Thank you, Michelle. Thanks Dr. Raju. I'm really here mostly to thank you all, to thank the ASGE and to thank Dr. Raju for the work that was put in. This has been an incredible, incredible benefit to the team at Mayo Clinic. And as many of you may know, we have a large enterprise. We have a big hospital in Florida, a big hospital in Arizona, and then our main hospital here in Rochester, Minnesota with a series or networks of hospitals out into the Wisconsin, Iowa, and South Dakota area beyond Minnesota. And one of the things that we saw is that attrition of our most talented staff in the room. Many of you who are attending here today do this work, this vital work to what we do. We were losing those people. Wonderful people doing wonderful work because we were not properly incentivizing and retaining those staff. We hadn't created a career pathway. And that's exactly what Dr. Raju, the team at ASGE have been working towards. And so we'll jump off. I have a disclosure slide here, but nothing other than I'm going to give you some of my own opinions. So again, this is the problem. We had advanced endoscopy, particularly advanced endoscopy technicians that are just highly, highly skilled, a lot of time and energy. So we're talking for their entire shift, they're working in advanced endoscopy for over six weeks, 40 to 80 hours a week. And they're just working alongside us to develop their skills from an advanced technician in endoscopy to become an advanced endoscopy assistant. And in our hospital system, that means assisting with endoscopic ultrasound, assisting with ERCP or bile duct and pancreas duct procedures, assisting with endoscopic suturing procedures and through the mouth surgical type procedures, resection and tissue ablation procedures. These are very high risk, but high reward procedures for patients. And it takes a steady hand. Everyone knows who's been in an endoscopy suite, where they're working, sort of operating with one hand and who are other hands, who's our right hand in that procedure is often the technician working alongside us. And so there's no doubt, I think to any of us working endoscopy that our technicians need to be absolutely excellent. And so unfortunately in our system, a technician role was sort of a stepping stone to something else. It was a stepping stone to nursing school. It was a stepping stone to maybe a higher level technician in another area. We actually have technologists throughout the hospital. We have a neurology technologist and a cardiac technologist. So we would lose a lot of our best and skilled technicians to the cardiology suites, for example, doing electrophysiology and interventional cardiology. And our turnover just was stunting our growth. Some wonderful physicians well-known in the ASGE struggled with their work every day when they came to work because of our technician turnover. And so this is where through partnership with the ASGE, we learned that there may be an opportunity to create this advancement that was needed because people love the work. I think if you've worked in endoscopy, you know we have a good time. There's music on in the background when it's appropriate. We do our best to have fun. I think GI attracts a certain type of person. And so they wanted to stay, but we just hadn't created this. So how do we create that career pathway was really answered by this ASGE program. We did it. We knew what we wanted to create, which was the advanced endoscopy assistant position, a technologist position, but we didn't know how to get there. And again, perfect timing with the ASGE rolling out their group membership opportunity and the opportunity for our technicians to train formally and receive their certification at the end, not a certificate or a certificate, not a certification, but it was something that we could use along with the amount of time they spent training alongside the physicians that we could use to justify to our HR department, creating this new role and to justify it being substantially higher in terms of compensation and reward for our teammates compared to a lot of the other competing positions. So I put this slide on just to detail what the advanced endoscopy assistant job entails, that basically the job requirements as written by our HR department entails. And it's a lot. This is, this is evidence. The fact that this slide is so busy is evidence of how much work that you all do alongside us and why it was so important that we create this role. So we're talking all the way down to participating in quality improvement and safety projects. These are, these are important things that physicians have to do to maintain their certification, but also understanding the GI abdominal and thoracic anatomy. Some of the biggest feedback, and you'll hear from one of my technicians in just a minute, some of the best feedback I've received about this program is, you know what, I've been helping you with ERCP for two years, three years, five years. I didn't really understand what we were doing in this one part of the procedure. And after doing this training, I get it. I now feel like I understand because I didn't, I didn't realize where the wire was going in this part of the procedure. And I obviously feel terrible that we hadn't done a good enough job educating our team so that they felt fully engaged and understanding of the procedures. But this is, it's just more evidence of why this kind of training program is so important. So there were barriers. I'm not going to lie. And I think a lot of you probably have seen this in your own institutions. There will be things that slow you down as you try to create this role. And as you go through training, one of the issues is that in the state of Minnesota, you have to have a certification in order to deliver a medication. And so for example, delivering or pushing contrast during an ERCP procedure is considered medication delivery. And so we were fortunately able to work along with our nursing colleagues, our Department of Nursing, our pharmacy department to establish number one, a criteria that our team is delivering that medication under the order of a physician. So that kind of keeps our team covered. But then also they were able to do an online module through our internal system of education to ensure that they had a certification that allowed them then to deliver medications. So that was one of the biggest barriers we had to get through to create this role. Again, I think if you make a big enough deal about this to your HR department, to those who are making decisions for your endoscopy unit, this is something that can be overcome. And then again, job descriptions and pay structure at large institutions and big practices, they're guarded in committees and red tape. And so again, it does require time. I know Dr. Raju had mentioned earlier, he was surprised how long the process of creating an education curriculum was in development. But also I think implementing it in a system can also take a very long time. I feel now totally worth it on the backside of this. So we needed a training program specific to the advanced endoscopy assistant role to credential into our new position. And this is really where the ASGE tech training program comes into light. One of the things I'll remember kind of the cards that you hold. So as you are advocating for your endoscopy unit and for your technicians and assistants in the room, remember that gastroenterology and endoscopy is a very high ROI area. So the return on investment to your team, I think you can show is going to be worth it to hospital administrators and others who need to make these decisions about rewarding your team and creating a true career pathway. And that it never hurts to ask. And I also would say, you know, without being annoying, the squeaky wheel often gets the oil. But just being persistent in asking and offering suggestions and solutions for how to move forward with creating this kind of program was ultimately successful for us. So the pathway to credentialing into the program in our own institution requires that an individual be a graduate of a diploma, associate or baccalaureate academic program in health science. And that can be as simple as doing a six-month program in cardiac ultrasound or IV placement. So it's not particularly onerous and is offered through our institution. So this is something that all of our techs will go through as they work towards this advanced endoscopy assistant role. It does require a minimum of 1,400 hours of experience working in our endoscopy specialty practice rooms as a technician. And we have a graduated technician program that then culminates in this advanced endoscopy assistant role. We do require ACLS certification. So when a patient has an issue during a procedure, our advanced endoscopy assistants are some of the first to step up and start administering life-saving care. It adds another person in the room who's fully capable of helping during a code situation. And then successful completion of the endotechnologist curriculum and certifying exam is required. This is something where I was nervous. I've taken a lot of tests in my life, but I was nervous for my team. They were nervous about taking the exam. And I have to say, they all made it through on their first attempt. They were so dedicated to the study and preparation. They even came to me with questions they got wrong and said, is this really even wrong? And I think I've reached out to Dr. Raju. There are times where there are some practice differences. And so I think some of them probably essentially got 100%. That's how much they really dedicated and cared about this training and really put themselves into it. And then ultimately, I'm coming to a close here. This is the most important thing. I think we all have to rest on our data. This is a snapshot in time that I think a lot of us would prefer to forget. But you can see right around 2020, 2021, probably multifactorial issues here. But like many of us saw in our practices, there was an exit. So there was a mass exodus. This was the worst our turnover had ever been in endoscopy. And our endoscopy technicians and LPNs exited at a rate of about 50% on our unit in 2020. It wasn't much better at 45% in 2021. And then we started talking about how do we stem the tide and how do we really retain our best and most talented staff members in 2022. And this is where things change. So we started talking about developing, not even implementing anything, no change in the role, no change in pay structure, benefits, just talking about how we were going to create this for folks. And in 2022, a big drop, a big dip, just from talking about how much we needed to institute a program. And then we implemented it just late, early in 2024. Not a single technician has left the Mayo Clinic endoscopy unit since we implemented this. I anticipate losing one who's applying to medical school probably in the next year or so. This training program and this position creates a durable, long-term career pathway for folks. And I think this to me was evidence that all of the work was worth it and why I'm here again to thank Dr. Raju and the ASGE. This is one of my technicians. I will say she is incredibly soft-spoken, incredibly talented with her hands in endoscopy. And so the fact that she agreed or offered actually to do this testimonial should speak to everyone for how thankful she is and how thankful we are that she's in the position she is. So I'll be quiet and let Lindsay speak for a minute. Hi, I'm Lindsay Podine. I'm an advanced endoscopy assistant at Mayo Clinic in Rochester, Minnesota. It was an incredibly valuable experience. The AEA training through ASGE was structured and comprehensive. And it really helped deepen my understanding of advanced endoscopic procedures. Before becoming an AEA, my exposure to ERCP procedures was limited. However, through this training, I developed a deeper understanding of both the technical aspects and the clinical rationale behind the steps we take during these procedures. It not only enhanced my procedural knowledge, but also gave me a clearer perspective on the purpose and importance of each task performed in the ERCP suite, ultimately allowing me to contribute more effectively to patient care and the overall workflow of my team. The online platform was easily accessible and user-friendly. It made the whole process less intimidating. The exam process was fair, but required preparation. It tested not just role knowledge, but also clinical reasoning. Absolutely, I would highly recommend it to any tech or nurse looking to move into a more specialized role. It really sets a strong foundation for the clinical and procedural expectations of an assistant. The training boosts your confidence, sharpens your skills, and gives you recognition within your team. It's a smart step for professional development. Since completing the training and officially stepping into the AEA role, I felt a real shift in my responsibilities and how I viewed within the team. I'm now entrusted with charting procedures and preparing medications. I also have a closer working relationship with my physicians. It's rewarding to know that my input matters during cases. I also feel more confident advocating for best practices and helping training staff. It's definitely been a positive change, both professionally and personally. Thank you so much. I'm going to pass the baton over now to our colleague at ASGE. Kevin's going to talk through some real-world examples of the program, and Kevin, I'll let you take it away.

advanced endoscopy assistant

Mayo Clinic

career pathway

technician retention

professional development