The New Gastroenterologist

For more information about the American Gastroenterological Association’s upcoming events and award deadlines, please visit http://agau.gastro.org and http://www.gastro.org/research-funding.
 

Upcoming Events

May 1, 2021
2021 AGA Postgraduate Course (Virtual Event)
Discover emerging science, leverage new tools and technologies and build lasting collaborations that will transform GI research and patient care at the AGA Postgraduate Course. Receive updates here.

May 21-23, 2021
Digestive Disease Week® (Virtual Event)
Save the date for the world’s leading event in digestive disease. DDW® brings professionals in gastroenterology, hepatology, endoscopy, and GI surgery together. Experience growth when you share your research, converge with trailblazers, and improve the lives of patients suffering from GI and liver diseases.

Early bird registration: Jan. 20 to Mar. 31, 2021.
 

Award Deadlines

AGA Student Abstract Award
This award supports recipients who are graduate students, medical students, or medical residents (residents up to postgraduate year 3) giving abstract-based oral or poster presentations at Digestive Disease Week® (DDW). The top scoring abstract will be designated the Student Abstract of the Year.

Application Deadline: Feb. 24, 2021
 

AGA–Moti L. & Kamla Rustgi International Travel Awards
This award provides support to early career (i.e., 35 years of age or younger at the time of Digestive Disease Week® (DDW)) basic, translational or clinical investigators residing outside North America giving abstract-based oral or poster presentations at DDW.

Application Deadline: Feb. 24, 2021
 

AGA Fellow Abstract Award
This award supports recipients who are MD, PhD, or equivalent fellows giving abstract-based oral or poster presentations at Digestive Disease Week® (DDW). The top scoring abstract will be designated the Fellow Abstract of the Year.

Application Deadline: Feb. 24, 2021
 

AGA-Aman Armaan Ahmed Family Summer Undergraduate Research Fellowship (SURF)
These fellowships support undergraduate students from groups traditionally underrepresented in biomedical research to perform 10 weeks of research related to digestive diseases under the mentorship of top investigators in the fields of gastroenterology and hepatology. The award provides a stipend, funding to offset travel and meal expenses, and opportunities to learn about future training and career options.

Application Deadline: Feb. 24, 2021

For more information about the American Gastroenterological Association’s upcoming events and award deadlines, please visit http://agau.gastro.org and http://www.gastro.org/research-funding.
 

Upcoming Events

May 1, 2021
2021 AGA Postgraduate Course (Virtual Event)
Discover emerging science, leverage new tools and technologies and build lasting collaborations that will transform GI research and patient care at the AGA Postgraduate Course. Receive updates here.

May 21-23, 2021
Digestive Disease Week® (Virtual Event)
Save the date for the world’s leading event in digestive disease. DDW® brings professionals in gastroenterology, hepatology, endoscopy, and GI surgery together. Experience growth when you share your research, converge with trailblazers, and improve the lives of patients suffering from GI and liver diseases.

Early bird registration: Jan. 20 to Mar. 31, 2021.
 

Award Deadlines

AGA Student Abstract Award
This award supports recipients who are graduate students, medical students, or medical residents (residents up to postgraduate year 3) giving abstract-based oral or poster presentations at Digestive Disease Week® (DDW). The top scoring abstract will be designated the Student Abstract of the Year.

Application Deadline: Feb. 24, 2021
 

AGA–Moti L. & Kamla Rustgi International Travel Awards
This award provides support to early career (i.e., 35 years of age or younger at the time of Digestive Disease Week® (DDW)) basic, translational or clinical investigators residing outside North America giving abstract-based oral or poster presentations at DDW.

Application Deadline: Feb. 24, 2021
 

AGA Fellow Abstract Award
This award supports recipients who are MD, PhD, or equivalent fellows giving abstract-based oral or poster presentations at Digestive Disease Week® (DDW). The top scoring abstract will be designated the Fellow Abstract of the Year.

Application Deadline: Feb. 24, 2021
 

AGA-Aman Armaan Ahmed Family Summer Undergraduate Research Fellowship (SURF)
These fellowships support undergraduate students from groups traditionally underrepresented in biomedical research to perform 10 weeks of research related to digestive diseases under the mentorship of top investigators in the fields of gastroenterology and hepatology. The award provides a stipend, funding to offset travel and meal expenses, and opportunities to learn about future training and career options.

Application Deadline: Feb. 24, 2021

For more information about the American Gastroenterological Association’s upcoming events and award deadlines, please visit http://agau.gastro.org and http://www.gastro.org/research-funding.
 

Upcoming Events

May 1, 2021
2021 AGA Postgraduate Course (Virtual Event)
Discover emerging science, leverage new tools and technologies and build lasting collaborations that will transform GI research and patient care at the AGA Postgraduate Course. Receive updates here.

May 21-23, 2021
Digestive Disease Week® (Virtual Event)
Save the date for the world’s leading event in digestive disease. DDW® brings professionals in gastroenterology, hepatology, endoscopy, and GI surgery together. Experience growth when you share your research, converge with trailblazers, and improve the lives of patients suffering from GI and liver diseases.

Early bird registration: Jan. 20 to Mar. 31, 2021.
 

Award Deadlines

AGA Student Abstract Award
This award supports recipients who are graduate students, medical students, or medical residents (residents up to postgraduate year 3) giving abstract-based oral or poster presentations at Digestive Disease Week® (DDW). The top scoring abstract will be designated the Student Abstract of the Year.

Application Deadline: Feb. 24, 2021
 

AGA–Moti L. & Kamla Rustgi International Travel Awards
This award provides support to early career (i.e., 35 years of age or younger at the time of Digestive Disease Week® (DDW)) basic, translational or clinical investigators residing outside North America giving abstract-based oral or poster presentations at DDW.

Application Deadline: Feb. 24, 2021
 

AGA Fellow Abstract Award
This award supports recipients who are MD, PhD, or equivalent fellows giving abstract-based oral or poster presentations at Digestive Disease Week® (DDW). The top scoring abstract will be designated the Fellow Abstract of the Year.

Application Deadline: Feb. 24, 2021
 

AGA-Aman Armaan Ahmed Family Summer Undergraduate Research Fellowship (SURF)
These fellowships support undergraduate students from groups traditionally underrepresented in biomedical research to perform 10 weeks of research related to digestive diseases under the mentorship of top investigators in the fields of gastroenterology and hepatology. The award provides a stipend, funding to offset travel and meal expenses, and opportunities to learn about future training and career options.

Application Deadline: Feb. 24, 2021

GASTROENTEROLOGY

October 2020
How to incorporate a chief fellow into a gastroenterology fellowship program. Mohammad Bilal et al. 2020 Oct;159(4):1227-30. doi: 10.1053/j.gastro.2020.09.001

Lower adenoma miss rate of computer-aided detection-assisted colonoscopy vs routine white-light colonoscopy in a prospective tandem study. Pu Wang et al. 2020 Oct;159(4):1252-61.e5. doi: 10.1053/j.gastro.2020.06.023

November 2020
Simulation-based mastery learning with virtual coaching: experience in training standardized upper endoscopy to novice endoscopists. Roy Soetikno et al. 2020 Nov;159(5):1632-6. doi: 10.1053/j.gastro.2020.06.096

Risk of small bowel adenocarcinoma, adenomas, and carcinoids in a nationwide cohort of individuals with celiac disease. Louise Emilsson et al. 2020 Nov;159(5):1686-94.e2 doi: 10.1053/j.gastro.2020.07.007

December 2020
Increased intestinal permeability is associated with later development of Crohn’s disease. Williams Turpin et al. 2020 Dec;159(6):2092-100.e5. doi: 10.1053/j.gastro.2020.08.005

January 2021
The role of angiotensin converting enzyme 2 in modulating gut microbiota, intestinal inflammation, and coronavirus infection. Josef M. Penninger et al. 2020 Oct 30:S0016-5085(20)35327-0. doi: 10.1053/j.gastro.2020.07.067

Behavioral and diet therapies in integrated care for patients with irritable bowel syndrome. William D. Chey et al. 2020 Oct 19:S0016-5085(20)35281-1. doi: 10.1053/j.gastro.2020.06.099

Efficacy and safety of tradipitant in patients with diabetic and idiopathic gastroparesis in a randomized, placebo-controlled trial. Jesse L. Carlin et al 2020 Jul 18;S0016-5085(20)34958-1. doi: 10.1053/j.gastro.2020.07.029

CLINICAL GASTROENTEROLOGY AND HEPATOLOGY

November 2020
The virtual gastroenterology clinic. Toyia James-Stevenson. 2020 Nov;18(12):2679-82. doi: 10.1016/j.cgh.2020.06.012

Risk factors associated with early-onset colorectal cancer. Valerie Gausman et al. 2020 Nov;18(12):2752-9.e2. doi: 10.1016/j.cgh.2019.10.009

Association of daily aspirin therapy with hepatocellular carcinoma risk in patients with chronic hepatitis c virus infection. Teng-Yu Lee et al. 2020 Nov;18(12):2784-92.e7. doi: 10.1016/j.cgh.2020.04.036

December 2020
Sensitivity of fecal immunochemical test for colorectal cancer detection differs according to stage and location. Tobias Niedermaier et al. 2020 Dec;18(13):2920-2928.e6. doi: 10.1016/j.cgh.2020.01.025

Effects of colesevelam on bowel symptoms, biomarkers, and colonic mucosal gene expression in patients with bile acid diarrhea in a randomized trial. Priya Vijayvargiya et al. 2020 Dec;18(13):2962-70.e6. doi: 10.1016/j.cgh.2020.02.027

Endoscopy for gastric cancer screening is cost effective for Asian Americans in the United States. Shailja C. Shah et al. 2020 Dec;18(13):3026-39. doi: 10.1016/j.cgh.2020.07.031

January 2021
C.O.V.I.D.: A survival guide for GI fellowship training during the COVID-19 pandemic. Tzu-Hao Lee et al. 2021 Jan;19(1):6-9. doi: 10.1016/j.cgh.2020.10.001

Use of proton pump inhibitors increases risk of incident kidney stones. Michael Simonov et al. 2021 Jan;19(1):72-9.e21. doi: 10.1016/j.cgh.2020.02.053

TECHNIQUES AND INNOVATIONS IN GASTROINTESTINAL ENDOSCOPY

Endoscopic extraction of large foreign bodies utilizing a novel push-pull extraction technique. Koushik K. Das and Michael L. Kochman. 2020 Oct;22(4):172-7. doi: 10.1016/j.tige.2020.06.004

GASTROENTEROLOGY

October 2020
How to incorporate a chief fellow into a gastroenterology fellowship program. Mohammad Bilal et al. 2020 Oct;159(4):1227-30. doi: 10.1053/j.gastro.2020.09.001

Lower adenoma miss rate of computer-aided detection-assisted colonoscopy vs routine white-light colonoscopy in a prospective tandem study. Pu Wang et al. 2020 Oct;159(4):1252-61.e5. doi: 10.1053/j.gastro.2020.06.023

November 2020
Simulation-based mastery learning with virtual coaching: experience in training standardized upper endoscopy to novice endoscopists. Roy Soetikno et al. 2020 Nov;159(5):1632-6. doi: 10.1053/j.gastro.2020.06.096

Risk of small bowel adenocarcinoma, adenomas, and carcinoids in a nationwide cohort of individuals with celiac disease. Louise Emilsson et al. 2020 Nov;159(5):1686-94.e2 doi: 10.1053/j.gastro.2020.07.007

December 2020
Increased intestinal permeability is associated with later development of Crohn’s disease. Williams Turpin et al. 2020 Dec;159(6):2092-100.e5. doi: 10.1053/j.gastro.2020.08.005

January 2021
The role of angiotensin converting enzyme 2 in modulating gut microbiota, intestinal inflammation, and coronavirus infection. Josef M. Penninger et al. 2020 Oct 30:S0016-5085(20)35327-0. doi: 10.1053/j.gastro.2020.07.067

Behavioral and diet therapies in integrated care for patients with irritable bowel syndrome. William D. Chey et al. 2020 Oct 19:S0016-5085(20)35281-1. doi: 10.1053/j.gastro.2020.06.099

Efficacy and safety of tradipitant in patients with diabetic and idiopathic gastroparesis in a randomized, placebo-controlled trial. Jesse L. Carlin et al 2020 Jul 18;S0016-5085(20)34958-1. doi: 10.1053/j.gastro.2020.07.029

CLINICAL GASTROENTEROLOGY AND HEPATOLOGY

November 2020
The virtual gastroenterology clinic. Toyia James-Stevenson. 2020 Nov;18(12):2679-82. doi: 10.1016/j.cgh.2020.06.012

Risk factors associated with early-onset colorectal cancer. Valerie Gausman et al. 2020 Nov;18(12):2752-9.e2. doi: 10.1016/j.cgh.2019.10.009

Association of daily aspirin therapy with hepatocellular carcinoma risk in patients with chronic hepatitis c virus infection. Teng-Yu Lee et al. 2020 Nov;18(12):2784-92.e7. doi: 10.1016/j.cgh.2020.04.036

December 2020
Sensitivity of fecal immunochemical test for colorectal cancer detection differs according to stage and location. Tobias Niedermaier et al. 2020 Dec;18(13):2920-2928.e6. doi: 10.1016/j.cgh.2020.01.025

Effects of colesevelam on bowel symptoms, biomarkers, and colonic mucosal gene expression in patients with bile acid diarrhea in a randomized trial. Priya Vijayvargiya et al. 2020 Dec;18(13):2962-70.e6. doi: 10.1016/j.cgh.2020.02.027

Endoscopy for gastric cancer screening is cost effective for Asian Americans in the United States. Shailja C. Shah et al. 2020 Dec;18(13):3026-39. doi: 10.1016/j.cgh.2020.07.031

January 2021
C.O.V.I.D.: A survival guide for GI fellowship training during the COVID-19 pandemic. Tzu-Hao Lee et al. 2021 Jan;19(1):6-9. doi: 10.1016/j.cgh.2020.10.001

Use of proton pump inhibitors increases risk of incident kidney stones. Michael Simonov et al. 2021 Jan;19(1):72-9.e21. doi: 10.1016/j.cgh.2020.02.053

TECHNIQUES AND INNOVATIONS IN GASTROINTESTINAL ENDOSCOPY

Endoscopic extraction of large foreign bodies utilizing a novel push-pull extraction technique. Koushik K. Das and Michael L. Kochman. 2020 Oct;22(4):172-7. doi: 10.1016/j.tige.2020.06.004

GASTROENTEROLOGY

October 2020
How to incorporate a chief fellow into a gastroenterology fellowship program. Mohammad Bilal et al. 2020 Oct;159(4):1227-30. doi: 10.1053/j.gastro.2020.09.001

Lower adenoma miss rate of computer-aided detection-assisted colonoscopy vs routine white-light colonoscopy in a prospective tandem study. Pu Wang et al. 2020 Oct;159(4):1252-61.e5. doi: 10.1053/j.gastro.2020.06.023

November 2020
Simulation-based mastery learning with virtual coaching: experience in training standardized upper endoscopy to novice endoscopists. Roy Soetikno et al. 2020 Nov;159(5):1632-6. doi: 10.1053/j.gastro.2020.06.096

Risk of small bowel adenocarcinoma, adenomas, and carcinoids in a nationwide cohort of individuals with celiac disease. Louise Emilsson et al. 2020 Nov;159(5):1686-94.e2 doi: 10.1053/j.gastro.2020.07.007

December 2020
Increased intestinal permeability is associated with later development of Crohn’s disease. Williams Turpin et al. 2020 Dec;159(6):2092-100.e5. doi: 10.1053/j.gastro.2020.08.005

January 2021
The role of angiotensin converting enzyme 2 in modulating gut microbiota, intestinal inflammation, and coronavirus infection. Josef M. Penninger et al. 2020 Oct 30:S0016-5085(20)35327-0. doi: 10.1053/j.gastro.2020.07.067

Behavioral and diet therapies in integrated care for patients with irritable bowel syndrome. William D. Chey et al. 2020 Oct 19:S0016-5085(20)35281-1. doi: 10.1053/j.gastro.2020.06.099

Efficacy and safety of tradipitant in patients with diabetic and idiopathic gastroparesis in a randomized, placebo-controlled trial. Jesse L. Carlin et al 2020 Jul 18;S0016-5085(20)34958-1. doi: 10.1053/j.gastro.2020.07.029

CLINICAL GASTROENTEROLOGY AND HEPATOLOGY

November 2020
The virtual gastroenterology clinic. Toyia James-Stevenson. 2020 Nov;18(12):2679-82. doi: 10.1016/j.cgh.2020.06.012

Risk factors associated with early-onset colorectal cancer. Valerie Gausman et al. 2020 Nov;18(12):2752-9.e2. doi: 10.1016/j.cgh.2019.10.009

Association of daily aspirin therapy with hepatocellular carcinoma risk in patients with chronic hepatitis c virus infection. Teng-Yu Lee et al. 2020 Nov;18(12):2784-92.e7. doi: 10.1016/j.cgh.2020.04.036

December 2020
Sensitivity of fecal immunochemical test for colorectal cancer detection differs according to stage and location. Tobias Niedermaier et al. 2020 Dec;18(13):2920-2928.e6. doi: 10.1016/j.cgh.2020.01.025

Effects of colesevelam on bowel symptoms, biomarkers, and colonic mucosal gene expression in patients with bile acid diarrhea in a randomized trial. Priya Vijayvargiya et al. 2020 Dec;18(13):2962-70.e6. doi: 10.1016/j.cgh.2020.02.027

Endoscopy for gastric cancer screening is cost effective for Asian Americans in the United States. Shailja C. Shah et al. 2020 Dec;18(13):3026-39. doi: 10.1016/j.cgh.2020.07.031

January 2021
C.O.V.I.D.: A survival guide for GI fellowship training during the COVID-19 pandemic. Tzu-Hao Lee et al. 2021 Jan;19(1):6-9. doi: 10.1016/j.cgh.2020.10.001

Use of proton pump inhibitors increases risk of incident kidney stones. Michael Simonov et al. 2021 Jan;19(1):72-9.e21. doi: 10.1016/j.cgh.2020.02.053

TECHNIQUES AND INNOVATIONS IN GASTROINTESTINAL ENDOSCOPY

Endoscopic extraction of large foreign bodies utilizing a novel push-pull extraction technique. Koushik K. Das and Michael L. Kochman. 2020 Oct;22(4):172-7. doi: 10.1016/j.tige.2020.06.004

Matthew Whitson, MD, MSEd (lead host)

Walk us through your current GI role and your path to getting there:

I am currently the GI fellowship director at Hofstra-Northwell, by way of Mount Sinai in New York City for medical school and residency and the University of Pennsylvania, Philadelphia, for GI fellowship. I’m about 60:40 clinical and scholarship. My clinical focus is in esophageal and swallowing disorders, which came about because of mentorship and clinical exposure while at UPenn. During my fellowship, I also got a master’s in medical education again because of the tremendous sponsorship from the faculty and leadership. I have educational roles in the medical school, the internal medicine residency, and, of course, the GI fellowship.

What is your favorite part about your current role? Least favorite part?

Favorite part: working with students and trainees. When you see a medical concept click for them and then see them apply that concept, or that skill, into practice it is incredibly rewarding. Least favorite part: the amount of written documentation needed to run a fellowship.

What are your interests outside of work?

I love going to see live music in New York and touring the museums of New York, preferably the MOMA, or getting to Storm King (an expansive sculpture garden) outside of the city when we can. Anytime we can get outside to go hiking or play golf is a good day.

What advice would you give to…

• Someone who matches into GI on Dec. 2: Celebrate; you’ve earned it! Those projects you started during residency – finish them now. Otherwise, it’s super hard to get them done during fellowship, especially if you are training at a different institution for GI fellowship.
• Someone who just graduated from GI fellowship: Negotiate that contract, and then negotiate it again. Have a budget, and don’t spend that “attending money” on anything major for at least 6 months.

How do you see the future of GI changing as a new generation of trainees enters the workforce?

The way we access information is changing. Everything is at the tip of your fingers at any time, so much so, it can be overwhelming. I think that learning how to critically appraise and access clinically appropriate data is a skill that everyone will need going forward. I think it will take an even more central role in our medical education. Beyond this, the importance of shared decision-making with your patients will continue to increase in the world of personalized medicine, as will the assortment of noninvasive testing options.

Why did you want to host this podcast?

Reading about mentorship, sponsorship, career development, etc. is important, but it doesn’t do these topics justice. It is such a nuanced thing and talking about it, exploring it, teasing it out is just so fun. I find these topics to be fascinating, and I wanted to talk with experts and hear how they approached difficult situations. Plus, I was a radio DJ when younger and have always dreamed of doing something in the audio medium as a professional.


What’s your favorite episode so far?

I won’t say favorite, but I think the Laurie Keefer episode is up there. It was such a nice conversation about a challenging concept: Building resilience in our trainees and ourselves. I learned a lot from her and have begun integrating some of these skills into my work as a program director.


What’s the best piece of advice you’ve gotten that’s helped you in your career so far?

I’m going to adopt this from a mentor of mine, but it’s the “me or my family rule.” What would you want done if the patient in front of you were your family member? If you keep that as your “True North,” then I think you are off to a good start as a clinician.

Nina Nandy, MD, MS (co-host)

Walk us through your current GI role and your path to getting there:

I think the biggest decision to make in medical school is medicine or surgery, and most things will fall under one of those categories. I liked the problem solving of medicine and the hands-on work of surgery, so I was leaning toward a procedural field then met some wonderful mentors in GI when I was in medical school. I think every field of medicine has a particular personality, and when I met gastroenterologists, it clicked with me, and I thought “I’ve found my people.” So, I went to residency in internal medicine with the goal of GI or bust. I am currently a practicing gastroenterologist, and I do general GI, liver disease, and motility.



What is your favorite part about your current role? Least favorite part?

I really love GI. I feel like I’ve found my calling, and its really exciting to be able to say that. What drew me to GI was the use of technology and minimally invasive endoscopy to see a person inside out and understand their pathology, the mix of chronic and acute conditions, and the educational aspect of talking to folks in clinic. I like putting people at ease, and GI is a great field for jokes. My least favorite part is doing peer-to-peers with insurance companies to get inflammatory bowel disease drugs approved.



What are your interests outside of work?

Outside of work, this podcast, and being division vice chief, I like to learn languages. I speak five and am working on a sixth. I’m writing a secret screenplay. I play piano and guitar, which reminds me of a quote: “All my life I wanted to play guitar badly. And now I play guitar. Badly.” I also love art; I use oil paint, acrylics, pen and ink, mixed media. I love to dance and am just getting into Peloton. But perhaps my most important role is maintaining the Instagram account for my two famous cats who will hopefully enable me to retire early. Are you out there, Purina?



What advice would you give to…

• Someone who matches into GI on Dec. 2: First of all, celebrate! Treat yo’self; you did it! Welcome to the most exciting field of medicine. But seriously, congratulate yourself for your hard work and don’t worry about being terrible at scoping because there’s a learning curve. Don’t worry about what you need to study because you are going to do it. Come in with an inquisitive, open mind. Don’t turn down consults because they seem ridiculous. You can always learn something! I think the best thing to do in fellowship is to do everything. Learn that motility and capsule, cannulate that common bile duct, place that esophageal stent! You won’t have this kind of support in the future, and you should get comfortable with everything possible while you can.
• Someone who just graduated from GI fellowship: As with those matching into GI, celebrate! Treat yo’self; you did it! I think this is the hardest transition; you don’t have that safety net anymore. You are the be-all, end-all last stop on the train. Just kidding. It seems that way, but you can always collaborate with colleagues and look things up on UpToDate. You know more than you think, and it is a continuous learning process, so it’s okay to have questions; it means you care. Yes, there will be more responsibility, and you need to keep up on path and your inbox because it will pile up. You need to think about appropriate follow-up and resources to offer your patients. You can keep up on current guidelines through your GI societies; do continuing medical education and postgraduate courses as well.

How do you see the future of GI changing as a new generation of trainees enters the workforce?

I think the future of GI is innovation, technology, social media, multidisciplinary learning. GI is a technology-centered field, and there will be new developments in medical devices and basic science research, such as the microbiome, which holds the key for numerous pathogenic processes. Physicians will need to be physician-scientists, physician-innovators, physician-business people, and physician-leaders. We must learn things beyond our own field to be successful in this changing world.



Why did you want to host this podcast?

I wanted to host this podcast because I think there is so much in fellowship we learn about GI but also so much we don’t learn about GI careers and the “real world” of practice. I wanted to create content focused on career development for early GIs and trainees and discuss “everything you wanted to know in fellowship but were afraid to ask.” I wanted to interview real successful people in the field, whether it be focusing on a career in medical education, basic science research, transplant hepatology, therapeutic endoscopy, or private practice. There are a lot of podcasts that do a great job focusing on guidelines, case reports, and research, but we wanted to take this one in a different direction. It is a great way to reach a broad audience across many platforms.



What’s your favorite episode so far?

I really like the Janice Jou episode. Not just because I’m on it, but also because she is a great, a dynamic, speaker, and our conversation was so effortless, and because she is a phenomenal program director and educator and has such valuable advice for trainees and early career gastroenterologists, drawing from her own experiences. Her tips – or rather “Janice jewels,” as I am trying to trademark on negotiation – are excellent. Check it out!



What’s the best piece of advice you’ve gotten that’s helped you in your career so far?

Don’t buy a house right out of training. Also, “live your life, not someone else’s.”

C.S. Tse, MD (co-host)

Walk us through your current GI role and your path to getting there:

I grew up in Toronto and moved to the United States for medical school at the Yale University, New Haven, Conn., and internal medicine residency at the Mayo Clinic in Rochester, Minnesota. During my residency, I became interested in gastroenterology with a particular interest in inflammatory bowel disease after studying the postoperative outcomes of IBD patients on biologics and examining the clinical course of IBD patients with coexistent celiac disease. I am a third-year gastroenterology fellow at Brown University. I will spend a year as the advanced IBD fellow at the University of California–San Diego from July 2021 to June 2022. My current research examines IBD patients’ quality of care and the psychosocial impacts on patients’ disease course. I am working with the Crohn’s and Colitis Foundation’s IBD Qorus Learning Health System to improve the quality of care and outcomes of patients with IBD. 



What is your favorite part about your current role? Least favorite part?

My favorite part of my current role is to combine patient care with clinical research, particularly for patients with IBD. My least favorite part is encountering “red tape” that may give a false sense of productivity but not actually be beneficial for patient care. Some of this is discussed in this article from the Harvard Business Review.



What are your interests outside of work?

I serve as the National President of the American Medical Women’s Association (AMWA) Residents & Fellows Division. I am a Core Faculty member of the AMWA IGNITE MD program, which is a nation-wide initiative to educate and empower female medical trainees. I currently serve as an abstract reviewer for Digestive Diseases Week® (since 2018). I previously served as an abstract reviewer and judge for the American Medical Association’s Scientific Symposium (2019 & 2020). Outside of work, I enjoy hiking, traveling, and reading.

 

What advice would you give to someone who matches into GI on Dec. 2:

Identify mentors early. (You can have more than one!) Try to imagine where you want your career to be in 5 years – generalist vs. specialist. Will you have a niche in practice? Is advanced endoscopy (ERCP, EUS, etc.) going to be a part of your practice? Academic, private practice, community practice, or hybrid? Knowing your goals will help tailor the GI fellowship experience to get you to where you want to be in your career. GI fellowship may be like a buffet table where there are many opportunities and options, but one can rarely do it all! Choosing and pursuing experiences that ultimately align with your goals can help you make the most out of your time during GI fellowship training. 



How do you see the future of GI changing as a new generation of trainees enters the workforce?

I think that there will be more integration of information technology and artificial intelligence into GI, just as for the rest of society. For example, we can see this clearly illustrated in the rapid uptake of telemedicine (including GI) during COVID-19. 



Why did you want to host this podcast?

I am intrigued by the opportunity to connect with GIs broadly through this AGA podcast. It is a portable way to use on-demand technology to engage in conversations relevant to other early GIs who may not be conventionally addressed by other means, such as journal articles, conferences, traditional didactics, and books. 



What’s your favorite episode so far?

Janice Jou’s podcast was phenomenal in providing mentorship advice (at a distance) to trainees who are interested in an academic career in clinical medicine.



What’s the best piece of advice you’ve gotten that’s helped you in your career so far?

“We are what we repeatedly do. Excellence, therefore, is not an act, but a habit.” This advice is most commonly credited to Aristotle.


Be sure to subscribe wherever you listen to podcasts or listen on the AGA website: https://gastro.org/podcast.
 

Dr. Whitson is GI fellowship director, Zucker School of Medicine at Hofstra-Northwell, Great Neck, N.Y. @MJWhitsonMD. Dr. Nandy is a gastroenterologist at Presbyterian Medical Group, Albuquerque, N.M. @NinaNandyMD. Dr. Tse is a GI fellow at Brown University, Providence, R.I. @CSTseMD.

Matthew Whitson, MD, MSEd (lead host)

Walk us through your current GI role and your path to getting there:

I am currently the GI fellowship director at Hofstra-Northwell, by way of Mount Sinai in New York City for medical school and residency and the University of Pennsylvania, Philadelphia, for GI fellowship. I’m about 60:40 clinical and scholarship. My clinical focus is in esophageal and swallowing disorders, which came about because of mentorship and clinical exposure while at UPenn. During my fellowship, I also got a master’s in medical education again because of the tremendous sponsorship from the faculty and leadership. I have educational roles in the medical school, the internal medicine residency, and, of course, the GI fellowship.

What is your favorite part about your current role? Least favorite part?

Favorite part: working with students and trainees. When you see a medical concept click for them and then see them apply that concept, or that skill, into practice it is incredibly rewarding. Least favorite part: the amount of written documentation needed to run a fellowship.

What are your interests outside of work?

I love going to see live music in New York and touring the museums of New York, preferably the MOMA, or getting to Storm King (an expansive sculpture garden) outside of the city when we can. Anytime we can get outside to go hiking or play golf is a good day.

What advice would you give to…

• Someone who matches into GI on Dec. 2: Celebrate; you’ve earned it! Those projects you started during residency – finish them now. Otherwise, it’s super hard to get them done during fellowship, especially if you are training at a different institution for GI fellowship.
• Someone who just graduated from GI fellowship: Negotiate that contract, and then negotiate it again. Have a budget, and don’t spend that “attending money” on anything major for at least 6 months.

How do you see the future of GI changing as a new generation of trainees enters the workforce?

The way we access information is changing. Everything is at the tip of your fingers at any time, so much so, it can be overwhelming. I think that learning how to critically appraise and access clinically appropriate data is a skill that everyone will need going forward. I think it will take an even more central role in our medical education. Beyond this, the importance of shared decision-making with your patients will continue to increase in the world of personalized medicine, as will the assortment of noninvasive testing options.

Why did you want to host this podcast?

Reading about mentorship, sponsorship, career development, etc. is important, but it doesn’t do these topics justice. It is such a nuanced thing and talking about it, exploring it, teasing it out is just so fun. I find these topics to be fascinating, and I wanted to talk with experts and hear how they approached difficult situations. Plus, I was a radio DJ when younger and have always dreamed of doing something in the audio medium as a professional.


What’s your favorite episode so far?

I won’t say favorite, but I think the Laurie Keefer episode is up there. It was such a nice conversation about a challenging concept: Building resilience in our trainees and ourselves. I learned a lot from her and have begun integrating some of these skills into my work as a program director.


What’s the best piece of advice you’ve gotten that’s helped you in your career so far?

I’m going to adopt this from a mentor of mine, but it’s the “me or my family rule.” What would you want done if the patient in front of you were your family member? If you keep that as your “True North,” then I think you are off to a good start as a clinician.

Nina Nandy, MD, MS (co-host)

Walk us through your current GI role and your path to getting there:

I think the biggest decision to make in medical school is medicine or surgery, and most things will fall under one of those categories. I liked the problem solving of medicine and the hands-on work of surgery, so I was leaning toward a procedural field then met some wonderful mentors in GI when I was in medical school. I think every field of medicine has a particular personality, and when I met gastroenterologists, it clicked with me, and I thought “I’ve found my people.” So, I went to residency in internal medicine with the goal of GI or bust. I am currently a practicing gastroenterologist, and I do general GI, liver disease, and motility.



What is your favorite part about your current role? Least favorite part?

I really love GI. I feel like I’ve found my calling, and its really exciting to be able to say that. What drew me to GI was the use of technology and minimally invasive endoscopy to see a person inside out and understand their pathology, the mix of chronic and acute conditions, and the educational aspect of talking to folks in clinic. I like putting people at ease, and GI is a great field for jokes. My least favorite part is doing peer-to-peers with insurance companies to get inflammatory bowel disease drugs approved.



What are your interests outside of work?

Outside of work, this podcast, and being division vice chief, I like to learn languages. I speak five and am working on a sixth. I’m writing a secret screenplay. I play piano and guitar, which reminds me of a quote: “All my life I wanted to play guitar badly. And now I play guitar. Badly.” I also love art; I use oil paint, acrylics, pen and ink, mixed media. I love to dance and am just getting into Peloton. But perhaps my most important role is maintaining the Instagram account for my two famous cats who will hopefully enable me to retire early. Are you out there, Purina?



What advice would you give to…

• Someone who matches into GI on Dec. 2: First of all, celebrate! Treat yo’self; you did it! Welcome to the most exciting field of medicine. But seriously, congratulate yourself for your hard work and don’t worry about being terrible at scoping because there’s a learning curve. Don’t worry about what you need to study because you are going to do it. Come in with an inquisitive, open mind. Don’t turn down consults because they seem ridiculous. You can always learn something! I think the best thing to do in fellowship is to do everything. Learn that motility and capsule, cannulate that common bile duct, place that esophageal stent! You won’t have this kind of support in the future, and you should get comfortable with everything possible while you can.
• Someone who just graduated from GI fellowship: As with those matching into GI, celebrate! Treat yo’self; you did it! I think this is the hardest transition; you don’t have that safety net anymore. You are the be-all, end-all last stop on the train. Just kidding. It seems that way, but you can always collaborate with colleagues and look things up on UpToDate. You know more than you think, and it is a continuous learning process, so it’s okay to have questions; it means you care. Yes, there will be more responsibility, and you need to keep up on path and your inbox because it will pile up. You need to think about appropriate follow-up and resources to offer your patients. You can keep up on current guidelines through your GI societies; do continuing medical education and postgraduate courses as well.

How do you see the future of GI changing as a new generation of trainees enters the workforce?

I think the future of GI is innovation, technology, social media, multidisciplinary learning. GI is a technology-centered field, and there will be new developments in medical devices and basic science research, such as the microbiome, which holds the key for numerous pathogenic processes. Physicians will need to be physician-scientists, physician-innovators, physician-business people, and physician-leaders. We must learn things beyond our own field to be successful in this changing world.



Why did you want to host this podcast?

I wanted to host this podcast because I think there is so much in fellowship we learn about GI but also so much we don’t learn about GI careers and the “real world” of practice. I wanted to create content focused on career development for early GIs and trainees and discuss “everything you wanted to know in fellowship but were afraid to ask.” I wanted to interview real successful people in the field, whether it be focusing on a career in medical education, basic science research, transplant hepatology, therapeutic endoscopy, or private practice. There are a lot of podcasts that do a great job focusing on guidelines, case reports, and research, but we wanted to take this one in a different direction. It is a great way to reach a broad audience across many platforms.



What’s your favorite episode so far?

I really like the Janice Jou episode. Not just because I’m on it, but also because she is a great, a dynamic, speaker, and our conversation was so effortless, and because she is a phenomenal program director and educator and has such valuable advice for trainees and early career gastroenterologists, drawing from her own experiences. Her tips – or rather “Janice jewels,” as I am trying to trademark on negotiation – are excellent. Check it out!



What’s the best piece of advice you’ve gotten that’s helped you in your career so far?

Don’t buy a house right out of training. Also, “live your life, not someone else’s.”

C.S. Tse, MD (co-host)

Walk us through your current GI role and your path to getting there:

I grew up in Toronto and moved to the United States for medical school at the Yale University, New Haven, Conn., and internal medicine residency at the Mayo Clinic in Rochester, Minnesota. During my residency, I became interested in gastroenterology with a particular interest in inflammatory bowel disease after studying the postoperative outcomes of IBD patients on biologics and examining the clinical course of IBD patients with coexistent celiac disease. I am a third-year gastroenterology fellow at Brown University. I will spend a year as the advanced IBD fellow at the University of California–San Diego from July 2021 to June 2022. My current research examines IBD patients’ quality of care and the psychosocial impacts on patients’ disease course. I am working with the Crohn’s and Colitis Foundation’s IBD Qorus Learning Health System to improve the quality of care and outcomes of patients with IBD. 



What is your favorite part about your current role? Least favorite part?

My favorite part of my current role is to combine patient care with clinical research, particularly for patients with IBD. My least favorite part is encountering “red tape” that may give a false sense of productivity but not actually be beneficial for patient care. Some of this is discussed in this article from the Harvard Business Review.



What are your interests outside of work?

I serve as the National President of the American Medical Women’s Association (AMWA) Residents & Fellows Division. I am a Core Faculty member of the AMWA IGNITE MD program, which is a nation-wide initiative to educate and empower female medical trainees. I currently serve as an abstract reviewer for Digestive Diseases Week® (since 2018). I previously served as an abstract reviewer and judge for the American Medical Association’s Scientific Symposium (2019 & 2020). Outside of work, I enjoy hiking, traveling, and reading.

 

What advice would you give to someone who matches into GI on Dec. 2:

Identify mentors early. (You can have more than one!) Try to imagine where you want your career to be in 5 years – generalist vs. specialist. Will you have a niche in practice? Is advanced endoscopy (ERCP, EUS, etc.) going to be a part of your practice? Academic, private practice, community practice, or hybrid? Knowing your goals will help tailor the GI fellowship experience to get you to where you want to be in your career. GI fellowship may be like a buffet table where there are many opportunities and options, but one can rarely do it all! Choosing and pursuing experiences that ultimately align with your goals can help you make the most out of your time during GI fellowship training. 



How do you see the future of GI changing as a new generation of trainees enters the workforce?

I think that there will be more integration of information technology and artificial intelligence into GI, just as for the rest of society. For example, we can see this clearly illustrated in the rapid uptake of telemedicine (including GI) during COVID-19. 



Why did you want to host this podcast?

I am intrigued by the opportunity to connect with GIs broadly through this AGA podcast. It is a portable way to use on-demand technology to engage in conversations relevant to other early GIs who may not be conventionally addressed by other means, such as journal articles, conferences, traditional didactics, and books. 



What’s your favorite episode so far?

Janice Jou’s podcast was phenomenal in providing mentorship advice (at a distance) to trainees who are interested in an academic career in clinical medicine.



What’s the best piece of advice you’ve gotten that’s helped you in your career so far?

“We are what we repeatedly do. Excellence, therefore, is not an act, but a habit.” This advice is most commonly credited to Aristotle.


Be sure to subscribe wherever you listen to podcasts or listen on the AGA website: https://gastro.org/podcast.
 

Dr. Whitson is GI fellowship director, Zucker School of Medicine at Hofstra-Northwell, Great Neck, N.Y. @MJWhitsonMD. Dr. Nandy is a gastroenterologist at Presbyterian Medical Group, Albuquerque, N.M. @NinaNandyMD. Dr. Tse is a GI fellow at Brown University, Providence, R.I. @CSTseMD.

Matthew Whitson, MD, MSEd (lead host)

Walk us through your current GI role and your path to getting there:

I am currently the GI fellowship director at Hofstra-Northwell, by way of Mount Sinai in New York City for medical school and residency and the University of Pennsylvania, Philadelphia, for GI fellowship. I’m about 60:40 clinical and scholarship. My clinical focus is in esophageal and swallowing disorders, which came about because of mentorship and clinical exposure while at UPenn. During my fellowship, I also got a master’s in medical education again because of the tremendous sponsorship from the faculty and leadership. I have educational roles in the medical school, the internal medicine residency, and, of course, the GI fellowship.

What is your favorite part about your current role? Least favorite part?

Favorite part: working with students and trainees. When you see a medical concept click for them and then see them apply that concept, or that skill, into practice it is incredibly rewarding. Least favorite part: the amount of written documentation needed to run a fellowship.

What are your interests outside of work?

I love going to see live music in New York and touring the museums of New York, preferably the MOMA, or getting to Storm King (an expansive sculpture garden) outside of the city when we can. Anytime we can get outside to go hiking or play golf is a good day.

What advice would you give to…

• Someone who matches into GI on Dec. 2: Celebrate; you’ve earned it! Those projects you started during residency – finish them now. Otherwise, it’s super hard to get them done during fellowship, especially if you are training at a different institution for GI fellowship.
• Someone who just graduated from GI fellowship: Negotiate that contract, and then negotiate it again. Have a budget, and don’t spend that “attending money” on anything major for at least 6 months.

How do you see the future of GI changing as a new generation of trainees enters the workforce?

The way we access information is changing. Everything is at the tip of your fingers at any time, so much so, it can be overwhelming. I think that learning how to critically appraise and access clinically appropriate data is a skill that everyone will need going forward. I think it will take an even more central role in our medical education. Beyond this, the importance of shared decision-making with your patients will continue to increase in the world of personalized medicine, as will the assortment of noninvasive testing options.

Why did you want to host this podcast?

Reading about mentorship, sponsorship, career development, etc. is important, but it doesn’t do these topics justice. It is such a nuanced thing and talking about it, exploring it, teasing it out is just so fun. I find these topics to be fascinating, and I wanted to talk with experts and hear how they approached difficult situations. Plus, I was a radio DJ when younger and have always dreamed of doing something in the audio medium as a professional.


What’s your favorite episode so far?

I won’t say favorite, but I think the Laurie Keefer episode is up there. It was such a nice conversation about a challenging concept: Building resilience in our trainees and ourselves. I learned a lot from her and have begun integrating some of these skills into my work as a program director.


What’s the best piece of advice you’ve gotten that’s helped you in your career so far?

I’m going to adopt this from a mentor of mine, but it’s the “me or my family rule.” What would you want done if the patient in front of you were your family member? If you keep that as your “True North,” then I think you are off to a good start as a clinician.

Nina Nandy, MD, MS (co-host)

Walk us through your current GI role and your path to getting there:

I think the biggest decision to make in medical school is medicine or surgery, and most things will fall under one of those categories. I liked the problem solving of medicine and the hands-on work of surgery, so I was leaning toward a procedural field then met some wonderful mentors in GI when I was in medical school. I think every field of medicine has a particular personality, and when I met gastroenterologists, it clicked with me, and I thought “I’ve found my people.” So, I went to residency in internal medicine with the goal of GI or bust. I am currently a practicing gastroenterologist, and I do general GI, liver disease, and motility.



What is your favorite part about your current role? Least favorite part?

I really love GI. I feel like I’ve found my calling, and its really exciting to be able to say that. What drew me to GI was the use of technology and minimally invasive endoscopy to see a person inside out and understand their pathology, the mix of chronic and acute conditions, and the educational aspect of talking to folks in clinic. I like putting people at ease, and GI is a great field for jokes. My least favorite part is doing peer-to-peers with insurance companies to get inflammatory bowel disease drugs approved.



What are your interests outside of work?

Outside of work, this podcast, and being division vice chief, I like to learn languages. I speak five and am working on a sixth. I’m writing a secret screenplay. I play piano and guitar, which reminds me of a quote: “All my life I wanted to play guitar badly. And now I play guitar. Badly.” I also love art; I use oil paint, acrylics, pen and ink, mixed media. I love to dance and am just getting into Peloton. But perhaps my most important role is maintaining the Instagram account for my two famous cats who will hopefully enable me to retire early. Are you out there, Purina?



What advice would you give to…

• Someone who matches into GI on Dec. 2: First of all, celebrate! Treat yo’self; you did it! Welcome to the most exciting field of medicine. But seriously, congratulate yourself for your hard work and don’t worry about being terrible at scoping because there’s a learning curve. Don’t worry about what you need to study because you are going to do it. Come in with an inquisitive, open mind. Don’t turn down consults because they seem ridiculous. You can always learn something! I think the best thing to do in fellowship is to do everything. Learn that motility and capsule, cannulate that common bile duct, place that esophageal stent! You won’t have this kind of support in the future, and you should get comfortable with everything possible while you can.
• Someone who just graduated from GI fellowship: As with those matching into GI, celebrate! Treat yo’self; you did it! I think this is the hardest transition; you don’t have that safety net anymore. You are the be-all, end-all last stop on the train. Just kidding. It seems that way, but you can always collaborate with colleagues and look things up on UpToDate. You know more than you think, and it is a continuous learning process, so it’s okay to have questions; it means you care. Yes, there will be more responsibility, and you need to keep up on path and your inbox because it will pile up. You need to think about appropriate follow-up and resources to offer your patients. You can keep up on current guidelines through your GI societies; do continuing medical education and postgraduate courses as well.

How do you see the future of GI changing as a new generation of trainees enters the workforce?

I think the future of GI is innovation, technology, social media, multidisciplinary learning. GI is a technology-centered field, and there will be new developments in medical devices and basic science research, such as the microbiome, which holds the key for numerous pathogenic processes. Physicians will need to be physician-scientists, physician-innovators, physician-business people, and physician-leaders. We must learn things beyond our own field to be successful in this changing world.



Why did you want to host this podcast?

I wanted to host this podcast because I think there is so much in fellowship we learn about GI but also so much we don’t learn about GI careers and the “real world” of practice. I wanted to create content focused on career development for early GIs and trainees and discuss “everything you wanted to know in fellowship but were afraid to ask.” I wanted to interview real successful people in the field, whether it be focusing on a career in medical education, basic science research, transplant hepatology, therapeutic endoscopy, or private practice. There are a lot of podcasts that do a great job focusing on guidelines, case reports, and research, but we wanted to take this one in a different direction. It is a great way to reach a broad audience across many platforms.



What’s your favorite episode so far?

I really like the Janice Jou episode. Not just because I’m on it, but also because she is a great, a dynamic, speaker, and our conversation was so effortless, and because she is a phenomenal program director and educator and has such valuable advice for trainees and early career gastroenterologists, drawing from her own experiences. Her tips – or rather “Janice jewels,” as I am trying to trademark on negotiation – are excellent. Check it out!



What’s the best piece of advice you’ve gotten that’s helped you in your career so far?

Don’t buy a house right out of training. Also, “live your life, not someone else’s.”

C.S. Tse, MD (co-host)

Walk us through your current GI role and your path to getting there:

I grew up in Toronto and moved to the United States for medical school at the Yale University, New Haven, Conn., and internal medicine residency at the Mayo Clinic in Rochester, Minnesota. During my residency, I became interested in gastroenterology with a particular interest in inflammatory bowel disease after studying the postoperative outcomes of IBD patients on biologics and examining the clinical course of IBD patients with coexistent celiac disease. I am a third-year gastroenterology fellow at Brown University. I will spend a year as the advanced IBD fellow at the University of California–San Diego from July 2021 to June 2022. My current research examines IBD patients’ quality of care and the psychosocial impacts on patients’ disease course. I am working with the Crohn’s and Colitis Foundation’s IBD Qorus Learning Health System to improve the quality of care and outcomes of patients with IBD. 



What is your favorite part about your current role? Least favorite part?

My favorite part of my current role is to combine patient care with clinical research, particularly for patients with IBD. My least favorite part is encountering “red tape” that may give a false sense of productivity but not actually be beneficial for patient care. Some of this is discussed in this article from the Harvard Business Review.



What are your interests outside of work?

I serve as the National President of the American Medical Women’s Association (AMWA) Residents & Fellows Division. I am a Core Faculty member of the AMWA IGNITE MD program, which is a nation-wide initiative to educate and empower female medical trainees. I currently serve as an abstract reviewer for Digestive Diseases Week® (since 2018). I previously served as an abstract reviewer and judge for the American Medical Association’s Scientific Symposium (2019 & 2020). Outside of work, I enjoy hiking, traveling, and reading.

 

What advice would you give to someone who matches into GI on Dec. 2:

Identify mentors early. (You can have more than one!) Try to imagine where you want your career to be in 5 years – generalist vs. specialist. Will you have a niche in practice? Is advanced endoscopy (ERCP, EUS, etc.) going to be a part of your practice? Academic, private practice, community practice, or hybrid? Knowing your goals will help tailor the GI fellowship experience to get you to where you want to be in your career. GI fellowship may be like a buffet table where there are many opportunities and options, but one can rarely do it all! Choosing and pursuing experiences that ultimately align with your goals can help you make the most out of your time during GI fellowship training. 



How do you see the future of GI changing as a new generation of trainees enters the workforce?

I think that there will be more integration of information technology and artificial intelligence into GI, just as for the rest of society. For example, we can see this clearly illustrated in the rapid uptake of telemedicine (including GI) during COVID-19. 



Why did you want to host this podcast?

I am intrigued by the opportunity to connect with GIs broadly through this AGA podcast. It is a portable way to use on-demand technology to engage in conversations relevant to other early GIs who may not be conventionally addressed by other means, such as journal articles, conferences, traditional didactics, and books. 



What’s your favorite episode so far?

Janice Jou’s podcast was phenomenal in providing mentorship advice (at a distance) to trainees who are interested in an academic career in clinical medicine.



What’s the best piece of advice you’ve gotten that’s helped you in your career so far?

“We are what we repeatedly do. Excellence, therefore, is not an act, but a habit.” This advice is most commonly credited to Aristotle.


Be sure to subscribe wherever you listen to podcasts or listen on the AGA website: https://gastro.org/podcast.
 

Dr. Whitson is GI fellowship director, Zucker School of Medicine at Hofstra-Northwell, Great Neck, N.Y. @MJWhitsonMD. Dr. Nandy is a gastroenterologist at Presbyterian Medical Group, Albuquerque, N.M. @NinaNandyMD. Dr. Tse is a GI fellow at Brown University, Providence, R.I. @CSTseMD.

A few years ago, I was asked to give a talk on impostor syndrome at a national conference. My initial thought was “I am not even remotely qualified to give this talk.” Upon reflection, I think that was the first time I acknowledged that I, too, suffer from this syndrome.

There are many definitions and designations (e.g., impostor phenomenon or fraud syndrome), but the one I use most often is high-achieving individuals who are marked by an inability to internalize their accomplishments and a persistent fear of being exposed as a fraud. People with high expressions of this syndrome believe that any success they achieve is due more to luck or error than to personal skill or accomplishment. They live in fear that their incompetence will be exposed and they will be revealed as a fraud both intellectually and within their job or role. First described by Clance and Imes in 1978,¹ the original authors observed that many highly respected and accomplished women did not experience an internal sense of success despite their education and evidence of academic achievement. Based in part on previous observations regarding the differential attribution of success in men and women,² the authors suggested that two general principles were found to be at the heart of this syndrome. The first was that an unexpected performance outcome will be attributed to a temporary cause. The second was that an expected performance outcome will be attributed to a stable cause. As such, the authors originally suggested that women tended to explain failure with lack of ability, whereas men attributed failure to luck or task difficulty. Furthermore, the authors emphasized environmental factors – such as mentorship, competition, and isolation – as the primary influence in the development of these tendencies.

Although originally described in women, this phenomenon can also affect men, as well as a wide variety of people from different occupations and cultures.^3-6 Furthermore, although environmental factors were originally linked as the primary driver of these tendencies, further research has suggested that personality factors play a larger role, and that up to 70% of people may experience this phenomenon in their lifetime.⁷ Personality traits such as perfectionism and neuroticism may be linked to the development of this phenomenon.^3,8

There are several online screening questionnaires that can be used to gauge whether individuals experience some or most of these traits. On one such questionnaire, the Clance IP Scale,⁹ poses such questions as: “I have often succeeded on a test or task even though I was afraid that I would not do well before I undertook the task” and “I am afraid people important to me may find out that I am not as capable as they think I am.” There are 20 questions scored from 1 to 5 and a score of 40 or below suggests few impostor tendencies, while a score of 80 or above suggests the respondent often has intense IP experiences. The higher the score, the more frequently and seriously the impostor syndrome interferes in a person’s life. What is unclear is whether this worsens, improves, or stays the same throughout one’s career. Of interest is that my personal score at this time is 43; however, it would have been 89 had I taken the test during college and medical school. What is unclear to me from the literature is what factors may play a role in a person’s perception of their abilities and their personal confidence over time.

Why is this important? Given that we are all professionals, impostor tendencies appear to have significant impact in the context of our work. This may have impact on us both as employers and as employees.¹⁰ Individuals with impostor syndrome tendencies often characterize themselves negatively and perform poorly on self-appraisals.¹¹ In a study of 201 Belgian white-collar workers, Vergauwe and colleagues found that impostor syndrome tendencies were negatively related to job satisfaction and organizational citizenship behavior; both of which could be influenced by a high degree of social support.¹⁰ Individuals with impostor syndrome tendencies do less career planning, explore career options less frequently, and are less inclined to lead.^12,13 These tendencies can be detrimental as the most qualified people for a position or opportunity may not step forward for consideration. Employers may tend to overlook these individuals for promotions or for pay raises which could negatively influence future earnings. Furthermore, a person may experience increased burnout as they continuously try to overcompensate for what they perceive as their shortcomings. They may feel concerned they are letting others down or not performing to standards. They may derive less enjoyment from life because of the constant focus on feelings of inadequacy.¹⁴ Research along these lines suggest impostor syndrome tendencies can have adverse personal and health-related consequences and may increase social anxiety, depression, and overall psychological distress.^15,16

What do I suggest? It is clear this affects a significant percentage of physicians, health care professionals, and professionals in general. Harboring these tendencies can have a negative impact on health, professional achievement, income, and happiness. It is important to self-reflect, identify if you are at risk, and if so, take the opportunity to explore solutions. My recommendations are:

• Name it: Take the test and see how you score.
• Be mindful: Self-reflection will help you identify the behaviors that are interfering with your happiness and success.
• Write it down: Be strategic and document your plan for success to reinforce your accomplishments.
• Create a feedback group: Friends and colleagues can help to mitigate the negative effects of impostor syndrome tendencies.
• Speak up: Ask for help; coaching has been documented to reduce impostor syndrome scores and help lessen the burden of these tendencies.
• Step out of your comfort zone: Develop a mantra, break bigger challenges into smaller pieces, and acknowledge little wins along the way.

In conclusion, impostor syndrome appears to be highly prevalent in professionals including those of us in medicine. The experience can adversely affect our careers and ability to secure key leadership positions. As managers, we also must keep in mind our role in mentoring others and recognizing the potential impact of impostor syndrome on those who report to us. Recognition of this phenomenon – and understanding of the effects on oneself – is the first step in overcoming the negative effects and moving toward realization of one’s potential.
 

Dr. Brown is a professor of medicine at Wayne State University, division chief of gastroenterology and hepatology at Henry Ford Hospital, and associate medical director at the Henry Ford Hospital Transplant Institute, all in Detroit.

References

1. Clance PR, Imes S. Psychother Theory Res Pract. 1978 Fall;15(3):1-7.

2. Deaux D. In J.H.Harvey, W.J.Ickes and R.F. Kidd (Eds). New directions in attribution research. Vol. 1. New York: Halsted Press Division, Wiley. 1976; p 335-42.

3. Bernard NS et al. J Pers Assess. 2002;78(2):321-33.

4. Topping ME et al. Acad Psychol Bull. 1985;(7):213-26.

5. Langford J et al. Psychotherapy. 1993;30(3):495-501.

6. Chae JH et al. J Pers Assess. 1995;65(3):468-85.

7. Harvey JC et al. If I’m successful, why do I feel like a fake? New York: Random House, 1985.

8. Ross SR et al. Pers Individ Diff. 2001;31:1347-55.

9. Clance PR. The impostor phenomenon: When success makes you feel like a fake. Toronto: Bantam Books, 1985; p 20-2.

10. Vergauwe J et al. J Bus Psychol. 2015;30:565-81.

11. Leary MR et al. J Pers. 2000;68(4):725-56.

12. Neureiter M et al. Front Psychol. 2016;7:48.

13. Neureiter M et al. J Vocat Behav. 2017;98:56-69.

14. Duhigg C. The power of habit: Why we do what we do in life and business. New York: Random House, 2012.

15. Henning K et al. Med Educ. 1998 Sep;32(5):456-64.

16. Oriel K et al. Fam Med. 2004 Apr;36(4):248-52.

17. Zanchetta M et al. Front Psychol. 2020 May 15;11:405.

A few years ago, I was asked to give a talk on impostor syndrome at a national conference. My initial thought was “I am not even remotely qualified to give this talk.” Upon reflection, I think that was the first time I acknowledged that I, too, suffer from this syndrome.

There are many definitions and designations (e.g., impostor phenomenon or fraud syndrome), but the one I use most often is high-achieving individuals who are marked by an inability to internalize their accomplishments and a persistent fear of being exposed as a fraud. People with high expressions of this syndrome believe that any success they achieve is due more to luck or error than to personal skill or accomplishment. They live in fear that their incompetence will be exposed and they will be revealed as a fraud both intellectually and within their job or role. First described by Clance and Imes in 1978,¹ the original authors observed that many highly respected and accomplished women did not experience an internal sense of success despite their education and evidence of academic achievement. Based in part on previous observations regarding the differential attribution of success in men and women,² the authors suggested that two general principles were found to be at the heart of this syndrome. The first was that an unexpected performance outcome will be attributed to a temporary cause. The second was that an expected performance outcome will be attributed to a stable cause. As such, the authors originally suggested that women tended to explain failure with lack of ability, whereas men attributed failure to luck or task difficulty. Furthermore, the authors emphasized environmental factors – such as mentorship, competition, and isolation – as the primary influence in the development of these tendencies.

Although originally described in women, this phenomenon can also affect men, as well as a wide variety of people from different occupations and cultures.^3-6 Furthermore, although environmental factors were originally linked as the primary driver of these tendencies, further research has suggested that personality factors play a larger role, and that up to 70% of people may experience this phenomenon in their lifetime.⁷ Personality traits such as perfectionism and neuroticism may be linked to the development of this phenomenon.^3,8

There are several online screening questionnaires that can be used to gauge whether individuals experience some or most of these traits. On one such questionnaire, the Clance IP Scale,⁹ poses such questions as: “I have often succeeded on a test or task even though I was afraid that I would not do well before I undertook the task” and “I am afraid people important to me may find out that I am not as capable as they think I am.” There are 20 questions scored from 1 to 5 and a score of 40 or below suggests few impostor tendencies, while a score of 80 or above suggests the respondent often has intense IP experiences. The higher the score, the more frequently and seriously the impostor syndrome interferes in a person’s life. What is unclear is whether this worsens, improves, or stays the same throughout one’s career. Of interest is that my personal score at this time is 43; however, it would have been 89 had I taken the test during college and medical school. What is unclear to me from the literature is what factors may play a role in a person’s perception of their abilities and their personal confidence over time.

Why is this important? Given that we are all professionals, impostor tendencies appear to have significant impact in the context of our work. This may have impact on us both as employers and as employees.¹⁰ Individuals with impostor syndrome tendencies often characterize themselves negatively and perform poorly on self-appraisals.¹¹ In a study of 201 Belgian white-collar workers, Vergauwe and colleagues found that impostor syndrome tendencies were negatively related to job satisfaction and organizational citizenship behavior; both of which could be influenced by a high degree of social support.¹⁰ Individuals with impostor syndrome tendencies do less career planning, explore career options less frequently, and are less inclined to lead.^12,13 These tendencies can be detrimental as the most qualified people for a position or opportunity may not step forward for consideration. Employers may tend to overlook these individuals for promotions or for pay raises which could negatively influence future earnings. Furthermore, a person may experience increased burnout as they continuously try to overcompensate for what they perceive as their shortcomings. They may feel concerned they are letting others down or not performing to standards. They may derive less enjoyment from life because of the constant focus on feelings of inadequacy.¹⁴ Research along these lines suggest impostor syndrome tendencies can have adverse personal and health-related consequences and may increase social anxiety, depression, and overall psychological distress.^15,16

What do I suggest? It is clear this affects a significant percentage of physicians, health care professionals, and professionals in general. Harboring these tendencies can have a negative impact on health, professional achievement, income, and happiness. It is important to self-reflect, identify if you are at risk, and if so, take the opportunity to explore solutions. My recommendations are:

• Name it: Take the test and see how you score.
• Be mindful: Self-reflection will help you identify the behaviors that are interfering with your happiness and success.
• Write it down: Be strategic and document your plan for success to reinforce your accomplishments.
• Create a feedback group: Friends and colleagues can help to mitigate the negative effects of impostor syndrome tendencies.
• Speak up: Ask for help; coaching has been documented to reduce impostor syndrome scores and help lessen the burden of these tendencies.
• Step out of your comfort zone: Develop a mantra, break bigger challenges into smaller pieces, and acknowledge little wins along the way.

In conclusion, impostor syndrome appears to be highly prevalent in professionals including those of us in medicine. The experience can adversely affect our careers and ability to secure key leadership positions. As managers, we also must keep in mind our role in mentoring others and recognizing the potential impact of impostor syndrome on those who report to us. Recognition of this phenomenon – and understanding of the effects on oneself – is the first step in overcoming the negative effects and moving toward realization of one’s potential.
 

Dr. Brown is a professor of medicine at Wayne State University, division chief of gastroenterology and hepatology at Henry Ford Hospital, and associate medical director at the Henry Ford Hospital Transplant Institute, all in Detroit.

References

1. Clance PR, Imes S. Psychother Theory Res Pract. 1978 Fall;15(3):1-7.

2. Deaux D. In J.H.Harvey, W.J.Ickes and R.F. Kidd (Eds). New directions in attribution research. Vol. 1. New York: Halsted Press Division, Wiley. 1976; p 335-42.

3. Bernard NS et al. J Pers Assess. 2002;78(2):321-33.

4. Topping ME et al. Acad Psychol Bull. 1985;(7):213-26.

5. Langford J et al. Psychotherapy. 1993;30(3):495-501.

6. Chae JH et al. J Pers Assess. 1995;65(3):468-85.

7. Harvey JC et al. If I’m successful, why do I feel like a fake? New York: Random House, 1985.

8. Ross SR et al. Pers Individ Diff. 2001;31:1347-55.

9. Clance PR. The impostor phenomenon: When success makes you feel like a fake. Toronto: Bantam Books, 1985; p 20-2.

10. Vergauwe J et al. J Bus Psychol. 2015;30:565-81.

11. Leary MR et al. J Pers. 2000;68(4):725-56.

12. Neureiter M et al. Front Psychol. 2016;7:48.

13. Neureiter M et al. J Vocat Behav. 2017;98:56-69.

14. Duhigg C. The power of habit: Why we do what we do in life and business. New York: Random House, 2012.

15. Henning K et al. Med Educ. 1998 Sep;32(5):456-64.

16. Oriel K et al. Fam Med. 2004 Apr;36(4):248-52.

17. Zanchetta M et al. Front Psychol. 2020 May 15;11:405.

A few years ago, I was asked to give a talk on impostor syndrome at a national conference. My initial thought was “I am not even remotely qualified to give this talk.” Upon reflection, I think that was the first time I acknowledged that I, too, suffer from this syndrome.

There are many definitions and designations (e.g., impostor phenomenon or fraud syndrome), but the one I use most often is high-achieving individuals who are marked by an inability to internalize their accomplishments and a persistent fear of being exposed as a fraud. People with high expressions of this syndrome believe that any success they achieve is due more to luck or error than to personal skill or accomplishment. They live in fear that their incompetence will be exposed and they will be revealed as a fraud both intellectually and within their job or role. First described by Clance and Imes in 1978,¹ the original authors observed that many highly respected and accomplished women did not experience an internal sense of success despite their education and evidence of academic achievement. Based in part on previous observations regarding the differential attribution of success in men and women,² the authors suggested that two general principles were found to be at the heart of this syndrome. The first was that an unexpected performance outcome will be attributed to a temporary cause. The second was that an expected performance outcome will be attributed to a stable cause. As such, the authors originally suggested that women tended to explain failure with lack of ability, whereas men attributed failure to luck or task difficulty. Furthermore, the authors emphasized environmental factors – such as mentorship, competition, and isolation – as the primary influence in the development of these tendencies.

Although originally described in women, this phenomenon can also affect men, as well as a wide variety of people from different occupations and cultures.^3-6 Furthermore, although environmental factors were originally linked as the primary driver of these tendencies, further research has suggested that personality factors play a larger role, and that up to 70% of people may experience this phenomenon in their lifetime.⁷ Personality traits such as perfectionism and neuroticism may be linked to the development of this phenomenon.^3,8

There are several online screening questionnaires that can be used to gauge whether individuals experience some or most of these traits. On one such questionnaire, the Clance IP Scale,⁹ poses such questions as: “I have often succeeded on a test or task even though I was afraid that I would not do well before I undertook the task” and “I am afraid people important to me may find out that I am not as capable as they think I am.” There are 20 questions scored from 1 to 5 and a score of 40 or below suggests few impostor tendencies, while a score of 80 or above suggests the respondent often has intense IP experiences. The higher the score, the more frequently and seriously the impostor syndrome interferes in a person’s life. What is unclear is whether this worsens, improves, or stays the same throughout one’s career. Of interest is that my personal score at this time is 43; however, it would have been 89 had I taken the test during college and medical school. What is unclear to me from the literature is what factors may play a role in a person’s perception of their abilities and their personal confidence over time.

Why is this important? Given that we are all professionals, impostor tendencies appear to have significant impact in the context of our work. This may have impact on us both as employers and as employees.¹⁰ Individuals with impostor syndrome tendencies often characterize themselves negatively and perform poorly on self-appraisals.¹¹ In a study of 201 Belgian white-collar workers, Vergauwe and colleagues found that impostor syndrome tendencies were negatively related to job satisfaction and organizational citizenship behavior; both of which could be influenced by a high degree of social support.¹⁰ Individuals with impostor syndrome tendencies do less career planning, explore career options less frequently, and are less inclined to lead.^12,13 These tendencies can be detrimental as the most qualified people for a position or opportunity may not step forward for consideration. Employers may tend to overlook these individuals for promotions or for pay raises which could negatively influence future earnings. Furthermore, a person may experience increased burnout as they continuously try to overcompensate for what they perceive as their shortcomings. They may feel concerned they are letting others down or not performing to standards. They may derive less enjoyment from life because of the constant focus on feelings of inadequacy.¹⁴ Research along these lines suggest impostor syndrome tendencies can have adverse personal and health-related consequences and may increase social anxiety, depression, and overall psychological distress.^15,16

What do I suggest? It is clear this affects a significant percentage of physicians, health care professionals, and professionals in general. Harboring these tendencies can have a negative impact on health, professional achievement, income, and happiness. It is important to self-reflect, identify if you are at risk, and if so, take the opportunity to explore solutions. My recommendations are:

• Name it: Take the test and see how you score.
• Be mindful: Self-reflection will help you identify the behaviors that are interfering with your happiness and success.
• Write it down: Be strategic and document your plan for success to reinforce your accomplishments.
• Create a feedback group: Friends and colleagues can help to mitigate the negative effects of impostor syndrome tendencies.
• Speak up: Ask for help; coaching has been documented to reduce impostor syndrome scores and help lessen the burden of these tendencies.
• Step out of your comfort zone: Develop a mantra, break bigger challenges into smaller pieces, and acknowledge little wins along the way.

In conclusion, impostor syndrome appears to be highly prevalent in professionals including those of us in medicine. The experience can adversely affect our careers and ability to secure key leadership positions. As managers, we also must keep in mind our role in mentoring others and recognizing the potential impact of impostor syndrome on those who report to us. Recognition of this phenomenon – and understanding of the effects on oneself – is the first step in overcoming the negative effects and moving toward realization of one’s potential.
 

Dr. Brown is a professor of medicine at Wayne State University, division chief of gastroenterology and hepatology at Henry Ford Hospital, and associate medical director at the Henry Ford Hospital Transplant Institute, all in Detroit.

References

1. Clance PR, Imes S. Psychother Theory Res Pract. 1978 Fall;15(3):1-7.

2. Deaux D. In J.H.Harvey, W.J.Ickes and R.F. Kidd (Eds). New directions in attribution research. Vol. 1. New York: Halsted Press Division, Wiley. 1976; p 335-42.

3. Bernard NS et al. J Pers Assess. 2002;78(2):321-33.

4. Topping ME et al. Acad Psychol Bull. 1985;(7):213-26.

5. Langford J et al. Psychotherapy. 1993;30(3):495-501.

6. Chae JH et al. J Pers Assess. 1995;65(3):468-85.

7. Harvey JC et al. If I’m successful, why do I feel like a fake? New York: Random House, 1985.

8. Ross SR et al. Pers Individ Diff. 2001;31:1347-55.

9. Clance PR. The impostor phenomenon: When success makes you feel like a fake. Toronto: Bantam Books, 1985; p 20-2.

10. Vergauwe J et al. J Bus Psychol. 2015;30:565-81.

11. Leary MR et al. J Pers. 2000;68(4):725-56.

12. Neureiter M et al. Front Psychol. 2016;7:48.

13. Neureiter M et al. J Vocat Behav. 2017;98:56-69.

14. Duhigg C. The power of habit: Why we do what we do in life and business. New York: Random House, 2012.

15. Henning K et al. Med Educ. 1998 Sep;32(5):456-64.

16. Oriel K et al. Fam Med. 2004 Apr;36(4):248-52.

17. Zanchetta M et al. Front Psychol. 2020 May 15;11:405.

Esophagology was a term coined in 1948 to describe a medical specialty devoted to the study of the anatomy, physiology, and pathology of the esophagus. The term was born out of increased interest and evolution in esophagology and supported by development in esophagoscopy.¹ While still rooted in these basic tenets, the landscape of esophagology is dramatically different in 2020. The last decade alone has seen unprecedented technological advances in esophagology, from the transformation of line tracings to high-resolution esophageal pressure topography to more recent innovations such as the functional lumen imaging probe. Successful therapeutic developments have increased opportunities for effective and less invasive treatment approaches for achalasia and gastroesophageal reflux disease (GERD). With changing concepts in esophageal diseases such as eosinophilic esophagitis, successful management now incorporates findings from recent discoveries that have revolutionized care pathways. Esophagology is an evolving, dynamic subspecialty of gastroenterology, and esophagologists require comprehensive and unique training during gastroenterology fellowship and beyond (see Figure 1).

Figure 1

Optimizing esophagology training during fellowship

First, and most importantly, an esophagologist must have a foundation in the basic principles of esophageal anatomy, physiology, and pathology (see Figure 2). While newer digital learning resources exist, tried and true book-based resources – text books, chapters, and reviews – related to esophageal mechanics, the interplay between muscle function and neurogenics, and factors associated with nociception, remain the optimal learning strategy.

Once equipped with a foundation in esophageal physiology, one can readily engage with esophageal technologies, as there exists a vast array of testing to assess esophageal function. A comprehensive understanding of each, including device configuration, clinical protocol, and data storage, promotes a depth of knowledge every esophagologist should develop. Aspiring esophagologists should take time to observe and perform procedures in their motility labs, particularly esophageal high-resolution manometry and ambulatory reflux monitoring studies. If afforded the opportunity through a research study or a clinical indication, esophagologists should also undergo the tests themselves. Empathy regarding the discomfort and tolerability of motility tests, which are notoriously challenging for patients, can promote rapport and trust with patients, increase patient satisfaction, and enhance one’s own understanding of resource utilization and safety.

Perhaps most critical to becoming an esophagologist, is acquiring sufficient competency in interpretation of esophageal studies. Prior research highlights the limitations in achieving competency when trainees adhere to the minimum case volume of studies recommended by the GI core curriculum.^2,3 With the bar set higher for the burgeoning esophagologist, one must not only practice with a higher case volume, but also engage in competency-based assessments and performance feedback.⁴ Trainees should start by reviewing tracings for their own patients. Preliminary interpretation of pending studies and review with a mentor before the final sign-off, participation in research that requires study, or even teaching co-trainees basic tenets of motility are other creative approaches to learning. Esophagologists will be expected to know how to navigate the software to access studies, manually review tracings, and generate reports. Trainees should refer to the multitude of societal guidelines and classification scheme recommendations available when developing competency in diagnostic impression.⁵

Figure 2

While esophagology is a medical specialty, it is imperative that the esophagologist has a robust understanding of therapeutic options and surgical interventions for esophageal pathology. Scrubbing into the operating room during foregut surgeries is an eye-opening experience. This includes thoracic and abdominal approaches, robotic, laparoscopic, and open techniques, and interventions for GERD, achalasia, diverticular disease, and bariatric management. Equally important is working alongside advanced endoscopy faculty to understand utilities of endoscopic ultrasound, ablative methods for Barrett’s esophagus, and advanced techniques such as peroral endoscopic myotomy and transoral incisionless fundoplication. This exposure is critical as the role of the esophagologist is to speak knowledgably of therapeutic options and the risks and benefits of alternative approaches. Further, the patient’s journey rarely ends with the intervention, and an esophagologist must understand how to evaluate symptoms and manage complications following therapy.

Figure 3

Steep learning curve post fellowship

Regardless of the robust nature of clinical esophagology training, early career esophagologists will face challenges and learn on the job.

Many esophagologists are directors of a motility lab early in their careers. This is often uncharted territory in terms of managing a team of nurses, technicians, and other providers. The director of a motility lab will be called upon to troubleshoot various arenas of diagnostic workup, from study acquisition and interpretation to technical barriers with equipment or software. Keys to maintaining a successful motility lab further include optimizing schedules and protocols, delineating roles and responsibilities of team members, ensuring adequate training across staff and providers, communicating expectations, and cultivating an open relationship with the motility lab supervisor. Crucial, yet often neglected during fellowship training, are the economic considerations of operating and expanding the motility lab, and the financial implications for one’s own practice.⁶ Participating in professional development workshops can be especially valuable in cultivating leadership skills.

The care an esophagologist provides relies heavily on collaborative relationships within the organization and peer mentorship, cooperation, and feedback. It is essential to cultivate multidisciplinary relationships with surgical (e.g., foregut surgery, laryngology), medical (e.g., pulmonology, allergy), radiology, and pathology colleagues, as well as with integrated health specialists including psychologists, dietitians, and speech language pathologists. It is also important to have open industry partnerships to ensure appropriate technical support and access to advancements.

Often organizations will have only one esophageal specialist within the group. Fortunately, the national and global community of esophagologists is highly collaborative and collegial. All esophagologists should have a network of mentors and colleagues within and outside of their organization to review complex cases, discuss challenges in the workplace, and foster research and innovation. Along these lines, both aspiring and practicing esophagologists should engage with professional societies as opportunities are abundant. Esophageal-focused societies include the ANMS, American Foregut Society, and International Society of Diseases of Esophagus, and the overarching GI societies also have a strong esophageal focus.

The path to becoming an esophagologist does not mirror the structure of the organ itself. Development is neither confined, unidirectional, nor set in length, but gradual, each step thoughtfully built on the last. Esophageal pathology is diverse, complex, and fascinating. With the appropriate training, mentorship, engagement, and leadership, esophagologists have the privilege of making a great impact on the lives of patients we meet, a fulfilling journey worth the time and effort it takes.
 

Dr. Delay is in the division of gastroenterology & hepatology, University of Colorado Anschutz Medical Campus, Aurora. Dr. Yadlapati is at the Center for Esophageal Diseases, division of gastroenterology, University of California San Diego, La Jolla. She is a consultant through institutional agreement to Medtronic, Ironwood Pharmaceuticals, and Diversatek; she has received research support from Ironwood Pharmaceuticals; and is on the advisory board of Phathom Pharmaceuticals.

References

1. Holinger PH. Arch Otolaryngol. 1948;47:119-26.

2. Yadlapati R et al. Clin Gastroenterol Hepatol. 2017;15:1708-14.e3.

3. Oversight Working Network et al. Gastrointest Endosc. 2014;80:16-27.

4. DeLay K et al. Am J Gastroenterol. 2020;115:1453-9.

5. Gyawali CP et al. Neurogastroenterol Motil. 2018;30(9):e13341.

6. Yadlapati R et al. Gastroenterology. 2020;158:1202-10.

Esophagology was a term coined in 1948 to describe a medical specialty devoted to the study of the anatomy, physiology, and pathology of the esophagus. The term was born out of increased interest and evolution in esophagology and supported by development in esophagoscopy.¹ While still rooted in these basic tenets, the landscape of esophagology is dramatically different in 2020. The last decade alone has seen unprecedented technological advances in esophagology, from the transformation of line tracings to high-resolution esophageal pressure topography to more recent innovations such as the functional lumen imaging probe. Successful therapeutic developments have increased opportunities for effective and less invasive treatment approaches for achalasia and gastroesophageal reflux disease (GERD). With changing concepts in esophageal diseases such as eosinophilic esophagitis, successful management now incorporates findings from recent discoveries that have revolutionized care pathways. Esophagology is an evolving, dynamic subspecialty of gastroenterology, and esophagologists require comprehensive and unique training during gastroenterology fellowship and beyond (see Figure 1).

Figure 1

Optimizing esophagology training during fellowship

First, and most importantly, an esophagologist must have a foundation in the basic principles of esophageal anatomy, physiology, and pathology (see Figure 2). While newer digital learning resources exist, tried and true book-based resources – text books, chapters, and reviews – related to esophageal mechanics, the interplay between muscle function and neurogenics, and factors associated with nociception, remain the optimal learning strategy.

Once equipped with a foundation in esophageal physiology, one can readily engage with esophageal technologies, as there exists a vast array of testing to assess esophageal function. A comprehensive understanding of each, including device configuration, clinical protocol, and data storage, promotes a depth of knowledge every esophagologist should develop. Aspiring esophagologists should take time to observe and perform procedures in their motility labs, particularly esophageal high-resolution manometry and ambulatory reflux monitoring studies. If afforded the opportunity through a research study or a clinical indication, esophagologists should also undergo the tests themselves. Empathy regarding the discomfort and tolerability of motility tests, which are notoriously challenging for patients, can promote rapport and trust with patients, increase patient satisfaction, and enhance one’s own understanding of resource utilization and safety.

Perhaps most critical to becoming an esophagologist, is acquiring sufficient competency in interpretation of esophageal studies. Prior research highlights the limitations in achieving competency when trainees adhere to the minimum case volume of studies recommended by the GI core curriculum.^2,3 With the bar set higher for the burgeoning esophagologist, one must not only practice with a higher case volume, but also engage in competency-based assessments and performance feedback.⁴ Trainees should start by reviewing tracings for their own patients. Preliminary interpretation of pending studies and review with a mentor before the final sign-off, participation in research that requires study, or even teaching co-trainees basic tenets of motility are other creative approaches to learning. Esophagologists will be expected to know how to navigate the software to access studies, manually review tracings, and generate reports. Trainees should refer to the multitude of societal guidelines and classification scheme recommendations available when developing competency in diagnostic impression.⁵

Figure 2

While esophagology is a medical specialty, it is imperative that the esophagologist has a robust understanding of therapeutic options and surgical interventions for esophageal pathology. Scrubbing into the operating room during foregut surgeries is an eye-opening experience. This includes thoracic and abdominal approaches, robotic, laparoscopic, and open techniques, and interventions for GERD, achalasia, diverticular disease, and bariatric management. Equally important is working alongside advanced endoscopy faculty to understand utilities of endoscopic ultrasound, ablative methods for Barrett’s esophagus, and advanced techniques such as peroral endoscopic myotomy and transoral incisionless fundoplication. This exposure is critical as the role of the esophagologist is to speak knowledgably of therapeutic options and the risks and benefits of alternative approaches. Further, the patient’s journey rarely ends with the intervention, and an esophagologist must understand how to evaluate symptoms and manage complications following therapy.

Figure 3

Steep learning curve post fellowship

Regardless of the robust nature of clinical esophagology training, early career esophagologists will face challenges and learn on the job.

Many esophagologists are directors of a motility lab early in their careers. This is often uncharted territory in terms of managing a team of nurses, technicians, and other providers. The director of a motility lab will be called upon to troubleshoot various arenas of diagnostic workup, from study acquisition and interpretation to technical barriers with equipment or software. Keys to maintaining a successful motility lab further include optimizing schedules and protocols, delineating roles and responsibilities of team members, ensuring adequate training across staff and providers, communicating expectations, and cultivating an open relationship with the motility lab supervisor. Crucial, yet often neglected during fellowship training, are the economic considerations of operating and expanding the motility lab, and the financial implications for one’s own practice.⁶ Participating in professional development workshops can be especially valuable in cultivating leadership skills.

The care an esophagologist provides relies heavily on collaborative relationships within the organization and peer mentorship, cooperation, and feedback. It is essential to cultivate multidisciplinary relationships with surgical (e.g., foregut surgery, laryngology), medical (e.g., pulmonology, allergy), radiology, and pathology colleagues, as well as with integrated health specialists including psychologists, dietitians, and speech language pathologists. It is also important to have open industry partnerships to ensure appropriate technical support and access to advancements.

Often organizations will have only one esophageal specialist within the group. Fortunately, the national and global community of esophagologists is highly collaborative and collegial. All esophagologists should have a network of mentors and colleagues within and outside of their organization to review complex cases, discuss challenges in the workplace, and foster research and innovation. Along these lines, both aspiring and practicing esophagologists should engage with professional societies as opportunities are abundant. Esophageal-focused societies include the ANMS, American Foregut Society, and International Society of Diseases of Esophagus, and the overarching GI societies also have a strong esophageal focus.

The path to becoming an esophagologist does not mirror the structure of the organ itself. Development is neither confined, unidirectional, nor set in length, but gradual, each step thoughtfully built on the last. Esophageal pathology is diverse, complex, and fascinating. With the appropriate training, mentorship, engagement, and leadership, esophagologists have the privilege of making a great impact on the lives of patients we meet, a fulfilling journey worth the time and effort it takes.
 

Dr. Delay is in the division of gastroenterology & hepatology, University of Colorado Anschutz Medical Campus, Aurora. Dr. Yadlapati is at the Center for Esophageal Diseases, division of gastroenterology, University of California San Diego, La Jolla. She is a consultant through institutional agreement to Medtronic, Ironwood Pharmaceuticals, and Diversatek; she has received research support from Ironwood Pharmaceuticals; and is on the advisory board of Phathom Pharmaceuticals.

References

1. Holinger PH. Arch Otolaryngol. 1948;47:119-26.

2. Yadlapati R et al. Clin Gastroenterol Hepatol. 2017;15:1708-14.e3.

3. Oversight Working Network et al. Gastrointest Endosc. 2014;80:16-27.

4. DeLay K et al. Am J Gastroenterol. 2020;115:1453-9.

5. Gyawali CP et al. Neurogastroenterol Motil. 2018;30(9):e13341.

6. Yadlapati R et al. Gastroenterology. 2020;158:1202-10.

Esophagology was a term coined in 1948 to describe a medical specialty devoted to the study of the anatomy, physiology, and pathology of the esophagus. The term was born out of increased interest and evolution in esophagology and supported by development in esophagoscopy.¹ While still rooted in these basic tenets, the landscape of esophagology is dramatically different in 2020. The last decade alone has seen unprecedented technological advances in esophagology, from the transformation of line tracings to high-resolution esophageal pressure topography to more recent innovations such as the functional lumen imaging probe. Successful therapeutic developments have increased opportunities for effective and less invasive treatment approaches for achalasia and gastroesophageal reflux disease (GERD). With changing concepts in esophageal diseases such as eosinophilic esophagitis, successful management now incorporates findings from recent discoveries that have revolutionized care pathways. Esophagology is an evolving, dynamic subspecialty of gastroenterology, and esophagologists require comprehensive and unique training during gastroenterology fellowship and beyond (see Figure 1).

Figure 1

Optimizing esophagology training during fellowship

First, and most importantly, an esophagologist must have a foundation in the basic principles of esophageal anatomy, physiology, and pathology (see Figure 2). While newer digital learning resources exist, tried and true book-based resources – text books, chapters, and reviews – related to esophageal mechanics, the interplay between muscle function and neurogenics, and factors associated with nociception, remain the optimal learning strategy.

Once equipped with a foundation in esophageal physiology, one can readily engage with esophageal technologies, as there exists a vast array of testing to assess esophageal function. A comprehensive understanding of each, including device configuration, clinical protocol, and data storage, promotes a depth of knowledge every esophagologist should develop. Aspiring esophagologists should take time to observe and perform procedures in their motility labs, particularly esophageal high-resolution manometry and ambulatory reflux monitoring studies. If afforded the opportunity through a research study or a clinical indication, esophagologists should also undergo the tests themselves. Empathy regarding the discomfort and tolerability of motility tests, which are notoriously challenging for patients, can promote rapport and trust with patients, increase patient satisfaction, and enhance one’s own understanding of resource utilization and safety.

Perhaps most critical to becoming an esophagologist, is acquiring sufficient competency in interpretation of esophageal studies. Prior research highlights the limitations in achieving competency when trainees adhere to the minimum case volume of studies recommended by the GI core curriculum.^2,3 With the bar set higher for the burgeoning esophagologist, one must not only practice with a higher case volume, but also engage in competency-based assessments and performance feedback.⁴ Trainees should start by reviewing tracings for their own patients. Preliminary interpretation of pending studies and review with a mentor before the final sign-off, participation in research that requires study, or even teaching co-trainees basic tenets of motility are other creative approaches to learning. Esophagologists will be expected to know how to navigate the software to access studies, manually review tracings, and generate reports. Trainees should refer to the multitude of societal guidelines and classification scheme recommendations available when developing competency in diagnostic impression.⁵

Figure 2

While esophagology is a medical specialty, it is imperative that the esophagologist has a robust understanding of therapeutic options and surgical interventions for esophageal pathology. Scrubbing into the operating room during foregut surgeries is an eye-opening experience. This includes thoracic and abdominal approaches, robotic, laparoscopic, and open techniques, and interventions for GERD, achalasia, diverticular disease, and bariatric management. Equally important is working alongside advanced endoscopy faculty to understand utilities of endoscopic ultrasound, ablative methods for Barrett’s esophagus, and advanced techniques such as peroral endoscopic myotomy and transoral incisionless fundoplication. This exposure is critical as the role of the esophagologist is to speak knowledgably of therapeutic options and the risks and benefits of alternative approaches. Further, the patient’s journey rarely ends with the intervention, and an esophagologist must understand how to evaluate symptoms and manage complications following therapy.

Figure 3

Steep learning curve post fellowship

Regardless of the robust nature of clinical esophagology training, early career esophagologists will face challenges and learn on the job.

Many esophagologists are directors of a motility lab early in their careers. This is often uncharted territory in terms of managing a team of nurses, technicians, and other providers. The director of a motility lab will be called upon to troubleshoot various arenas of diagnostic workup, from study acquisition and interpretation to technical barriers with equipment or software. Keys to maintaining a successful motility lab further include optimizing schedules and protocols, delineating roles and responsibilities of team members, ensuring adequate training across staff and providers, communicating expectations, and cultivating an open relationship with the motility lab supervisor. Crucial, yet often neglected during fellowship training, are the economic considerations of operating and expanding the motility lab, and the financial implications for one’s own practice.⁶ Participating in professional development workshops can be especially valuable in cultivating leadership skills.

The care an esophagologist provides relies heavily on collaborative relationships within the organization and peer mentorship, cooperation, and feedback. It is essential to cultivate multidisciplinary relationships with surgical (e.g., foregut surgery, laryngology), medical (e.g., pulmonology, allergy), radiology, and pathology colleagues, as well as with integrated health specialists including psychologists, dietitians, and speech language pathologists. It is also important to have open industry partnerships to ensure appropriate technical support and access to advancements.

Often organizations will have only one esophageal specialist within the group. Fortunately, the national and global community of esophagologists is highly collaborative and collegial. All esophagologists should have a network of mentors and colleagues within and outside of their organization to review complex cases, discuss challenges in the workplace, and foster research and innovation. Along these lines, both aspiring and practicing esophagologists should engage with professional societies as opportunities are abundant. Esophageal-focused societies include the ANMS, American Foregut Society, and International Society of Diseases of Esophagus, and the overarching GI societies also have a strong esophageal focus.

The path to becoming an esophagologist does not mirror the structure of the organ itself. Development is neither confined, unidirectional, nor set in length, but gradual, each step thoughtfully built on the last. Esophageal pathology is diverse, complex, and fascinating. With the appropriate training, mentorship, engagement, and leadership, esophagologists have the privilege of making a great impact on the lives of patients we meet, a fulfilling journey worth the time and effort it takes.
 

Dr. Delay is in the division of gastroenterology & hepatology, University of Colorado Anschutz Medical Campus, Aurora. Dr. Yadlapati is at the Center for Esophageal Diseases, division of gastroenterology, University of California San Diego, La Jolla. She is a consultant through institutional agreement to Medtronic, Ironwood Pharmaceuticals, and Diversatek; she has received research support from Ironwood Pharmaceuticals; and is on the advisory board of Phathom Pharmaceuticals.

References

1. Holinger PH. Arch Otolaryngol. 1948;47:119-26.

2. Yadlapati R et al. Clin Gastroenterol Hepatol. 2017;15:1708-14.e3.

3. Oversight Working Network et al. Gastrointest Endosc. 2014;80:16-27.

4. DeLay K et al. Am J Gastroenterol. 2020;115:1453-9.

5. Gyawali CP et al. Neurogastroenterol Motil. 2018;30(9):e13341.

6. Yadlapati R et al. Gastroenterology. 2020;158:1202-10.

The last decade has seen an increased focus on the use of social media for medical education. Twitter, with over 330 million active users, is the most popular social media platform for medical education. We describe here our recent initiative to establish a weekly online gastroenterology-focused journal club on Twitter.

How was the idea conceived?

Sultan Mahmood, MD (@SultanMahmoodMD)

@GiJournal started off as an informal discussion in which we would post a summary of the article and invite an expert in the field to comment. However, the interest in the journal club quickly took off as we gained more followers and a worldwide audience joined our journal club discussions on a weekly basis. As the COVID-19 pandemic took hold and endoscopy suites around the word closed, interest in online medical education grew. @GIJournal provided a platform for trainees and practicing physicians alike to stay up to date with the latest publications from the comfort of their homes. Needless to say, the journal club has evolved since its inception in that we now work with a team of experts and trainees who run the journal club on a rotating basis.
 

How does @GiJournal work?

Ijlal Akbar Ali, MD (@IjlalAkbar)

How is this different from any other journal club?

Atoosa Rabiee, MD (@AtoosaRabiee)

Although worldwide participation is a key strength of the online @GiJournal platform, it may be challenging for some members to attend the live discussion based on time difference. We account for this in two ways. First, participants are encouraged to continue with comments and questions afterward at their convenience, which allows experts and moderators to continue the conversation, often for several days. Second, to promote inclusivity, we have created a unique, customized publication to summarize and present the key points of conversation for each session. This asynchronous access is a quality not found in more traditional journal club formats. Finally, studies have shown that articles shared on social media tend to have increased citations and higher Altmetric scores.
 

What are the opportunities for trainees and recent graduates?

Sunil Amin, MD, MPH (@SunilAminMD)

Our surveys have shown that 30%-45% of the @GiJournal discussion participants are trainees. Both gastroenterology fellows and internal medicine residents from around the world are an integral part of each specialty panel for the weekly @GIjournal discussions. Trainees are paired up with a specific faculty mentor and together they choose an article for discussion, create a summary, informal twitter poll, and questions for the discussion. This direct access provides an opportunity for trainees to interact, ask questions, and learn from faculty in an informal atmosphere.

We have heard from multiple trainees who have developed long-term relationships with the experts and faculty mentors they worked with and are now also working on research projects. Additionally, trainees can bring the expertise they have now acquired back to their home institutions to pick articles, add specific teaching points, and enrich their local journal club discussions. Finally, trainees who present on the @GiJournal platform are given unique visibility to the many faculty members and opinion leaders participating in each discussion. This may facilitate future networking opportunities and enhance their CVs for future fellowship or employment applications.

Plans for the future?

Allon Kahn, MD (@AllonKahn)

How can you join the @GiJournal discussions?

@SultanMahmoodMD

Joining the journal club discussion is easy. Just follow the @GiJournal handle on Twitter and turn on the notifications icon. Although we encourage everyone to “actively” participate in the discussion by asking questions or sharing your personal experience, joining the discussion as an “observer” is also a great way to learn. The discussion starts at 8 p.m. EST every Wednesday. Follow the #GIJC and the @GiJournal handle as questions are posted by the faculty moderator and answered by the experts. Even if you miss the discussion, the @GiJournal Digest is a great way to recap the discussions in an easy-to-read PDF format. The @GiJournal Digest is a monthly publication that archives the four @GiJournal club discussions in the previous month. Follow the link below to access the recent publications: http://ow.ly/uu2550C3RXX

Conclusion

In summary, we believe Twitter-based journal clubs offer an engaging way of virtual learning from the comfort of one’s home and a convenient way to directly interact with the experts. The success of @GiJournal highlights the importance of social media for medical education in the field of gastroenterology and hepatology and we look forward to developing this endeavor further.

Dr. Mahmood is clinical assistant professor of medicine, co–program director of the GI fellowship program, UB division of gastroenterology, hepatology & nutrition, State University of New York at Buffalo; Dr. Rabiee is assistant professor of medicine, director of hepatology, division of gastroenterology and hepatology, Washington DC VA Medical Center, Washington; Dr. Amin is assistant professor of medicine, director of endoscopy, The Lennar Foundation Medical Center, division of digestive health and liver disease, department of medicine, University of Miami; Dr. Kahn is assistant professor of medicine, division of gastroenterology & hepatology, Mayo Clinic, Scottsdale, Ariz.; and Dr. Akbar Ali is a gastroenterology fellow in the division of digestive diseases and nutrition, University of Oklahoma Health Sciences Center, Oklahoma City.

The last decade has seen an increased focus on the use of social media for medical education. Twitter, with over 330 million active users, is the most popular social media platform for medical education. We describe here our recent initiative to establish a weekly online gastroenterology-focused journal club on Twitter.

How was the idea conceived?

Sultan Mahmood, MD (@SultanMahmoodMD)

@GiJournal started off as an informal discussion in which we would post a summary of the article and invite an expert in the field to comment. However, the interest in the journal club quickly took off as we gained more followers and a worldwide audience joined our journal club discussions on a weekly basis. As the COVID-19 pandemic took hold and endoscopy suites around the word closed, interest in online medical education grew. @GIJournal provided a platform for trainees and practicing physicians alike to stay up to date with the latest publications from the comfort of their homes. Needless to say, the journal club has evolved since its inception in that we now work with a team of experts and trainees who run the journal club on a rotating basis.
 

How does @GiJournal work?

Ijlal Akbar Ali, MD (@IjlalAkbar)

How is this different from any other journal club?

Atoosa Rabiee, MD (@AtoosaRabiee)

Although worldwide participation is a key strength of the online @GiJournal platform, it may be challenging for some members to attend the live discussion based on time difference. We account for this in two ways. First, participants are encouraged to continue with comments and questions afterward at their convenience, which allows experts and moderators to continue the conversation, often for several days. Second, to promote inclusivity, we have created a unique, customized publication to summarize and present the key points of conversation for each session. This asynchronous access is a quality not found in more traditional journal club formats. Finally, studies have shown that articles shared on social media tend to have increased citations and higher Altmetric scores.
 

What are the opportunities for trainees and recent graduates?

Sunil Amin, MD, MPH (@SunilAminMD)

Our surveys have shown that 30%-45% of the @GiJournal discussion participants are trainees. Both gastroenterology fellows and internal medicine residents from around the world are an integral part of each specialty panel for the weekly @GIjournal discussions. Trainees are paired up with a specific faculty mentor and together they choose an article for discussion, create a summary, informal twitter poll, and questions for the discussion. This direct access provides an opportunity for trainees to interact, ask questions, and learn from faculty in an informal atmosphere.

We have heard from multiple trainees who have developed long-term relationships with the experts and faculty mentors they worked with and are now also working on research projects. Additionally, trainees can bring the expertise they have now acquired back to their home institutions to pick articles, add specific teaching points, and enrich their local journal club discussions. Finally, trainees who present on the @GiJournal platform are given unique visibility to the many faculty members and opinion leaders participating in each discussion. This may facilitate future networking opportunities and enhance their CVs for future fellowship or employment applications.

Plans for the future?

Allon Kahn, MD (@AllonKahn)

How can you join the @GiJournal discussions?

@SultanMahmoodMD

Joining the journal club discussion is easy. Just follow the @GiJournal handle on Twitter and turn on the notifications icon. Although we encourage everyone to “actively” participate in the discussion by asking questions or sharing your personal experience, joining the discussion as an “observer” is also a great way to learn. The discussion starts at 8 p.m. EST every Wednesday. Follow the #GIJC and the @GiJournal handle as questions are posted by the faculty moderator and answered by the experts. Even if you miss the discussion, the @GiJournal Digest is a great way to recap the discussions in an easy-to-read PDF format. The @GiJournal Digest is a monthly publication that archives the four @GiJournal club discussions in the previous month. Follow the link below to access the recent publications: http://ow.ly/uu2550C3RXX

Conclusion

In summary, we believe Twitter-based journal clubs offer an engaging way of virtual learning from the comfort of one’s home and a convenient way to directly interact with the experts. The success of @GiJournal highlights the importance of social media for medical education in the field of gastroenterology and hepatology and we look forward to developing this endeavor further.

Dr. Mahmood is clinical assistant professor of medicine, co–program director of the GI fellowship program, UB division of gastroenterology, hepatology & nutrition, State University of New York at Buffalo; Dr. Rabiee is assistant professor of medicine, director of hepatology, division of gastroenterology and hepatology, Washington DC VA Medical Center, Washington; Dr. Amin is assistant professor of medicine, director of endoscopy, The Lennar Foundation Medical Center, division of digestive health and liver disease, department of medicine, University of Miami; Dr. Kahn is assistant professor of medicine, division of gastroenterology & hepatology, Mayo Clinic, Scottsdale, Ariz.; and Dr. Akbar Ali is a gastroenterology fellow in the division of digestive diseases and nutrition, University of Oklahoma Health Sciences Center, Oklahoma City.

The last decade has seen an increased focus on the use of social media for medical education. Twitter, with over 330 million active users, is the most popular social media platform for medical education. We describe here our recent initiative to establish a weekly online gastroenterology-focused journal club on Twitter.

How was the idea conceived?

Sultan Mahmood, MD (@SultanMahmoodMD)

@GiJournal started off as an informal discussion in which we would post a summary of the article and invite an expert in the field to comment. However, the interest in the journal club quickly took off as we gained more followers and a worldwide audience joined our journal club discussions on a weekly basis. As the COVID-19 pandemic took hold and endoscopy suites around the word closed, interest in online medical education grew. @GIJournal provided a platform for trainees and practicing physicians alike to stay up to date with the latest publications from the comfort of their homes. Needless to say, the journal club has evolved since its inception in that we now work with a team of experts and trainees who run the journal club on a rotating basis.
 

How does @GiJournal work?

Ijlal Akbar Ali, MD (@IjlalAkbar)

How is this different from any other journal club?

Atoosa Rabiee, MD (@AtoosaRabiee)

Although worldwide participation is a key strength of the online @GiJournal platform, it may be challenging for some members to attend the live discussion based on time difference. We account for this in two ways. First, participants are encouraged to continue with comments and questions afterward at their convenience, which allows experts and moderators to continue the conversation, often for several days. Second, to promote inclusivity, we have created a unique, customized publication to summarize and present the key points of conversation for each session. This asynchronous access is a quality not found in more traditional journal club formats. Finally, studies have shown that articles shared on social media tend to have increased citations and higher Altmetric scores.
 

What are the opportunities for trainees and recent graduates?

Sunil Amin, MD, MPH (@SunilAminMD)

Our surveys have shown that 30%-45% of the @GiJournal discussion participants are trainees. Both gastroenterology fellows and internal medicine residents from around the world are an integral part of each specialty panel for the weekly @GIjournal discussions. Trainees are paired up with a specific faculty mentor and together they choose an article for discussion, create a summary, informal twitter poll, and questions for the discussion. This direct access provides an opportunity for trainees to interact, ask questions, and learn from faculty in an informal atmosphere.

We have heard from multiple trainees who have developed long-term relationships with the experts and faculty mentors they worked with and are now also working on research projects. Additionally, trainees can bring the expertise they have now acquired back to their home institutions to pick articles, add specific teaching points, and enrich their local journal club discussions. Finally, trainees who present on the @GiJournal platform are given unique visibility to the many faculty members and opinion leaders participating in each discussion. This may facilitate future networking opportunities and enhance their CVs for future fellowship or employment applications.

Plans for the future?

Allon Kahn, MD (@AllonKahn)

How can you join the @GiJournal discussions?

@SultanMahmoodMD

Joining the journal club discussion is easy. Just follow the @GiJournal handle on Twitter and turn on the notifications icon. Although we encourage everyone to “actively” participate in the discussion by asking questions or sharing your personal experience, joining the discussion as an “observer” is also a great way to learn. The discussion starts at 8 p.m. EST every Wednesday. Follow the #GIJC and the @GiJournal handle as questions are posted by the faculty moderator and answered by the experts. Even if you miss the discussion, the @GiJournal Digest is a great way to recap the discussions in an easy-to-read PDF format. The @GiJournal Digest is a monthly publication that archives the four @GiJournal club discussions in the previous month. Follow the link below to access the recent publications: http://ow.ly/uu2550C3RXX

Conclusion

In summary, we believe Twitter-based journal clubs offer an engaging way of virtual learning from the comfort of one’s home and a convenient way to directly interact with the experts. The success of @GiJournal highlights the importance of social media for medical education in the field of gastroenterology and hepatology and we look forward to developing this endeavor further.

Dr. Mahmood is clinical assistant professor of medicine, co–program director of the GI fellowship program, UB division of gastroenterology, hepatology & nutrition, State University of New York at Buffalo; Dr. Rabiee is assistant professor of medicine, director of hepatology, division of gastroenterology and hepatology, Washington DC VA Medical Center, Washington; Dr. Amin is assistant professor of medicine, director of endoscopy, The Lennar Foundation Medical Center, division of digestive health and liver disease, department of medicine, University of Miami; Dr. Kahn is assistant professor of medicine, division of gastroenterology & hepatology, Mayo Clinic, Scottsdale, Ariz.; and Dr. Akbar Ali is a gastroenterology fellow in the division of digestive diseases and nutrition, University of Oklahoma Health Sciences Center, Oklahoma City.

A 53-year-old woman was referred for surveillance colonoscopy. She is a current smoker with a history of chronic kidney disease, chronic obstructive pulmonary disease, atrial fibrillation, and two diminutive hyperplastic polyps found on average-risk screening colonoscopy 3 years previously. Her prep at the time was excellent and she was advised to return in 10 years for follow-up. She has taken the day off work, arranged for a driver, is prepped, and is on your schedule for a colonoscopy for a “history of polyps.” Is this an appropriate referral and how should you handle it?

Most of us have had questionable referrals on our endoscopy schedules. While judgments can vary among providers about when a patient should undergo a procedure or what intervention is most needed, some direct-access referrals for endoscopy are considered inappropriate by most standards. In examining referrals for colonoscopy, studies have shown that as many as 23% of screening colonoscopies among Medicare beneficiaries and 14.2% of Veterans Affairs patients in a large colorectal cancer screening study are inappropriate.^1,2 A prospective multicenter study found 29% of colonoscopies to be inappropriate, and surveillance studies were confirmed as the most frequent source of inappropriate procedures.^3,4 Endoscopies are performed so frequently, effectively, and safely that they can be readily scheduled by gastroenterologists and nongastroenterologists alike. Open access has facilitated and expedited needed procedures, providing benefit to patient and provider and freeing clinic visit time for more complex consults. But while endoscopy is very safe, it is not without risk or cost. What should be the response when a patient in the endoscopy unit appears to be inappropriately referred?

The first step is to determine what is inappropriate. There are several situations when a procedure might be considered inappropriate, particularly when we try to apply ethical principles.

1. The performance of the procedure is contrary to society guidelines. The American Gastroenterological Association, American Society for Gastrointestinal Endoscopy, and American College of Gastroenterology publish clinical guidelines. These documents are drafted after rigorous research and literature review, and the strength of the recommendations is confirmed by incorporation of GRADE (Grading of Recommendations Assessment, Development, and Evaluation) methodology. Such guidelines allow gastroenterologists across the country to practice confidently in a manner consistent with the current available data and the standards of care for the GI community. A patient who is referred for a procedure for an indication that does not adhere to – or contradicts – guidelines, may be at risk for substandard care and possibly at risk for harm. It is the physician’s ethical responsibility to provide the most “good” and the least harm for patients, consistent with the ethical principle of beneficence.

Guidelines, however, are not mandates, and an argument may be made that in order to provide the best care, alternatives may be offered to a patient. Some circumstances require clinical judgments based on unique patient characteristics and the need for individualized care. As a rule, however, the goal of guidelines is to assist doctors in providing the best care.

2. The procedure is not the correct test for the clinical question. While endoscopy can address many clinical queries, endoscopy is not always the right procedure for a specific medical question. A patient referred for an esophagogastroduodenoscopy (EGD) to rule out gastroparesis is being subjected to the wrong test to answer the clinical question. Some information may be obtained from an EGD (e.g., retained food may suggest dysmotility or the patient could have gastric outlet obstruction) but this is not the recommended initial management step. Is it reasonable to proceed with a test that cannot answer the question asked? Continuing with the endoscopy would not enhance beneficence and might be a futile service for the patient. Is this doing the best for the patient?

Dr. Fisher is professor of clinical medicine and director of small-bowel imaging, division of gastroenterology, University of Pennsylvania, Philadelphia.

References

1. Sheffield KM et al. JAMA Intern Med. 2013 Apr 8;173(7):542-50.

2. Powell AA et al. J Gen Intern Med. 2015 Jun;30(6):732-41.

3. Petruzziello L et al. J Clin Gastroenterol. 2012;46(7):590-4.

4. Kapila N et al. Dig Dis Sci. 2019;64(10):2798-805.

A 53-year-old woman was referred for surveillance colonoscopy. She is a current smoker with a history of chronic kidney disease, chronic obstructive pulmonary disease, atrial fibrillation, and two diminutive hyperplastic polyps found on average-risk screening colonoscopy 3 years previously. Her prep at the time was excellent and she was advised to return in 10 years for follow-up. She has taken the day off work, arranged for a driver, is prepped, and is on your schedule for a colonoscopy for a “history of polyps.” Is this an appropriate referral and how should you handle it?

Most of us have had questionable referrals on our endoscopy schedules. While judgments can vary among providers about when a patient should undergo a procedure or what intervention is most needed, some direct-access referrals for endoscopy are considered inappropriate by most standards. In examining referrals for colonoscopy, studies have shown that as many as 23% of screening colonoscopies among Medicare beneficiaries and 14.2% of Veterans Affairs patients in a large colorectal cancer screening study are inappropriate.^1,2 A prospective multicenter study found 29% of colonoscopies to be inappropriate, and surveillance studies were confirmed as the most frequent source of inappropriate procedures.^3,4 Endoscopies are performed so frequently, effectively, and safely that they can be readily scheduled by gastroenterologists and nongastroenterologists alike. Open access has facilitated and expedited needed procedures, providing benefit to patient and provider and freeing clinic visit time for more complex consults. But while endoscopy is very safe, it is not without risk or cost. What should be the response when a patient in the endoscopy unit appears to be inappropriately referred?

The first step is to determine what is inappropriate. There are several situations when a procedure might be considered inappropriate, particularly when we try to apply ethical principles.

1. The performance of the procedure is contrary to society guidelines. The American Gastroenterological Association, American Society for Gastrointestinal Endoscopy, and American College of Gastroenterology publish clinical guidelines. These documents are drafted after rigorous research and literature review, and the strength of the recommendations is confirmed by incorporation of GRADE (Grading of Recommendations Assessment, Development, and Evaluation) methodology. Such guidelines allow gastroenterologists across the country to practice confidently in a manner consistent with the current available data and the standards of care for the GI community. A patient who is referred for a procedure for an indication that does not adhere to – or contradicts – guidelines, may be at risk for substandard care and possibly at risk for harm. It is the physician’s ethical responsibility to provide the most “good” and the least harm for patients, consistent with the ethical principle of beneficence.

Guidelines, however, are not mandates, and an argument may be made that in order to provide the best care, alternatives may be offered to a patient. Some circumstances require clinical judgments based on unique patient characteristics and the need for individualized care. As a rule, however, the goal of guidelines is to assist doctors in providing the best care.

2. The procedure is not the correct test for the clinical question. While endoscopy can address many clinical queries, endoscopy is not always the right procedure for a specific medical question. A patient referred for an esophagogastroduodenoscopy (EGD) to rule out gastroparesis is being subjected to the wrong test to answer the clinical question. Some information may be obtained from an EGD (e.g., retained food may suggest dysmotility or the patient could have gastric outlet obstruction) but this is not the recommended initial management step. Is it reasonable to proceed with a test that cannot answer the question asked? Continuing with the endoscopy would not enhance beneficence and might be a futile service for the patient. Is this doing the best for the patient?

Dr. Fisher is professor of clinical medicine and director of small-bowel imaging, division of gastroenterology, University of Pennsylvania, Philadelphia.

References

1. Sheffield KM et al. JAMA Intern Med. 2013 Apr 8;173(7):542-50.

2. Powell AA et al. J Gen Intern Med. 2015 Jun;30(6):732-41.

3. Petruzziello L et al. J Clin Gastroenterol. 2012;46(7):590-4.

4. Kapila N et al. Dig Dis Sci. 2019;64(10):2798-805.

A 53-year-old woman was referred for surveillance colonoscopy. She is a current smoker with a history of chronic kidney disease, chronic obstructive pulmonary disease, atrial fibrillation, and two diminutive hyperplastic polyps found on average-risk screening colonoscopy 3 years previously. Her prep at the time was excellent and she was advised to return in 10 years for follow-up. She has taken the day off work, arranged for a driver, is prepped, and is on your schedule for a colonoscopy for a “history of polyps.” Is this an appropriate referral and how should you handle it?

Most of us have had questionable referrals on our endoscopy schedules. While judgments can vary among providers about when a patient should undergo a procedure or what intervention is most needed, some direct-access referrals for endoscopy are considered inappropriate by most standards. In examining referrals for colonoscopy, studies have shown that as many as 23% of screening colonoscopies among Medicare beneficiaries and 14.2% of Veterans Affairs patients in a large colorectal cancer screening study are inappropriate.^1,2 A prospective multicenter study found 29% of colonoscopies to be inappropriate, and surveillance studies were confirmed as the most frequent source of inappropriate procedures.^3,4 Endoscopies are performed so frequently, effectively, and safely that they can be readily scheduled by gastroenterologists and nongastroenterologists alike. Open access has facilitated and expedited needed procedures, providing benefit to patient and provider and freeing clinic visit time for more complex consults. But while endoscopy is very safe, it is not without risk or cost. What should be the response when a patient in the endoscopy unit appears to be inappropriately referred?

The first step is to determine what is inappropriate. There are several situations when a procedure might be considered inappropriate, particularly when we try to apply ethical principles.

1. The performance of the procedure is contrary to society guidelines. The American Gastroenterological Association, American Society for Gastrointestinal Endoscopy, and American College of Gastroenterology publish clinical guidelines. These documents are drafted after rigorous research and literature review, and the strength of the recommendations is confirmed by incorporation of GRADE (Grading of Recommendations Assessment, Development, and Evaluation) methodology. Such guidelines allow gastroenterologists across the country to practice confidently in a manner consistent with the current available data and the standards of care for the GI community. A patient who is referred for a procedure for an indication that does not adhere to – or contradicts – guidelines, may be at risk for substandard care and possibly at risk for harm. It is the physician’s ethical responsibility to provide the most “good” and the least harm for patients, consistent with the ethical principle of beneficence.

Guidelines, however, are not mandates, and an argument may be made that in order to provide the best care, alternatives may be offered to a patient. Some circumstances require clinical judgments based on unique patient characteristics and the need for individualized care. As a rule, however, the goal of guidelines is to assist doctors in providing the best care.

2. The procedure is not the correct test for the clinical question. While endoscopy can address many clinical queries, endoscopy is not always the right procedure for a specific medical question. A patient referred for an esophagogastroduodenoscopy (EGD) to rule out gastroparesis is being subjected to the wrong test to answer the clinical question. Some information may be obtained from an EGD (e.g., retained food may suggest dysmotility or the patient could have gastric outlet obstruction) but this is not the recommended initial management step. Is it reasonable to proceed with a test that cannot answer the question asked? Continuing with the endoscopy would not enhance beneficence and might be a futile service for the patient. Is this doing the best for the patient?

Dr. Fisher is professor of clinical medicine and director of small-bowel imaging, division of gastroenterology, University of Pennsylvania, Philadelphia.

References

1. Sheffield KM et al. JAMA Intern Med. 2013 Apr 8;173(7):542-50.

2. Powell AA et al. J Gen Intern Med. 2015 Jun;30(6):732-41.

3. Petruzziello L et al. J Clin Gastroenterol. 2012;46(7):590-4.

4. Kapila N et al. Dig Dis Sci. 2019;64(10):2798-805.

Coaching is a new topic in medicine. I first heard about coaching several years ago and met the term with skepticism. I was unsure how coaching was different than mentoring or advising and I wondered about its usefulness. However, the reason that I even started to learn about coaching was because I was struggling. I had finally arrived in my career, I had my dream job with two healthy kids, a perfect house, and good marriage. I kept hearing the refrain in my head: “Is this all there is?” I had this arrival fallacy that after all this striving and straining that I would finally be content. I felt unfulfilled and was dissatisfied with where I was that was affecting all parts of my life.

As I was wrestling with these thoughts, I had an opportunity to become a coach to residents around the country through the Association of Women Surgeons. I discussed with them what fills them up, what gets them down, how to set goals, and what their goals were for the year, as well as imposter syndrome. Impostor syndrome is defined as a pattern in which an individual doubts their accomplishments or talents and has a persistent internalized fear of being exposed as a “fraud.” Despite external evidence of their competence, those experiencing this phenomenon remain convinced that they are fooling everyone around them and do not deserve all they have achieved. Individuals incorrectly attribute their success to luck or interpret it as a result of deceiving others into thinking they are more intelligent than they perceive themselves to be. Imposter syndrome is prevalent and deep in medicine. As perfectionists, we are especially vulnerable to imposter syndrome as we set unrealistic ideals for ourselves. When we fail to reach these ideals, we feel like frauds, setting up this cycle of self-doubt that is toxic. When we feel that we can’t achieve the goals that we are striving for we will always find ourselves lacking. There is a slow, insidious erosion of self over the years. Imposter syndrome is well documented in medicine and is even felt as early as medical school.^1,2

When I began coaching these residents the most profound thing that came out of these sessions was that my life was getting better – I knew what filled me up, what got me down, what my goals were for the year, and how I still deal with imposter syndrome. Coaching gave me a framework for helping determine what I wanted for the rest of my life. As I began coaching, I started learning all the ways in which I could figure out my values, my personal and professional goals, and perhaps most importantly, my relationships with myself and others.

Another perspective on coaching is to look at a professional athlete such as Tom Brady, one of the greatest quarterbacks of all time. He has a quarterback coach. No coach is going to be a better quarterback than Tom Brady. A coach for him is to be there as an advocate, break his fundamentals down technically, and help him improve upon what he already knows. A coach also identifies strengths and weaknesses, and helps him capitalize on both by bringing awareness, reflection, accountability, and support. If world-class athletes still want and benefit from coaching in a sport they have already mastered, coaching for physicians is just another tool to help us improve our abilities in and out of medicine.

The way I visualize coaching in medicine is a conscious effort to notice and evaluate how our thoughts affect our experiences and how our perspective shows up in the results of our lives. Coaching is more encompassing than advising or mentoring. It is about examining deeply held beliefs to see if they are really serving us, if they are in line with our values and how we want to live our lives.

Coaching has also been validated in medicine in several papers. In an article by Dyrbye et al. in JAMA Internal Medicine, measures of emotional exhaustion and burnout decreased in physicians who were coached and increased in those who were not.³ In another study from this year by McGonagle et al., a randomized, controlled trial showed that primary care physicians who had sessions (as short as 6 weeks) to address burnout, psychological capital, and job satisfaction experienced an improvement in measures which persisted for 6 months after intervention.⁴ Numerous other articles in medicine also exist to demonstrate the effect of coaching on mitigating burnout at an institutional level.

Physicians are inherently driven by their love of learning. As physicians, we love getting to the root cause of any problem and coming up with creative solutions. Any challenge we have, or just wanting to improve the quality of our lives, can be addressed with coaching. As perpetual students we can use coaching to truly master ourselves.

Dr. Shah is associate professor of surgery, Rush University Medical Center, Chicago. Instagram: ami.shahmdcoaching.

References

1. Gottlieb M et al. Med Educ. 2020 Feb;54(2):116-24.

2. Villwock JA et al. Int J Med Educ. 2016 Oct 31;7:364-9.

3. Dyrbye LN et al. JAMA Intern Med. 2019 Aug 5;179(10):1406-14.

4. McGonagle AK et al. J Occup Health Psychol. 2020 Apr 16. doi: 10.1037/ocp0000180.

Coaching is a new topic in medicine. I first heard about coaching several years ago and met the term with skepticism. I was unsure how coaching was different than mentoring or advising and I wondered about its usefulness. However, the reason that I even started to learn about coaching was because I was struggling. I had finally arrived in my career, I had my dream job with two healthy kids, a perfect house, and good marriage. I kept hearing the refrain in my head: “Is this all there is?” I had this arrival fallacy that after all this striving and straining that I would finally be content. I felt unfulfilled and was dissatisfied with where I was that was affecting all parts of my life.

As I was wrestling with these thoughts, I had an opportunity to become a coach to residents around the country through the Association of Women Surgeons. I discussed with them what fills them up, what gets them down, how to set goals, and what their goals were for the year, as well as imposter syndrome. Impostor syndrome is defined as a pattern in which an individual doubts their accomplishments or talents and has a persistent internalized fear of being exposed as a “fraud.” Despite external evidence of their competence, those experiencing this phenomenon remain convinced that they are fooling everyone around them and do not deserve all they have achieved. Individuals incorrectly attribute their success to luck or interpret it as a result of deceiving others into thinking they are more intelligent than they perceive themselves to be. Imposter syndrome is prevalent and deep in medicine. As perfectionists, we are especially vulnerable to imposter syndrome as we set unrealistic ideals for ourselves. When we fail to reach these ideals, we feel like frauds, setting up this cycle of self-doubt that is toxic. When we feel that we can’t achieve the goals that we are striving for we will always find ourselves lacking. There is a slow, insidious erosion of self over the years. Imposter syndrome is well documented in medicine and is even felt as early as medical school.^1,2

When I began coaching these residents the most profound thing that came out of these sessions was that my life was getting better – I knew what filled me up, what got me down, what my goals were for the year, and how I still deal with imposter syndrome. Coaching gave me a framework for helping determine what I wanted for the rest of my life. As I began coaching, I started learning all the ways in which I could figure out my values, my personal and professional goals, and perhaps most importantly, my relationships with myself and others.

Another perspective on coaching is to look at a professional athlete such as Tom Brady, one of the greatest quarterbacks of all time. He has a quarterback coach. No coach is going to be a better quarterback than Tom Brady. A coach for him is to be there as an advocate, break his fundamentals down technically, and help him improve upon what he already knows. A coach also identifies strengths and weaknesses, and helps him capitalize on both by bringing awareness, reflection, accountability, and support. If world-class athletes still want and benefit from coaching in a sport they have already mastered, coaching for physicians is just another tool to help us improve our abilities in and out of medicine.

The way I visualize coaching in medicine is a conscious effort to notice and evaluate how our thoughts affect our experiences and how our perspective shows up in the results of our lives. Coaching is more encompassing than advising or mentoring. It is about examining deeply held beliefs to see if they are really serving us, if they are in line with our values and how we want to live our lives.

Coaching has also been validated in medicine in several papers. In an article by Dyrbye et al. in JAMA Internal Medicine, measures of emotional exhaustion and burnout decreased in physicians who were coached and increased in those who were not.³ In another study from this year by McGonagle et al., a randomized, controlled trial showed that primary care physicians who had sessions (as short as 6 weeks) to address burnout, psychological capital, and job satisfaction experienced an improvement in measures which persisted for 6 months after intervention.⁴ Numerous other articles in medicine also exist to demonstrate the effect of coaching on mitigating burnout at an institutional level.

Physicians are inherently driven by their love of learning. As physicians, we love getting to the root cause of any problem and coming up with creative solutions. Any challenge we have, or just wanting to improve the quality of our lives, can be addressed with coaching. As perpetual students we can use coaching to truly master ourselves.

Dr. Shah is associate professor of surgery, Rush University Medical Center, Chicago. Instagram: ami.shahmdcoaching.

References

1. Gottlieb M et al. Med Educ. 2020 Feb;54(2):116-24.

2. Villwock JA et al. Int J Med Educ. 2016 Oct 31;7:364-9.

3. Dyrbye LN et al. JAMA Intern Med. 2019 Aug 5;179(10):1406-14.

4. McGonagle AK et al. J Occup Health Psychol. 2020 Apr 16. doi: 10.1037/ocp0000180.

Coaching is a new topic in medicine. I first heard about coaching several years ago and met the term with skepticism. I was unsure how coaching was different than mentoring or advising and I wondered about its usefulness. However, the reason that I even started to learn about coaching was because I was struggling. I had finally arrived in my career, I had my dream job with two healthy kids, a perfect house, and good marriage. I kept hearing the refrain in my head: “Is this all there is?” I had this arrival fallacy that after all this striving and straining that I would finally be content. I felt unfulfilled and was dissatisfied with where I was that was affecting all parts of my life.

As I was wrestling with these thoughts, I had an opportunity to become a coach to residents around the country through the Association of Women Surgeons. I discussed with them what fills them up, what gets them down, how to set goals, and what their goals were for the year, as well as imposter syndrome. Impostor syndrome is defined as a pattern in which an individual doubts their accomplishments or talents and has a persistent internalized fear of being exposed as a “fraud.” Despite external evidence of their competence, those experiencing this phenomenon remain convinced that they are fooling everyone around them and do not deserve all they have achieved. Individuals incorrectly attribute their success to luck or interpret it as a result of deceiving others into thinking they are more intelligent than they perceive themselves to be. Imposter syndrome is prevalent and deep in medicine. As perfectionists, we are especially vulnerable to imposter syndrome as we set unrealistic ideals for ourselves. When we fail to reach these ideals, we feel like frauds, setting up this cycle of self-doubt that is toxic. When we feel that we can’t achieve the goals that we are striving for we will always find ourselves lacking. There is a slow, insidious erosion of self over the years. Imposter syndrome is well documented in medicine and is even felt as early as medical school.^1,2

When I began coaching these residents the most profound thing that came out of these sessions was that my life was getting better – I knew what filled me up, what got me down, what my goals were for the year, and how I still deal with imposter syndrome. Coaching gave me a framework for helping determine what I wanted for the rest of my life. As I began coaching, I started learning all the ways in which I could figure out my values, my personal and professional goals, and perhaps most importantly, my relationships with myself and others.

Another perspective on coaching is to look at a professional athlete such as Tom Brady, one of the greatest quarterbacks of all time. He has a quarterback coach. No coach is going to be a better quarterback than Tom Brady. A coach for him is to be there as an advocate, break his fundamentals down technically, and help him improve upon what he already knows. A coach also identifies strengths and weaknesses, and helps him capitalize on both by bringing awareness, reflection, accountability, and support. If world-class athletes still want and benefit from coaching in a sport they have already mastered, coaching for physicians is just another tool to help us improve our abilities in and out of medicine.

The way I visualize coaching in medicine is a conscious effort to notice and evaluate how our thoughts affect our experiences and how our perspective shows up in the results of our lives. Coaching is more encompassing than advising or mentoring. It is about examining deeply held beliefs to see if they are really serving us, if they are in line with our values and how we want to live our lives.

Coaching has also been validated in medicine in several papers. In an article by Dyrbye et al. in JAMA Internal Medicine, measures of emotional exhaustion and burnout decreased in physicians who were coached and increased in those who were not.³ In another study from this year by McGonagle et al., a randomized, controlled trial showed that primary care physicians who had sessions (as short as 6 weeks) to address burnout, psychological capital, and job satisfaction experienced an improvement in measures which persisted for 6 months after intervention.⁴ Numerous other articles in medicine also exist to demonstrate the effect of coaching on mitigating burnout at an institutional level.

Physicians are inherently driven by their love of learning. As physicians, we love getting to the root cause of any problem and coming up with creative solutions. Any challenge we have, or just wanting to improve the quality of our lives, can be addressed with coaching. As perpetual students we can use coaching to truly master ourselves.

Dr. Shah is associate professor of surgery, Rush University Medical Center, Chicago. Instagram: ami.shahmdcoaching.

References

1. Gottlieb M et al. Med Educ. 2020 Feb;54(2):116-24.

2. Villwock JA et al. Int J Med Educ. 2016 Oct 31;7:364-9.

3. Dyrbye LN et al. JAMA Intern Med. 2019 Aug 5;179(10):1406-14.

4. McGonagle AK et al. J Occup Health Psychol. 2020 Apr 16. doi: 10.1037/ocp0000180.

Telehealth has been steadily gaining mainstream use throughout the last decade, but the practice was recently shoved, almost overnight, into the forefront of the health care profession. Telehealth is now used more frequently by medical groups and physicians than ever before. General reports before the COVID-19 pandemic approximated 90% of health care organizations used or planned to use telehealth in the future. This future may already be a reality, with a McKinsey & Company report estimating that physicians saw 50-175 times more patients over telehealth platforms since the pandemic’s start.¹

In general, telehealth includes use of electronic communication and information technologies to deliver long-distance or remote health care. A physician’s use of telemedicine (clinical services) is one of the most common uses, but the industry also includes other professionals, such as pharmacists and nurses.

• Increased access to health care.
• Increased access to medical specialists in small and rural communities.
• Improved long-term care from the comfort of patients’ homes.
• Improved platforms to document patient care outside regular business hours.

But along with these benefits, telehealth carries the disadvantage of potential increased liability. This increased liability could stem from:

• Breached standards of care.
• Inadequate or improper licensing.
• Limited care options.
• Decision making without a proper physical exam.
• Increased informed consent requirements.
• Restricted prescription access.

Before expanding any practice into telemedicine, awareness of potential legal issues is crucial.

Standard of care

Currently, telehealth laws and regulations vary significantly from state to state. But one rule is consistent across the board – that the standard of care for practicing medicine through telemedicine is identical to the standard of care required for practicing medicine during physical practice. It still requires the appropriate examination, testing, labs, imaging, and consultations that any in-person diagnosis needs. For physicians, it also includes supervising nonphysician clinicians, where state law requires supervision.

The American Telemedicine Association currently determines the primary governing standards and guidelines for telemedicine. These can help physicians understand best practices in meeting the standard of care through telemedicine. The American Gastroenterological Association provides coding guidelines and other resources to help physicians with telehealth and e-visits. Other professional societies, such as the American College of Radiology and the American Academy of Dermatology, offer guidelines specific to their medical specialties’ standards of care. These standards still vary from state to state, so medical professionals must be aware of any differences before treating patients in multiple states.
 

Licensing

Licensing is one of telemedicine’s most confusing legal issues. All states require a license to practice medicine (traditional or telehealth) within their borders. Without that license, practicing medicine in the state is a crime. On top of being criminal, unlicensed practice can affect insurance, liability, billing, and malpractice coverage. When in a brick-and-mortar clinic, a physician’s confidence in practicing within the licensed jurisdiction is easy. Now, the distinction is not so clear. Patients and physicians no longer have to be in the same room, city, or even state, meaning there could be unknown conflicting laws between the two locations. With rare exceptions, standards of care are based on the patient’s location, not the physician’s location. This increases the risk of practicing without being correctly licensed to higher than ever.

Because licensing is a significant roadblock in providing telemedicine, efforts are underway to make the process simpler and more streamlined. The Federation of State Medical Boards developed the Interstate Medical Licensure Compact (IMLC).² This can qualify physicians to practice medicine across state lines within the compact so long as they meet specific eligibility requirements. The IMLC creates a fast-track option for physicians to fill out one application and receive licenses from multiple states at once. Currently, the compact includes 32 states, the District of Columbia, and Guam.³

Informed consent

Telemedicine health care still requires informed consent from patients. In fact, in some states, the requirements for care provided through telehealth are actually stricter than requirements for informed consent obtained in person.

Most informed consent laws require physicians to cover the risks and benefits of a recommended course of treatment and all feasible and reasonable material alternatives. On top of this traditional informed consent, physicians must get additional consent to receive care over a telehealth platform. This unique requirement explains what telehealth is, possible risks and expected benefits, and security measures used to protect patient information. States vary regarding when verbal consent is sufficient, and when written consent is required.
 

Prescriptions

Telemedicine is still a relatively new industry, and few legal opinions specifically address telemedicine malpractice. However, prescribing medication based on telemedicine information is among the few issues the courts have addressed. A 2008 decision found that a physician review of patient questionnaires submitted over the Internet was insufficient to prescribe medication without a physical examination determining patient health.⁴ This cautious approach stemmed from telehealth’s early concern about the absence of patient-physician relationships and potential online pharmacy abuse. Since this decision, many states require an “in-person” visit with a patient before prescribing medication. The definition of what qualifies as an in-person visit varies from state to state – some still consider the use of real-time, audiovisual conferencing sufficient.

The law is still evolving for prescriptions. Some states don’t allow any prescriptions, while others allow physicians to prescribe their patients’ medications as part of an appropriate treatment plan according to their professional discretion. Almost every state prohibits the prescription of controlled substances based on telemedicine.
 

Conclusion

Telemedicine is becoming an increasingly significant part of both physician-patient relationships and the broader health care industry. Used appropriately, it can be an incredibly effective method of care for physicians and patients. Physicians should learn the laws governing telemedicine in every state they want to practice and continue to stay current on any changes. The Center for Connected Health Policy offers a report, updated semiannually, to help physicians stay up to date on their state laws. These efforts will help prevent physicians from exposure to liability and medical malpractice claims.

Mr. Hyde is a partner at Younker Hyde Macfarlane, a law firm that focuses on prosecuting medical malpractice claims on behalf of injured patients. Ms. Johnson is an associate attorney with the firm. You can find them at YHMLaw.com.

References

1. Bestsennyy O, Harris A, Rost J. Telehealth: A quarter-trillion-dollar post-COVID-19 reality? Mckinsey & Company, May 29, 2020.

2. FSMB: Draft Interstate Compact for Physician Licensure Nears Completion, 2014.

3. Interstate Medical Licensure Compact: U.S. State Participation in the Compact.

4. See, Low Cost Pharm., Inc. v. Ariz. State Bd. Of Pharm, 2008 Ariz. App. Unpub. LEXIS 790, referencing conclusion of Arizona Medical Board.

Telehealth has been steadily gaining mainstream use throughout the last decade, but the practice was recently shoved, almost overnight, into the forefront of the health care profession. Telehealth is now used more frequently by medical groups and physicians than ever before. General reports before the COVID-19 pandemic approximated 90% of health care organizations used or planned to use telehealth in the future. This future may already be a reality, with a McKinsey & Company report estimating that physicians saw 50-175 times more patients over telehealth platforms since the pandemic’s start.¹

In general, telehealth includes use of electronic communication and information technologies to deliver long-distance or remote health care. A physician’s use of telemedicine (clinical services) is one of the most common uses, but the industry also includes other professionals, such as pharmacists and nurses.

• Increased access to health care.
• Increased access to medical specialists in small and rural communities.
• Improved long-term care from the comfort of patients’ homes.
• Improved platforms to document patient care outside regular business hours.

But along with these benefits, telehealth carries the disadvantage of potential increased liability. This increased liability could stem from:

• Breached standards of care.
• Inadequate or improper licensing.
• Limited care options.
• Decision making without a proper physical exam.
• Increased informed consent requirements.
• Restricted prescription access.

Before expanding any practice into telemedicine, awareness of potential legal issues is crucial.

Standard of care

Currently, telehealth laws and regulations vary significantly from state to state. But one rule is consistent across the board – that the standard of care for practicing medicine through telemedicine is identical to the standard of care required for practicing medicine during physical practice. It still requires the appropriate examination, testing, labs, imaging, and consultations that any in-person diagnosis needs. For physicians, it also includes supervising nonphysician clinicians, where state law requires supervision.

The American Telemedicine Association currently determines the primary governing standards and guidelines for telemedicine. These can help physicians understand best practices in meeting the standard of care through telemedicine. The American Gastroenterological Association provides coding guidelines and other resources to help physicians with telehealth and e-visits. Other professional societies, such as the American College of Radiology and the American Academy of Dermatology, offer guidelines specific to their medical specialties’ standards of care. These standards still vary from state to state, so medical professionals must be aware of any differences before treating patients in multiple states.
 

Licensing

Licensing is one of telemedicine’s most confusing legal issues. All states require a license to practice medicine (traditional or telehealth) within their borders. Without that license, practicing medicine in the state is a crime. On top of being criminal, unlicensed practice can affect insurance, liability, billing, and malpractice coverage. When in a brick-and-mortar clinic, a physician’s confidence in practicing within the licensed jurisdiction is easy. Now, the distinction is not so clear. Patients and physicians no longer have to be in the same room, city, or even state, meaning there could be unknown conflicting laws between the two locations. With rare exceptions, standards of care are based on the patient’s location, not the physician’s location. This increases the risk of practicing without being correctly licensed to higher than ever.

Because licensing is a significant roadblock in providing telemedicine, efforts are underway to make the process simpler and more streamlined. The Federation of State Medical Boards developed the Interstate Medical Licensure Compact (IMLC).² This can qualify physicians to practice medicine across state lines within the compact so long as they meet specific eligibility requirements. The IMLC creates a fast-track option for physicians to fill out one application and receive licenses from multiple states at once. Currently, the compact includes 32 states, the District of Columbia, and Guam.³

Informed consent

Telemedicine health care still requires informed consent from patients. In fact, in some states, the requirements for care provided through telehealth are actually stricter than requirements for informed consent obtained in person.

Most informed consent laws require physicians to cover the risks and benefits of a recommended course of treatment and all feasible and reasonable material alternatives. On top of this traditional informed consent, physicians must get additional consent to receive care over a telehealth platform. This unique requirement explains what telehealth is, possible risks and expected benefits, and security measures used to protect patient information. States vary regarding when verbal consent is sufficient, and when written consent is required.
 

Prescriptions

Telemedicine is still a relatively new industry, and few legal opinions specifically address telemedicine malpractice. However, prescribing medication based on telemedicine information is among the few issues the courts have addressed. A 2008 decision found that a physician review of patient questionnaires submitted over the Internet was insufficient to prescribe medication without a physical examination determining patient health.⁴ This cautious approach stemmed from telehealth’s early concern about the absence of patient-physician relationships and potential online pharmacy abuse. Since this decision, many states require an “in-person” visit with a patient before prescribing medication. The definition of what qualifies as an in-person visit varies from state to state – some still consider the use of real-time, audiovisual conferencing sufficient.

The law is still evolving for prescriptions. Some states don’t allow any prescriptions, while others allow physicians to prescribe their patients’ medications as part of an appropriate treatment plan according to their professional discretion. Almost every state prohibits the prescription of controlled substances based on telemedicine.
 

Conclusion

Telemedicine is becoming an increasingly significant part of both physician-patient relationships and the broader health care industry. Used appropriately, it can be an incredibly effective method of care for physicians and patients. Physicians should learn the laws governing telemedicine in every state they want to practice and continue to stay current on any changes. The Center for Connected Health Policy offers a report, updated semiannually, to help physicians stay up to date on their state laws. These efforts will help prevent physicians from exposure to liability and medical malpractice claims.

Mr. Hyde is a partner at Younker Hyde Macfarlane, a law firm that focuses on prosecuting medical malpractice claims on behalf of injured patients. Ms. Johnson is an associate attorney with the firm. You can find them at YHMLaw.com.

References

1. Bestsennyy O, Harris A, Rost J. Telehealth: A quarter-trillion-dollar post-COVID-19 reality? Mckinsey & Company, May 29, 2020.

2. FSMB: Draft Interstate Compact for Physician Licensure Nears Completion, 2014.

3. Interstate Medical Licensure Compact: U.S. State Participation in the Compact.

4. See, Low Cost Pharm., Inc. v. Ariz. State Bd. Of Pharm, 2008 Ariz. App. Unpub. LEXIS 790, referencing conclusion of Arizona Medical Board.

Telehealth has been steadily gaining mainstream use throughout the last decade, but the practice was recently shoved, almost overnight, into the forefront of the health care profession. Telehealth is now used more frequently by medical groups and physicians than ever before. General reports before the COVID-19 pandemic approximated 90% of health care organizations used or planned to use telehealth in the future. This future may already be a reality, with a McKinsey & Company report estimating that physicians saw 50-175 times more patients over telehealth platforms since the pandemic’s start.¹

In general, telehealth includes use of electronic communication and information technologies to deliver long-distance or remote health care. A physician’s use of telemedicine (clinical services) is one of the most common uses, but the industry also includes other professionals, such as pharmacists and nurses.

• Increased access to health care.
• Increased access to medical specialists in small and rural communities.
• Improved long-term care from the comfort of patients’ homes.
• Improved platforms to document patient care outside regular business hours.

But along with these benefits, telehealth carries the disadvantage of potential increased liability. This increased liability could stem from:

• Breached standards of care.
• Inadequate or improper licensing.
• Limited care options.
• Decision making without a proper physical exam.
• Increased informed consent requirements.
• Restricted prescription access.

Before expanding any practice into telemedicine, awareness of potential legal issues is crucial.

Standard of care

Currently, telehealth laws and regulations vary significantly from state to state. But one rule is consistent across the board – that the standard of care for practicing medicine through telemedicine is identical to the standard of care required for practicing medicine during physical practice. It still requires the appropriate examination, testing, labs, imaging, and consultations that any in-person diagnosis needs. For physicians, it also includes supervising nonphysician clinicians, where state law requires supervision.

The American Telemedicine Association currently determines the primary governing standards and guidelines for telemedicine. These can help physicians understand best practices in meeting the standard of care through telemedicine. The American Gastroenterological Association provides coding guidelines and other resources to help physicians with telehealth and e-visits. Other professional societies, such as the American College of Radiology and the American Academy of Dermatology, offer guidelines specific to their medical specialties’ standards of care. These standards still vary from state to state, so medical professionals must be aware of any differences before treating patients in multiple states.
 

Licensing

Licensing is one of telemedicine’s most confusing legal issues. All states require a license to practice medicine (traditional or telehealth) within their borders. Without that license, practicing medicine in the state is a crime. On top of being criminal, unlicensed practice can affect insurance, liability, billing, and malpractice coverage. When in a brick-and-mortar clinic, a physician’s confidence in practicing within the licensed jurisdiction is easy. Now, the distinction is not so clear. Patients and physicians no longer have to be in the same room, city, or even state, meaning there could be unknown conflicting laws between the two locations. With rare exceptions, standards of care are based on the patient’s location, not the physician’s location. This increases the risk of practicing without being correctly licensed to higher than ever.

Because licensing is a significant roadblock in providing telemedicine, efforts are underway to make the process simpler and more streamlined. The Federation of State Medical Boards developed the Interstate Medical Licensure Compact (IMLC).² This can qualify physicians to practice medicine across state lines within the compact so long as they meet specific eligibility requirements. The IMLC creates a fast-track option for physicians to fill out one application and receive licenses from multiple states at once. Currently, the compact includes 32 states, the District of Columbia, and Guam.³

Informed consent

Telemedicine health care still requires informed consent from patients. In fact, in some states, the requirements for care provided through telehealth are actually stricter than requirements for informed consent obtained in person.

Most informed consent laws require physicians to cover the risks and benefits of a recommended course of treatment and all feasible and reasonable material alternatives. On top of this traditional informed consent, physicians must get additional consent to receive care over a telehealth platform. This unique requirement explains what telehealth is, possible risks and expected benefits, and security measures used to protect patient information. States vary regarding when verbal consent is sufficient, and when written consent is required.
 

Prescriptions

Telemedicine is still a relatively new industry, and few legal opinions specifically address telemedicine malpractice. However, prescribing medication based on telemedicine information is among the few issues the courts have addressed. A 2008 decision found that a physician review of patient questionnaires submitted over the Internet was insufficient to prescribe medication without a physical examination determining patient health.⁴ This cautious approach stemmed from telehealth’s early concern about the absence of patient-physician relationships and potential online pharmacy abuse. Since this decision, many states require an “in-person” visit with a patient before prescribing medication. The definition of what qualifies as an in-person visit varies from state to state – some still consider the use of real-time, audiovisual conferencing sufficient.

The law is still evolving for prescriptions. Some states don’t allow any prescriptions, while others allow physicians to prescribe their patients’ medications as part of an appropriate treatment plan according to their professional discretion. Almost every state prohibits the prescription of controlled substances based on telemedicine.
 

Conclusion

Telemedicine is becoming an increasingly significant part of both physician-patient relationships and the broader health care industry. Used appropriately, it can be an incredibly effective method of care for physicians and patients. Physicians should learn the laws governing telemedicine in every state they want to practice and continue to stay current on any changes. The Center for Connected Health Policy offers a report, updated semiannually, to help physicians stay up to date on their state laws. These efforts will help prevent physicians from exposure to liability and medical malpractice claims.

Mr. Hyde is a partner at Younker Hyde Macfarlane, a law firm that focuses on prosecuting medical malpractice claims on behalf of injured patients. Ms. Johnson is an associate attorney with the firm. You can find them at YHMLaw.com.

References

1. Bestsennyy O, Harris A, Rost J. Telehealth: A quarter-trillion-dollar post-COVID-19 reality? Mckinsey & Company, May 29, 2020.

2. FSMB: Draft Interstate Compact for Physician Licensure Nears Completion, 2014.

3. Interstate Medical Licensure Compact: U.S. State Participation in the Compact.

4. See, Low Cost Pharm., Inc. v. Ariz. State Bd. Of Pharm, 2008 Ariz. App. Unpub. LEXIS 790, referencing conclusion of Arizona Medical Board.

Dear colleagues,

I’m excited to introduce the November issue of The New Gastroenterologist – the last edition of 2020 features a fantastic line-up of articles! As the year comes to a close, we reflect on what has certainly been an interesting year, defined by a set of unique challenges we have faced as a nation and as a specialty.

AGA Institute

The fellowship recruitment season is one that has looked starkly different as interviews have converted to a virtual format. Dr. Wissam Khan, Dr. Nada Al Masalmeh, Dr. Stephanie Judd, and Dr. Diane Levine (Wayne State University) compile a helpful list of tips and tricks on proper interview etiquette in the new era of web-based interviews.

Financial planning in the face of a pandemic is a formidable task – Jonathan Tudor (Fidelity Investments) offers valuable advice for gastroenterologists on how to remain secure in your finances even in uncertain circumstances.

This quarter’s “In Focus” feature, written by Dr. Yutaka Tomizawa (University of Washington), is a comprehensive piece elucidating the role of gastroenterologists in the management of gastric cancer. The article reviews the individual risk factors that exist for gastric cancer and provides guidance on how to stratify patients accordingly, which is critical in the ethnically diverse population of the United States.

Keeping a procedure log during fellowship can seem daunting and cumbersome, but it is important. Dr. Houman Rezaizadeh (University of Connecticut) shares his program’s experience with the AGA Procedure Log, a convenient online tracking tool, which can provide accurate and secure documentation of endoscopic procedures performed throughout fellowship.

Dr. Nazia Hasan (North Bay Health Care) and Dr. Allison Schulman (University of Michigan) broach an incredibly important topic: the paucity of women in interventional endoscopy. Dr. Hasan and Dr. Shulman candidly discuss the barriers women face in pursuing this subspecialty and offer practical solutions on how to approach these challenges – a piece that will surely resonate with many young gastroenterologists.

We wrap up our first year of TNG’s ethics series with two cases discussing the utilization of cannabis therapy in inflammatory bowel disease (IBD). Dr. Jami Kinnucan (University of Michigan) and Dr. Arun Swaminath (Lenox Hill Hospital) systematically review existing data on the efficacy of cannabis use in IBD, the risks associated with therapy, and legal implications for both physicians and patients.

Also in this issue is a high-yield clinical review on the endoscopic drainage of pancreatic fluid collections by Dr. Robert Moran and Dr. Joseph Elmunzer (Medical University of South Carolina). Dr. Manol Jovani (Johns Hopkins) teaches us about confounding – a critical concept to keep in mind when evaluating any manuscript. Lastly, our DHPA Private Practice Perspectives article, written by Dr. Mehul Lalani (US Digestive), reviews how quality measures and initiatives are tracked and implemented in private practice.

If you have interest in contributing or have ideas for future TNG topics, please contact me ([email protected]), or Ryan Farrell ([email protected]), managing editor of TNG.
 

Stay well,

Vijaya L. Rao, MD
Editor in Chief
Assistant Professor of Medicine, University of Chicago, Section of Gastroenterology, Hepatology & Nutrition

Dear colleagues,

I’m excited to introduce the November issue of The New Gastroenterologist – the last edition of 2020 features a fantastic line-up of articles! As the year comes to a close, we reflect on what has certainly been an interesting year, defined by a set of unique challenges we have faced as a nation and as a specialty.

AGA Institute

The fellowship recruitment season is one that has looked starkly different as interviews have converted to a virtual format. Dr. Wissam Khan, Dr. Nada Al Masalmeh, Dr. Stephanie Judd, and Dr. Diane Levine (Wayne State University) compile a helpful list of tips and tricks on proper interview etiquette in the new era of web-based interviews.

Financial planning in the face of a pandemic is a formidable task – Jonathan Tudor (Fidelity Investments) offers valuable advice for gastroenterologists on how to remain secure in your finances even in uncertain circumstances.

This quarter’s “In Focus” feature, written by Dr. Yutaka Tomizawa (University of Washington), is a comprehensive piece elucidating the role of gastroenterologists in the management of gastric cancer. The article reviews the individual risk factors that exist for gastric cancer and provides guidance on how to stratify patients accordingly, which is critical in the ethnically diverse population of the United States.

Keeping a procedure log during fellowship can seem daunting and cumbersome, but it is important. Dr. Houman Rezaizadeh (University of Connecticut) shares his program’s experience with the AGA Procedure Log, a convenient online tracking tool, which can provide accurate and secure documentation of endoscopic procedures performed throughout fellowship.

Dr. Nazia Hasan (North Bay Health Care) and Dr. Allison Schulman (University of Michigan) broach an incredibly important topic: the paucity of women in interventional endoscopy. Dr. Hasan and Dr. Shulman candidly discuss the barriers women face in pursuing this subspecialty and offer practical solutions on how to approach these challenges – a piece that will surely resonate with many young gastroenterologists.

We wrap up our first year of TNG’s ethics series with two cases discussing the utilization of cannabis therapy in inflammatory bowel disease (IBD). Dr. Jami Kinnucan (University of Michigan) and Dr. Arun Swaminath (Lenox Hill Hospital) systematically review existing data on the efficacy of cannabis use in IBD, the risks associated with therapy, and legal implications for both physicians and patients.

Also in this issue is a high-yield clinical review on the endoscopic drainage of pancreatic fluid collections by Dr. Robert Moran and Dr. Joseph Elmunzer (Medical University of South Carolina). Dr. Manol Jovani (Johns Hopkins) teaches us about confounding – a critical concept to keep in mind when evaluating any manuscript. Lastly, our DHPA Private Practice Perspectives article, written by Dr. Mehul Lalani (US Digestive), reviews how quality measures and initiatives are tracked and implemented in private practice.

If you have interest in contributing or have ideas for future TNG topics, please contact me ([email protected]), or Ryan Farrell ([email protected]), managing editor of TNG.
 

Stay well,

Vijaya L. Rao, MD
Editor in Chief
Assistant Professor of Medicine, University of Chicago, Section of Gastroenterology, Hepatology & Nutrition

Dear colleagues,

I’m excited to introduce the November issue of The New Gastroenterologist – the last edition of 2020 features a fantastic line-up of articles! As the year comes to a close, we reflect on what has certainly been an interesting year, defined by a set of unique challenges we have faced as a nation and as a specialty.

AGA Institute

The fellowship recruitment season is one that has looked starkly different as interviews have converted to a virtual format. Dr. Wissam Khan, Dr. Nada Al Masalmeh, Dr. Stephanie Judd, and Dr. Diane Levine (Wayne State University) compile a helpful list of tips and tricks on proper interview etiquette in the new era of web-based interviews.

Financial planning in the face of a pandemic is a formidable task – Jonathan Tudor (Fidelity Investments) offers valuable advice for gastroenterologists on how to remain secure in your finances even in uncertain circumstances.

This quarter’s “In Focus” feature, written by Dr. Yutaka Tomizawa (University of Washington), is a comprehensive piece elucidating the role of gastroenterologists in the management of gastric cancer. The article reviews the individual risk factors that exist for gastric cancer and provides guidance on how to stratify patients accordingly, which is critical in the ethnically diverse population of the United States.

Keeping a procedure log during fellowship can seem daunting and cumbersome, but it is important. Dr. Houman Rezaizadeh (University of Connecticut) shares his program’s experience with the AGA Procedure Log, a convenient online tracking tool, which can provide accurate and secure documentation of endoscopic procedures performed throughout fellowship.

Dr. Nazia Hasan (North Bay Health Care) and Dr. Allison Schulman (University of Michigan) broach an incredibly important topic: the paucity of women in interventional endoscopy. Dr. Hasan and Dr. Shulman candidly discuss the barriers women face in pursuing this subspecialty and offer practical solutions on how to approach these challenges – a piece that will surely resonate with many young gastroenterologists.

We wrap up our first year of TNG’s ethics series with two cases discussing the utilization of cannabis therapy in inflammatory bowel disease (IBD). Dr. Jami Kinnucan (University of Michigan) and Dr. Arun Swaminath (Lenox Hill Hospital) systematically review existing data on the efficacy of cannabis use in IBD, the risks associated with therapy, and legal implications for both physicians and patients.

Also in this issue is a high-yield clinical review on the endoscopic drainage of pancreatic fluid collections by Dr. Robert Moran and Dr. Joseph Elmunzer (Medical University of South Carolina). Dr. Manol Jovani (Johns Hopkins) teaches us about confounding – a critical concept to keep in mind when evaluating any manuscript. Lastly, our DHPA Private Practice Perspectives article, written by Dr. Mehul Lalani (US Digestive), reviews how quality measures and initiatives are tracked and implemented in private practice.

If you have interest in contributing or have ideas for future TNG topics, please contact me ([email protected]), or Ryan Farrell ([email protected]), managing editor of TNG.
 

Stay well,

Vijaya L. Rao, MD
Editor in Chief
Assistant Professor of Medicine, University of Chicago, Section of Gastroenterology, Hepatology & Nutrition