowship? And then the second part of the question is, are there some scores that are more important than others, such as, you know, step three versus step two, et cetera? I, to my knowledge, I didn't feel that the step scores were very important. I felt like as each step or rung of the ladder, you moved up in your training, that the step scores kind of mattered less and less. And the benefit with GI is kind of like you have that buffer in a sense, in terms of internal medicine residency, where the step scores are maybe more important to get into your residency program. Once you're already into your residency program, by the time you're looking at fellowship, no one's really looking at your steps scores, you know? And the rest of the panelists may have different opinions, but that was kind of my thought and what I kind of experienced in the process. I don't remember step scores coming up at all at that point in the game, because at that point, you know, because of residency, you've already pretty much shown that you know how to be a doctor. And that point is really coming down to your letters of recommendation and how you performed as a resident. At that point, no one's necessarily really worried about the standardized test at that point in the game, so. Thank you, Dr. Campbell. Anyone else have anything to add to that as well? No, I mean, the only thing I think I would add is that, you know, right now, if you're applying for your, you know, you're going to give your USMLE step two, you know, like anything in life, in that moment, you want to aim for the best possible. You know, none of this is a deal breaker and one thing or one test never makes your career, it never breaks your career. But if you have a good step score, it might help you get into a good residency program. You know, while Dr. Campbell is right, like in the fellowship application, it doesn't matter. But like Dr. Buck has said, that once you get into a great residency program, that opens doors for great fellowship opportunities. So everything, you know, you can do to work on these things towards now, I think that helps. But also to echo what Dr. Campbell said, I don't think one thing ever makes or breaks anything. So if someone does have a low COMLEX or step score, so just remember that that's not a barrier to becoming a gastroenterologist. There are other things that you can work on that we touched upon earlier to augment that or compensate or show that you're passionate and committed about the specialty. And I think one more thing I would just add too, is that not necessarily so much about the scores, but my thoughts are more so the progression of those scores throughout the step one, two, and three. As you go up through those steps, they become more and more clinical and less basic science-based. So you wanna do show that you are, you know, your scores are improving as you step up the rung ladder. If you, I don't know what the score system is now, but if you blow out step one out of the, you know, out of the park, and then step two and three, you're struggling, those are more clinical, then that may raise a eyebrow. But so don't worry, I know a lot of people get so much emphasis placed on step one, but further you go at that point, no one's caring about how well you remember the Krebs cycle. So. Sure. Thank you so much. All right. So sort of, I think this is kind of a good segue into this next question. Does the choice of like where you go for residency really affect your GI fellowship match? And then kind of how does it affect your fellowship match? And I'd really love to hear from Dr. Willard if she is available to answer the question. Yes. I think that was good for the rest of the questions, fingers crossed. I do think that while it's not mandatory, I do think that it is good if your IM residency has a GI fellowship as part of the university for multiple reasons. Number one, for letters, you'll get the opportunity to rotate on GI rotations and then as well as for mentors. So you'll get the opportunity to meet various faculty in the GI department at your institution. And they can meet you, get to know you and develop relationships so they can write you strong letters. And number three, also from a research standpoint, right? Like it tends to be a little bit easier to find research opportunities when you have a GI, GI research opportunities if you have a GI department at your institution where you're training. With that being said, are there people that get into GI fellowship at a residency that doesn't have a GI program? Sure, there are. It does take a little bit more work on the applicant's part in order to reach out nationwide or reach out to a local GI fellowship program and really try to participate in the research, get your name on papers as well as to find mentors. So, sure. Thank you. And actually, I think we might even have some questions in the chat that might be sort of relevant to this too. So we'll kind of answer those now. One of our attendees said, my program does not have a robust GI department. Is there any mentorship available through the portal of ASGE? Does anyone want to try to tackle that? I mean, I think, yes. Are you saying that if you're a resident and you don't have good mentorship, then through ASGE and some other organizations have really good and robust mentorship programs. We will share with all of you and how you can become members. And actually, all of you get free membership for the first year for all those of you attending. But there are also some other GI organizations like the ACG. For Underrepresented Minorities is an excellent organization of American Black and Gastro and Hepatology organization that have mentorship programs that do extend to residents. And I highly encourage, even if you have robust mentors of your own program to seek out external mentors through these societal programs because it broadens your perspectives and horizons. So yes, there is definitely opportunity to our GI organizations. Perfect, thank you. Oh, I can add something to that. Sure. So like you said, ASGE, there's also the American College of Gastroenterology and they have, in each state, you have a local state society and each of those state societies have mentors that you could potentially tap into. Say for example, here in Georgia, it's called the GGES. So Georgia Gastroenterology Society. And within that, you have people from Emory, MCG, some other programs here. So if you are at a local community program where there's no GI department, that's a ticket right there to go and socialize, meet people, get some contacts, get some mentors that way. And that's one I would really tap into is your local GI society chapter within your state. It's very accessible and that's a low-hanging fruit. Awesome, thank you. All right, Dr. McLean, we have been a little bit quiet over there. So I'm gonna ask you this next question. So I know we've talked a lot about research. Do you feel like research is one necessary before GI fellowship, but also what about after you are in fellowship? Do you feel like it's, or after you're in fellowship or after you complete fellowship, do you feel like it's necessary to do research then? I do think research is necessary in both of those scenarios. I think beforehand, when you just wanna present yourself as a well-rounded applicant for GI fellowship, the ways that you show that you're actually interested is through doing research, right? If you do well on a clinical rotation, that says to me that you did well during your rotation, not necessarily that you want to do GI. But if in your independent time, you're looking into things, you're writing abstracts, you're presenting things, I think that really shows a different level of dedication. So I think it's important then. A lot of GI fellowships, once you get into them, also could have you continue some form of scholarly activity because I think in this growing field, it's important that we're all doing research, right? It's important that we're all helping to advance the field. Now, I don't think that means that everyone needs to be super gung-ho about research, like pushing out 30 abstracts or 20 publications every year. Yes, there are gonna be people who do that, but then there are gonna be people who maybe don't do that as much. And I think the big thing with research is really just finding the research that works for you. I'm someone who never really loved research, right? That's just not something I wake up in the morning thinking about doing. And I think all of my encounters with research in the beginning were very basic science, and that always was a barrier for me. So clinical research was something that was a lot easier for me to fall into. So it's really just figuring out what research interests you and I think finding mentors is really a big way to help usher you in the right path. But to answer your question, I think research is important, both before and after fellowship. Sure. Dr. Bala, I have a question for you. It's similar to those questions, but it's a little bit different. If someone is applying for GI fellowship, do you think it's important for them to have as much research as they can? Like, is it necessary to have 10 to 20 abstracts or is it more of a situation where it's like, if you have a couple of good research projects that you can talk about doing your interviews, you're good to go? I mean, what's more important, quality or quantity here? I think that's great. I think that some people might not have access to high quality research and they might choose quantity. But if you do have, well, in life, if you have better quality, it's always better than quantity. So if you have better quantity. So I don't necessarily think there's an upper limit. I mean, I think when we're recruiting for fellows, you're not looking for all, if you're recruiting for a year, we're not really looking for all of them to be researchers. We know some are gonna be excellent clinicians, some are gonna be researchers, some are gonna be passionate about a career in education. So we're looking for a packet. So I think that research is not the only thing. I think it's important because GI is so competitive, but I think that making sure that you are basically trying to demonstrate passion. And for some, it might be that you're passionate about improving access and diversity in underrepresented minorities, or you're passionate about volunteering for some things and those things or education, and those things are also equally important. So the application as a whole is a package. Some people might excel in research, others might excel in other things. And at the end of the day, it's a balance of you want. And I always tell people that, there's 170 odd GI fellowship programs and each program will have their own vision. And it's like, you're not gonna do fellowship in all 170 programs. So there is that one program out there that is looking for someone like you and what you bring to that team. Just like once we graduate, all of us here, we've graduated or have a different job. And that's what we found is best fulfills our personal and professional needs. So I think that's how sort of I approach the scholarly, and that's why I never use the word research because research sounds intimidating. It sounds like you're working from morning till night on an experiment with a test tube and then the bottle breaks at the end and now your whole project is over. So a lot of scholarly opportunities involving in case reports, quality improvement projects, those are all things that we value when you apply for a fellowship. Perfect, thank you. I'm gonna answer a couple of these questions. We've got a few in this Q&A box. So let me just take a moment to get over here. Okay, so sort of on the same research track, how does one seek out research opportunities as a resident from an outside institution? And what's the best way to obtain mentorship and networking without conferences? So I think we touched on this briefly earlier. One way, again, you can always do case reports as a resident, or as a resident, you can do case reports. As a medical student, you can do case reports. You don't necessarily need a GI mentor to do a case report. It can be someone in internal medicine doing a case report on a GI topic. That's one thing, but there's a lot of different ways that's one thing, but like I said, you can go through your local. So if you're any state you're in, there are gonna be at least two or three major university programs there. You can try to reach out to those guys and say, okay, can I do a rotation? Maybe use that as your way in to get to know the program director. And then they might introduce you to someone who might be looking for someone who's willing to put in the work and help provide a service to help someone with their research. And that's how you get your foot in the door. And like I said earlier, go through your local GI society. Those guys are there for you, to help you. And so when I say local GI society, if you just Google whatever state you're in, local GI society of that state, it'll come up. You'll see when their meetings are. They have conferences. They also have like poster presentations that you can do. And when you go, a lot of the program directors at all the programs from your state are gonna be there. And so you can meet them at that time and network and try to get a foot in in some institution that is within your state. Perfect. Can I add something quickly? Sure. So this is not along that topic. I know part of this, right, when we're talking about this in the research, it's about building your CV for the application. So it doesn't always, granted you do wanna have some research but different programs are gonna have different levels of availability of research, right? So the thing that I always was told, I remember from when I was in residency, you wanna go after that, what we call low hanging fruit, right? So what are the things that you can do easily, won't take as much time and you can put on your CV. Those are things like poster presentations at like ACG. And all that comes down to is not necessarily, you don't have to have a big research program but you just have to have GI, some GI physicians or fellows at your program that may have just come across an interesting case. And all you have to do is talk to the fellows or attendings at your program. You can say, hey, do you have any cases that are interested in that I should write up? And a lot of times they do, they just don't have the time. You know, the fellows attending, you don't have the time. So they actually may welcome having somebody that will come and write up the case for them. And then you both put your name on it and you can present at ACG. So just keep that in mind as well. There are other ways to also build your CV that may also be less labor intensive. Sure, thank you. I'll piggyback one second. With the ACG, they actually have a case report journal so that if you have something that is even worthwhile like beyond just ACG National Conference poster presentation, you can turn it into a case report that then can be published in the journal, which when I was previously at another institution, we had multiple residents do that and then submitted their case reports to the journal and got accepted and published. I forgot about that. That's actually an awesome idea, yeah. All right, perfect. One of the other questions we have is what advice do you have for a hospitalist who is working towards applying for a GI fellowship? I can jump in and answer this one. It is tough given the hours that you work and your grueling schedule, but I do think that one not as difficult way is to do quality improvement work. And so that's another form of low-hanging fruit in your institution. There's always something that needs to be approved, whether it be the endoscopy suite process. You can go to your GI department and question them as to what issues they may be having and develop a quality improvement project around that. I've seen other hospitalists do that that then subsequently apply to GI fellowship. So that was gonna be kind of my main suggestion was to do quality improvement work. Thank you. One thing to add is as a hospitalist, you actually have more time than a resident. To me personally, I think, because you have one week on, one week off. The whole week off, hey, it's time for GI, baby. You know, it's all about being hungry and kind of hustling. Sometimes you gotta go after it because if you're not doing it, someone else is doing it somewhere else. I've seen hospitalists that when I was at Ohio State that were hospitalists that became fellows at Ohio State later, because you go to an institution where there's a fellowship, don't go to like a local community place to do your hospitalist service year, because yes, you're gonna make more money there, but what's your end goal to match into GI? Go to the academic center, go be a hospitalist there, get a GI there, then socialize with the GI people, you know the program director, the assistant program director, you figure out who's doing research on what, and then on your off week, it's not time to go do more moonlighting shifts, it's time to go do some GI work, and that's how you get it. You know, nobody's gonna offer you anything, you gotta go take it, and so that's what you do, your off week, it's time to work. Perfect, thank you. All right, there was another one I wanted us to be sure to get to, oh, here it is. And maybe Dr. Bokta, I'd love to hear from you to start, what other things, you know, I guess we already kind of talked about when choosing a residency program to really consider, of course, a place that has a GI fellowship, but are there any other sort of factors that we need to consider for people that are applying for residency programs, but also the second part of that is also for fellowships, you know, is there something specific that we should, you know, as an applicant look for when we're applying to fellowship programs as well? I think stepping up just from med school, going into residency, having that fellowship program there is important to get you to that next step. If you look at a lot of people who are in GI fellowship, there are so many programs that take their own residence, and so it's just really nice to have that opportunity because they're gonna know you the best. You can establish relationships. I know certain programs, for example, internal medicine residencies, where if you are a chief resident at that program, you basically automatically kind of have an in, or they will always have a preference for their chief residents going into a fellowship. You know, not just GI, that's cardiology, et cetera, but that can be extremely beneficial. So it's hard when you're just trying to take all the steps to go to the next point. So residence, you're just getting into med school, you wanna finish that, you wanna do your boards, you wanna do that, but you really, if you're really interested in something beyond, especially a fellowship, you do have to kind of consider that. So I would say the biggest point is figuring out if there is a residency program that obviously has a fellowship program, and if you have any ideas if they're like to take their own residence, because that is gonna be probably the best way to get your foot in the door. Beyond that, again, identifying places where you recognize that, hey, this institution is doing a lot of research, and I see in all the journals, I see, oh, this one keeps popping up, or this one keeps popping up. There must be something going on there. And that's just gonna, again, we're talking about foot in the door, foot in the door. And I like how we put it too, it's just you do have to hustle. And so these are the places that are gonna get you there. Sure, perfect. Does anyone else have anything to add as well? I can add, I guess, I guess for the other portion of it. So for those of you who have already made it past the residency stage, looking into fellowship, the important things for me, as an interventional fellow now, I knew when I was a resident or I had an inkling that this was something that I wanted to do. So when I started interviewing at different programs, something that was important to me was programs that would allow me to have that as a part of my job. And so that's what I'm gonna talk about today. I'm gonna talk about how I got that as a part of my GI fellowship. It's not a standard thing in general GI fellowship to have interventional exposure, to do ERCPs or to do EUS. That's generally reserved for the fourth year. But a few places that I interviewed at, they were like, this is a standard part of our curriculum. That really pulled me in. And I think it just kind of fits into the general discussion that it's been tonight. You really wanna go somewhere where you can kind of look forward and see what's gonna happen next. So as a medical student, you wanna be in a place where you're like, okay, they have a fellowship. I could end up there. I have the resources to end up there. That would be more desirable. If you want to do a transplant year, then when you're looking at a GI fellowship, it's like, well, I want to be somewhere that has a transplant center because that's the easiest way. Because as we said, a lot of places are gonna take their own because it's like a year long or a three year long interview, as opposed to what you're gonna do in one day. They're gonna know you the best and that's the best place you're gonna have to really shine. So that would be my advice. That's perfect. Thank you. All right, there was, I think maybe two questions about letters actually. So, and this will be applicable to sort of people in medical school, but also beyond. Is it better to get a letter from a strong GI faculty? This will obviously be for fellowship, but getting a letter from a strong GI faculty member who you're not sure will write a good letter. You're not thinking they maybe won't write a good letter at all, but you're just not sure. Or is it better to get a letter from maybe an internal medicine faculty member who you know can speak well of you? Absolutely someone that can write a strong letter for you. Like if someone writes a lukewarm or not so good letter, I mean, that could be the dagger for you, to be honest. So absolutely someone who can write a strong letter. And when you ask for the letter to say, do you think you can write me a strong letter of recommendation? You just, that is at that stage in the game, more than everything we're talking about, step scores, the letter of recommendations are major. So you do not want someone that's like, no, they're not bad, you know? That's not a good sign for sure. Over the big name, that someone gives you a lukewarm letter, someone that may not have as big a name, but is gonna write, you know, a glowing recommendation, that's what you want. I was gonna echo those comments, as well as mention that look at it, if you look at it from the program director standpoint, right, there's hundreds of folks that are applying to different GI programs. So they're reading letter after letter after letter. So they want something that's gonna stand out. So I think it does matter a lot more as long as the letter is strong versus who it's from. I agree. I think after reading letter after letter, they're looking for that, those words, those keywords. And they know what exceptional, no reservations, they're looking for those. And when you get that lukewarm, yeah, they're okay, that that's more of a red flag than the name of the person who wrote that for you. But when you have an internal medicine doctor saying, exceptional, I have no hesitation recommending this person, that matters way more than, like, it just does. You know, I'll just add to this. I think this comes up a lot. And, you know, a lot of times we talk about mentorship, but I think that this, for especially if those of you are still in medical school, you know, finding mentors is great. But as you do that, remember, you will find great mentors if you also become an excellent mentee. So, you know, in the Q&A, Dr. Jennifer Christie put in the, it was our incoming ASG president, get your hustle on. So, you know, I always tell that, you know, to be a good, to find a good mentor, you have to meet your, you have to meet, you have to be a good mentee and try to meet your mentor at least 40% of the way. So try to be respectful of their time, try to make sure that you make it easy for them to mentor you. Like I always give this example that if I'm, you know, if I want to really get mentored by someone, and I know they're really busy, I try to figure out how I can make it easier for them to mentor me. So I'll be like, you know, I'll just walk to your car because, you know, that way they don't have to spend any extra time with me, but they do have to walk to the parking lot for 10 minutes after a clinic that's over. And then when I walked to them with the, you know, after the clinic, 10 minutes of the car, guess what? They stand in the parking lot for 15 more minutes. And I ended up having a 25 minute, you know, meeting with someone who didn't have time for the next four weeks to do that. So one of the ways to find a good mentor is trying to be an effective mentee. And if you can do that, you will find that people will support you. And when you have good mentors and they believe in you, your letters will be glowing and, you know, they'll speak for themselves. Perfect, thank you. All right, I want to make sure I'm being respectful of everyone's time. I did 747. All right, I think we have time for at least one or two more questions. And someone just threw one in now. So since GI is more competitive to get into, do you all foresee there being an increase in the number of GI fellowship programs in the future? That is a fantastic question. I think, yes, and they are increasing. I mean, you know, we see every year new programs opening up and definitely there's a great demand and specialties just booming in all directions, whether you're doing endoscopy, IBD, hepatology, motility, esophagus. So I think there's definitely need and more programs are coming. I'd like to add that I think there is a GI doctor shortage nationwide right now. So I do agree that I think there's going to be more and more fellowship programs added as the years move on. Perfect. All right. Let's see, who haven't we heard from in a while? Dr. McLean, knowing what you know about the field now, would you pick GI again? Totally. I think that in my experience thus far, which is, you know, obviously been as a trainee, it's been great in that it allows me to, one, work with my hands. So, you know, I really love the procedural aspect, the instant gratification of, I can see this and I can fix it, as opposed to a lot of the things that made me take a lot more time in medicine. I think it gives me a really good lifestyle and offers a good lifestyle. You know, earlier I was talking about my decision to choose GI was because so many other people had suggested they would do it again. And a big part of that was lifestyle. And I think in general, you know, gastroenterologists from what I've seen, I always describe people, describe them to people as the cool kids, you know. In general, I feel like we're generally very easy to get along with. We're some of the nicest attendings. And I think a lot of that is for a reason. It's the personality that really is pulled into this field. So I definitely have no hesitation. I would choose it again for sure. Awesome. Dr. Bhakta, what about you? I was thinking the same thing. I was like, at one point, I remember when I decided internal medicine, I knew I wanted to do something beyond that. And I was like, okay, cardiology looks cool. Hematology, oncology, that's interesting. You really, I applaud everyone that's in this webinar. Like you don't know anything until you're going through that process and really experiencing and seeing the patients, the pathophysiology, and not only that, the people who are in that field. And so when I was with the cardiologist, I was like, ooh, uh-uh. I was like, I'm not this intense. I don't care that much about the ZKG. And then with the GI people, they were talking about poop. And I was like, this is great. And making jokes about it, but also just, again, the pathophysiology, the procedural aspect. And I think something to recognize is you can go into cardiology and you can be a general cardiologist. You do clinic pretty much all the time, unless you go into maybe interventional or EP, but in GI, general GI, you are going to do clinic and procedure, and you have this kind of balance between the two. And then you have all these other subspecialties outside of that within GI, interventional endoscopy, motility, hepatology. It's just, IBD is its own little niche. It's just so many things you can do. And again, for me, it was personality. It's just laid back energy, but just some of the smartest people in the room. I love that answer. That's perfect. All right. So it is 7.50. So I think I'm gonna just get to our last question here. And this one is gonna be directed toward Dr. Bilal. Can you please talk about how students can get involved with ASGE? Yes. My favorite question of the night. So, like I said earlier, that if you go to the ASGE webpage under membership, you can join. ASGE does have opportunity for student membership. Everyone who is on the call tonight gets one year of free ASGE membership. And that comes with a lot of perks. And I think here, Michelle is gonna pull up some of these resources for you all. We'll send an email in a couple of weeks with all that information. We just verify that you're good standing from either your site director, your clerkship coordinator, your dean or whatever person you would want us to reach out to make sure that you're good standing. I also encourage that while ASGE is an organization or some of our sister organizations are there, there's also, like I said earlier, dedicated organizations if you're from an underrepresented minority, especially the American Black and Gastro and Hepatology Organization. So all these organizations, majority of them have medical students membership open. And that is because in GI, our leaders, our field as a whole, as a community, we really value the diversity and we know we wanna invest in the pipeline. So I think every organization is thrilled to have medical students, early career residents be part of our organizations. So please, I highly encourage you to join these organizations because they're gonna open lots of doors and opportunities that you won't know about. You'll literally get an email every day from an organization. And I'll tell you about once every couple of weeks there'll be a hidden opportunity to participate in something. Perfect, thank you. All right, does anyone have, any of our panelists have any last minute thoughts or comments you wanted to share with the group? Just wanna chime in and say good luck to everyone on the call. Again, I commend you all for being here and it is a long journey, but it's very, very, very well worth it in the end. So good luck and definitely please feel free to reach out to myself or any of the other panelists if you have any other questions. I'll just briefly say thank you again for having all of us on this call. It was fun and good luck to everyone. And just keep in mind that it's competitive, yes, but people do it every day. So you can do it too. All right, perfect, thank you so much for that. So in the interest of time, I think we only have like five minutes. We do have to wrap up, but I just wanna say that this has been a very insightful discussion. I wanna thank all of my panelists here for your thoughtful comments. And of course, thank my audience here for asking some excellent questions. I'm really grateful that all of you came and making this event a success. Before you go, I wanna let you know, you will be getting an email that'll have the contact information for myself as well as all of our panelists as well. You can feel free to reach out to any of us with any questions, comments, whatever. That same email will also have information on how to access the recorded version of this panel for anyone who wishes to view it later or even share it with someone who unfortunately wasn't able to join us this evening. And then finally, that email will also contain a very, very, very short survey. We ask that you just share some of it with us. So let us know how we did and how we can improve in the future. And that way, next time it'll be more tailored to your needs. The last thing I will say is that if any of you are planning to attend AMEC, what is that? Is it next week? I think it's next week, Easter weekend in Connecticut. Please stop by the Exhibitor Hall. I'll be there manning a booth for ASGE and would love, love, love to meet you in person. Thank you again and have a wonderful night. Thank you.

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GI fellowship programs

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