FIT Update

FIT Update: Top Tips for New GI Fellows

Sunny Patel, MD

@SunnyPatelMD

elcome to our incoming W gastroenterology fellows!

You have recently embarked on a ride of a lifetime training in this field is exciting, rewarding, challenging, and most definitely, characterbuilding. It was only a few months ago that you had gained a sense of accomplishment as you proudly read the correspondence proclaiming your match to the field of gastroenterology. As July inched closer, you may remember that feeling of accomplishment diminishing into a mixture of excitement, cluelessness, and fear.

Your first year of fellowship is, without a doubt, the most challenging of your three-years of training. You are faced with learning a new language and procedural skill set from day one. Overnight, you transform from an internal medicine resident to an “expert” in gastroenterology (at least that’s how the rest of the hospital sees it). You are spread thin between learning the basics of endoscopy, managing consults, and learning to prioritize and coordinate procedures. You take on a more prominent role as an educator as you now have a team of residents and students looking for guidance. Your attendings expect you to keep the pace of morning rounds and keep the team focused. As the saying goes, “everything comes in time”, and this is no different---be patient and prepare to work hard. Learn to triage. Under your new title of gastroenterology fellow, you will be overwhelmed at times with consults to see, procedures to complete, and/ or research to finish.

1. Learning to triage and prioritize your tasks will be a key survival tool. Chart review and evaluate your sickest patients first, anticipating the need for a procedure sooner rather than later. If they require a procedure, you need to decide who will be performing it and where it should be done (i.e. operating room, endoscopy suite, or bedside). Do not forget to communicate your plan with all those involved including the endoscopy team, primary care team, and of course, your attending. This can be a very stressful period but if you learn to prioritize and work efficiently, each month will be better than the prior.

2. Learn basics of endoscopy.

Early in your first year, spend time with the endoscopy technicians and nurses. They will show you how to set up equipment correctly and troubleshoot common problems. Take every opportunity to perform bedside endoscopies outside of the comforts of the endoscopy suite—this will make you more efficient and test your knowledge. While on consults you will likely be taking overnight call where you will be confronted with emergent overnight procedures. I urge you to anticipate your equipment needs during these encounters. For example, if called to perform an endoscopy on a foreign body or GI bleed, try to prepare equipment needed to complete the task and have it ready to be used. It may seem unnecessary, but when seconds count, you will be grateful. This not only helps maintain a smooth case, but also makes you look like a rock star.

3. Learn to accept criticism.

Frequently, we receive positive criticism from our mentors and peers, boosting our morale and confidence. Try your best to focus on evaluations which provide more constructive criticism. In my opinion, one constructive comment is significantly more valuable than ten “you’re doing great!” reviews.

4. If you do not know, ask for help. You have spent countless hours studying and trying to be the best, but do not forget, you are not expected to know everything. However, you are expected to identify what you do not know. Many of us try to “figure it out,” but there will always be a time when you need to seek help. This not only applies to your first year, but to the rest of your career. Remember,

patient safety comes first! Second year of fellowship will start before you know it and you will surprise yourself on how much you have learned over the past year. The new first year fellows will be coming to you for advice. Take this opportunity to become a better teacher and mentor.

5. Identify your weaknesses. Take your time in endoscopy to identify your weaknesses. Ask those who are more experienced for “tricks of the trade.” Veteran attendings were once in your shoes too! There is something to take away from every case if you look for the opportunity. There is always a lesson you have not learned or a technique you have yet to master.

6. As you continue to build your knowledge base, seek out attendings who are experts in their own subspecialties. Not every attending will be the best at managing every disease, but they will have expertise in specific subspecialties of gastroenterology, for example, IBD, GI motility, advanced therapeutics, etc. You will even see different ways of managing the same disease-- this is why medicine is an art! 7. Engage in research. When it comes to research it may seem like a mountainous task. Learn to ask yourself “why.” This is the best way to start a research project of your own. When you have an idea, run it by a mentor or someone who subspecializes in that topic and it will take off from there. Talk to your senior fellows about the ins and outs of research at your institution. They will be your best assets when trying to get your project up and running.

8. Challenge your skills. Later in your second year, when you are more proficient with screening colonoscopies and EGDs, start to focus on therapeutic endoscopy procedures. Seek out technically difficult and challenging cases such as GI bleeds, IBD, large polypectomies, dilations, etc. If you have an advance endoscopist at your institution, try to take advantage of their skillset. You will be amazed at how well they are able to get you through the most difficult cases.

You will be a third-year fellow before you have a chance to blink. The first- and second-year fellows will look up to you as both, a leader and mentor. As the senior fellow, you have a

responsibility to educate. This will only help to solidify your own knowledge in anticipation of taking your boards.

9. Transition to attending. In your final year of training think through every case and develop plans as if you were the attending. This will help build confidence and make the transition to becoming an attending smoother. Use your last few months to fine tune your endoscopy skills. Often, new attendings wished they had completed more high-risk procedures during their training. Also, they wished they had pressured themselves to perform endoscopy faster without sacrificing technique or accuracy, as they are now required to do as an attending.

Each year of fellowship seems to progress faster than the one prior. Before you know it, your training time will come to an end. Take this time to ask questions and do as much as you can. In the end, you are only as good as your training!

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