The New Gastroenterologist

Dear Colleagues,

Welcome to the second edition of The New Gastroenterologist in its e-newsletter format! As more content in medicine, and life in general, is moving toward digital platforms, we at the AGA believe this transition will improve both content dissemination and accessibility to all our readers. In this new format, we will to continue to provide articles on topics of importance to the early-career community, expand our offerings by including the new “In Focus” articles (concise overviews of GI topics) both digitally and in GI & Hepatology News print issues, as well as increase the use of multimedia resources, such as videos, to further enhance our content.

The “In Focus” article this month is authored by the members of the AGA’s Diversity Committee and focuses on the extremely important topic of barriers preventing colorectal cancer screening in underserved populations. This comprehensive overview will undoubtedly help us in our mission to ensure valuable colorectal cancer screening is more frequently, and widely, applied. And be sure to look for it in the May print issue of GI & Hepatology News as well.

Digestive Disease Week (DDW^®), which many of us will be attending, features cutting-edge research and provides an invaluable opportunity for networking. With DDW right around the corner, Lea Ann Chen (NYU) gives some very helpful pointers to ensure that you get the most out of your experience. Additionally, David Leiman (Duke) and Neil Sengupta (University of Chicago) provide an overview of how best to incorporate new evidence into your daily practice. This is such a critical topic nowadays given the ever-growing number of journal articles published as well as the speed at which information is disseminated both throughout our field and in the popular press.

In our postfellowship pathways section, Elizabeth Verna (Columbia) provides an overview of the advanced training options available in hepatology including the new ABIM pilot program that combines a transplant hepatology fellowship year with the third year of fellowship. Finally, there is an overview on strategies for retirement savings by A.J. Bellamah (BNB Wealth Management), which is an area where so many of us get a late start due to extended training and student loan burden.

Please also check out the “In Case You Missed It” section to see selected articles published in the AGA journals, which are particularly relevant to those of us in our early careers. If you have any ideas for future articles, or are interested in contributing to The New Gastroenterologist, please contact me at [email protected] or the managing editor, Ryan Farrell, at [email protected].
 

Sincerely,

Bryson W. Katona, MD, PhD

Editor in Chief

Dr. Katona is an instructor of medicine in the division of gastroenterology at the University of Pennsylvania, Philadelphia.

Dear Colleagues,

Welcome to the second edition of The New Gastroenterologist in its e-newsletter format! As more content in medicine, and life in general, is moving toward digital platforms, we at the AGA believe this transition will improve both content dissemination and accessibility to all our readers. In this new format, we will to continue to provide articles on topics of importance to the early-career community, expand our offerings by including the new “In Focus” articles (concise overviews of GI topics) both digitally and in GI & Hepatology News print issues, as well as increase the use of multimedia resources, such as videos, to further enhance our content.

The “In Focus” article this month is authored by the members of the AGA’s Diversity Committee and focuses on the extremely important topic of barriers preventing colorectal cancer screening in underserved populations. This comprehensive overview will undoubtedly help us in our mission to ensure valuable colorectal cancer screening is more frequently, and widely, applied. And be sure to look for it in the May print issue of GI & Hepatology News as well.

Digestive Disease Week (DDW^®), which many of us will be attending, features cutting-edge research and provides an invaluable opportunity for networking. With DDW right around the corner, Lea Ann Chen (NYU) gives some very helpful pointers to ensure that you get the most out of your experience. Additionally, David Leiman (Duke) and Neil Sengupta (University of Chicago) provide an overview of how best to incorporate new evidence into your daily practice. This is such a critical topic nowadays given the ever-growing number of journal articles published as well as the speed at which information is disseminated both throughout our field and in the popular press.

In our postfellowship pathways section, Elizabeth Verna (Columbia) provides an overview of the advanced training options available in hepatology including the new ABIM pilot program that combines a transplant hepatology fellowship year with the third year of fellowship. Finally, there is an overview on strategies for retirement savings by A.J. Bellamah (BNB Wealth Management), which is an area where so many of us get a late start due to extended training and student loan burden.

Please also check out the “In Case You Missed It” section to see selected articles published in the AGA journals, which are particularly relevant to those of us in our early careers. If you have any ideas for future articles, or are interested in contributing to The New Gastroenterologist, please contact me at [email protected] or the managing editor, Ryan Farrell, at [email protected].
 

Sincerely,

Bryson W. Katona, MD, PhD

Editor in Chief

Dr. Katona is an instructor of medicine in the division of gastroenterology at the University of Pennsylvania, Philadelphia.

Dear Colleagues,

Welcome to the second edition of The New Gastroenterologist in its e-newsletter format! As more content in medicine, and life in general, is moving toward digital platforms, we at the AGA believe this transition will improve both content dissemination and accessibility to all our readers. In this new format, we will to continue to provide articles on topics of importance to the early-career community, expand our offerings by including the new “In Focus” articles (concise overviews of GI topics) both digitally and in GI & Hepatology News print issues, as well as increase the use of multimedia resources, such as videos, to further enhance our content.

The “In Focus” article this month is authored by the members of the AGA’s Diversity Committee and focuses on the extremely important topic of barriers preventing colorectal cancer screening in underserved populations. This comprehensive overview will undoubtedly help us in our mission to ensure valuable colorectal cancer screening is more frequently, and widely, applied. And be sure to look for it in the May print issue of GI & Hepatology News as well.

Digestive Disease Week (DDW^®), which many of us will be attending, features cutting-edge research and provides an invaluable opportunity for networking. With DDW right around the corner, Lea Ann Chen (NYU) gives some very helpful pointers to ensure that you get the most out of your experience. Additionally, David Leiman (Duke) and Neil Sengupta (University of Chicago) provide an overview of how best to incorporate new evidence into your daily practice. This is such a critical topic nowadays given the ever-growing number of journal articles published as well as the speed at which information is disseminated both throughout our field and in the popular press.

In our postfellowship pathways section, Elizabeth Verna (Columbia) provides an overview of the advanced training options available in hepatology including the new ABIM pilot program that combines a transplant hepatology fellowship year with the third year of fellowship. Finally, there is an overview on strategies for retirement savings by A.J. Bellamah (BNB Wealth Management), which is an area where so many of us get a late start due to extended training and student loan burden.

Please also check out the “In Case You Missed It” section to see selected articles published in the AGA journals, which are particularly relevant to those of us in our early careers. If you have any ideas for future articles, or are interested in contributing to The New Gastroenterologist, please contact me at [email protected] or the managing editor, Ryan Farrell, at [email protected].
 

Sincerely,

Bryson W. Katona, MD, PhD

Editor in Chief

Dr. Katona is an instructor of medicine in the division of gastroenterology at the University of Pennsylvania, Philadelphia.

Approaching the concept of retirement savings is particularly unique for medical professionals: Balancing a tremendously demanding career with family life and personal time allows few to have the luxury of extra time to address financial planning. Many in the field have higher priorities than saving for retirement on their minds, which compounds the issue.

According to the Association of American Medical Colleges, 76% of medical students will have student debt by the time they graduate. Among those students, the average debt is a staggering $190,000. The average American couple has only about $163,000 in savings by the time they are about 60 years old, so coming out of school, the average doctor will have more in debt than most have saved in their lifetimes. This means that many doctors can’t really start saving significantly until the latter half of their careers. With that in mind, consider these tips to help you on your journey to financial security.
 

Pay off debt or start saving for retirement?

When it comes to the decision of investing toward retirement or paying off debt more aggressively, there is really only one question that needs to be answered: “Can I make more investing than the loan is costing me?” Given the fact that Direct Graduate Plus Loans are now sitting at about 7% interest rates, an investment would have to make more than 7% per year to make sense. While we can look back at the historical performance of the stock market over time, it is pretty safe to say that in this scenario paying off the student loans as aggressively as possible is the best choice. The reason being is that the loans have a guaranteed cost of 7% per year in accrued interest, whereas an investment is never fully guaranteed to grow.

Make no mistake: High-interest debt is a financial dead weight; the longer it sits, the more it will attempt to sink you financially. A general rule of thumb is that the higher the interest rate on the loan, the more aggressively it should be paid off. Once the high interest loans are taken care of, saving for retirement can reenter the equation.
 

The company match

That being said, there is one caveat to this rule that you should strongly consider if the opportunity exists: the 401(k) or 403(b) company match. If you work in a position that offers a match on retirement plan contributions, taking advantage of this could substantially benefit you. In a typical safe harbor retirement plan, you will see something like a 3.5% company match for a 6% salary contribution. While there is no one formula that applies to every situation, an opportunity such as this shouldn’t be passed up.

Saving for retirement can be difficult enough. Why not take advantage of a situation in which you are getting free money? You should think about contributing enough to get the maximum match and putting the rest toward student debt. If you are unsure about your particular course of action, I’d suggest speaking to your financial professional to assist in coming up with a suitable game plan.

Roth deferral option

While many folks understand the general ins and outs of how retirement plans work, they fail to realize that there are actually two different types of contributions that can be made in most 401(k)s and 403(b)s: traditional deferrals and Roth deferrals. A traditional deferral is the standard pretax contribution option that lets you skip paying taxes now. Instead, you get taxed at your normal income tax bracket when the money is withdrawn in retirement. This is the option that most people use.

Roth deferrals are posttax contributions. Every dollar contributed gets taxed as ordinary income. Why would one do this, you ask? While there are a variety of different benefits, the primary advantage is that you never have to pay taxes on this money again. To reiterate, you pay taxes on this money now and never have to pay any taxes on it again. This can be extraordinarily helpful in retirement because it gives you the flexibility to choose between taxable and tax-free income.

While you can contribute to personal Roth IRAs to the tune of $5,500 a year if you are under 50 years old and $6,500 if you are 50 years and older, high income earners can be hampered by income limits. For instance, if you make over $135,000 a year as a single person or over $199,000 as a married couple, you are ineligible to make Roth IRA contributions. However, a benefit to Roth contributions in your company 401(k) or 403(b) plan is that these income limits don’t apply. Regardless of your level of income, you can make Roth deferrals in company sponsored retirement plans that allow them.

This strategy is best fit for, but not limited to, those who are earlier on in their careers and can reasonably expect to make much more in the future than they do now. Younger investors have the benefit of time: The more time an investment has to grow, the more it should be worth later on. Also, younger professionals are probably going to be paying the least amount of taxes early in their careers. While not all retirement plans allow for Roth deferrals, if the option is available, why not get taxes out of the way while it’s still relatively cheaper to do so?

AJ Bellamah

More aggressive strategies for those who need to “catch up” on retirement savings

Because many in the medical field have burdensome student loans, saving for retirement is often something that is pushed off by necessity. That being said, there are different ways to start saving more aggressively the closer you get toward retirement.

Catch up contributions. 401(k)s, 403(b)s, and IRAs all have built in “catch up” contributions that allow those aged 50 or older to save more. For instance, up to age 49 years, the maximum annual contribution in a 401(k) or 403(b) is $18,500 for 2018. At age 50 years, you are allowed to add an additional $6000 “catch up” contribution for a total of $24,500 per year. Likewise, IRAs allow for an additional $1000 per year contribution at age 50 years for a $6500 total yearly contribution.

Spousal IRAs. If you have a nonworking spouse, you may be able to contribute to an IRA on his or her behalf. To be eligible for a spousal IRA contribution, you must be married, file a joint income tax return, and have an earned income of at least what is being contributed to the IRAs. This would allow an additional $5,500 to $6,500 in retirement savings per year depending on your spouse’s age.

Simplified Employee Pension IRAs. For those who are self-employed, it could be worthwhile to look into opening up a Simplified Employee Pension (SEP) IRA. These types of retirement plans are similar to traditional IRAs except that they can only be opened up by an employer. The benefit of a SEP IRA is that it allows for a maximum pretax contribution of up to $54,000 or 25% of your total income, whichever is less.

Cash balance plans. For very-high-earning business owners or sole proprietors, saving $24,500 a year pretax in a 401(k) isn’t necessarily going to move the needle all that much. However, there is a plan available that may help tremendously. The cash balance plan is a little known hybrid retirement plan that allows high-earning practices and business owners to put away a serious amount of money in a short amount of time. For instance, an optimally set up cash balance plan would allow a 59 year old to save up to $278,000 in qualified pretax dollars in a single year. Undoubtedly, such plans are one of the most effective and efficient ways to save money for retirement for those who qualify.

Check out the maximum contributions limits of some retirement strategies below based on your age group.

Mr. Bellamah is a registered investment advisor with BNB Wealth Management http://www.bnbinc.com/.

Approaching the concept of retirement savings is particularly unique for medical professionals: Balancing a tremendously demanding career with family life and personal time allows few to have the luxury of extra time to address financial planning. Many in the field have higher priorities than saving for retirement on their minds, which compounds the issue.

According to the Association of American Medical Colleges, 76% of medical students will have student debt by the time they graduate. Among those students, the average debt is a staggering $190,000. The average American couple has only about $163,000 in savings by the time they are about 60 years old, so coming out of school, the average doctor will have more in debt than most have saved in their lifetimes. This means that many doctors can’t really start saving significantly until the latter half of their careers. With that in mind, consider these tips to help you on your journey to financial security.
 

Pay off debt or start saving for retirement?

When it comes to the decision of investing toward retirement or paying off debt more aggressively, there is really only one question that needs to be answered: “Can I make more investing than the loan is costing me?” Given the fact that Direct Graduate Plus Loans are now sitting at about 7% interest rates, an investment would have to make more than 7% per year to make sense. While we can look back at the historical performance of the stock market over time, it is pretty safe to say that in this scenario paying off the student loans as aggressively as possible is the best choice. The reason being is that the loans have a guaranteed cost of 7% per year in accrued interest, whereas an investment is never fully guaranteed to grow.

Make no mistake: High-interest debt is a financial dead weight; the longer it sits, the more it will attempt to sink you financially. A general rule of thumb is that the higher the interest rate on the loan, the more aggressively it should be paid off. Once the high interest loans are taken care of, saving for retirement can reenter the equation.
 

The company match

That being said, there is one caveat to this rule that you should strongly consider if the opportunity exists: the 401(k) or 403(b) company match. If you work in a position that offers a match on retirement plan contributions, taking advantage of this could substantially benefit you. In a typical safe harbor retirement plan, you will see something like a 3.5% company match for a 6% salary contribution. While there is no one formula that applies to every situation, an opportunity such as this shouldn’t be passed up.

Saving for retirement can be difficult enough. Why not take advantage of a situation in which you are getting free money? You should think about contributing enough to get the maximum match and putting the rest toward student debt. If you are unsure about your particular course of action, I’d suggest speaking to your financial professional to assist in coming up with a suitable game plan.

Roth deferral option

While many folks understand the general ins and outs of how retirement plans work, they fail to realize that there are actually two different types of contributions that can be made in most 401(k)s and 403(b)s: traditional deferrals and Roth deferrals. A traditional deferral is the standard pretax contribution option that lets you skip paying taxes now. Instead, you get taxed at your normal income tax bracket when the money is withdrawn in retirement. This is the option that most people use.

Roth deferrals are posttax contributions. Every dollar contributed gets taxed as ordinary income. Why would one do this, you ask? While there are a variety of different benefits, the primary advantage is that you never have to pay taxes on this money again. To reiterate, you pay taxes on this money now and never have to pay any taxes on it again. This can be extraordinarily helpful in retirement because it gives you the flexibility to choose between taxable and tax-free income.

While you can contribute to personal Roth IRAs to the tune of $5,500 a year if you are under 50 years old and $6,500 if you are 50 years and older, high income earners can be hampered by income limits. For instance, if you make over $135,000 a year as a single person or over $199,000 as a married couple, you are ineligible to make Roth IRA contributions. However, a benefit to Roth contributions in your company 401(k) or 403(b) plan is that these income limits don’t apply. Regardless of your level of income, you can make Roth deferrals in company sponsored retirement plans that allow them.

This strategy is best fit for, but not limited to, those who are earlier on in their careers and can reasonably expect to make much more in the future than they do now. Younger investors have the benefit of time: The more time an investment has to grow, the more it should be worth later on. Also, younger professionals are probably going to be paying the least amount of taxes early in their careers. While not all retirement plans allow for Roth deferrals, if the option is available, why not get taxes out of the way while it’s still relatively cheaper to do so?

AJ Bellamah

More aggressive strategies for those who need to “catch up” on retirement savings

Because many in the medical field have burdensome student loans, saving for retirement is often something that is pushed off by necessity. That being said, there are different ways to start saving more aggressively the closer you get toward retirement.

Catch up contributions. 401(k)s, 403(b)s, and IRAs all have built in “catch up” contributions that allow those aged 50 or older to save more. For instance, up to age 49 years, the maximum annual contribution in a 401(k) or 403(b) is $18,500 for 2018. At age 50 years, you are allowed to add an additional $6000 “catch up” contribution for a total of $24,500 per year. Likewise, IRAs allow for an additional $1000 per year contribution at age 50 years for a $6500 total yearly contribution.

Spousal IRAs. If you have a nonworking spouse, you may be able to contribute to an IRA on his or her behalf. To be eligible for a spousal IRA contribution, you must be married, file a joint income tax return, and have an earned income of at least what is being contributed to the IRAs. This would allow an additional $5,500 to $6,500 in retirement savings per year depending on your spouse’s age.

Simplified Employee Pension IRAs. For those who are self-employed, it could be worthwhile to look into opening up a Simplified Employee Pension (SEP) IRA. These types of retirement plans are similar to traditional IRAs except that they can only be opened up by an employer. The benefit of a SEP IRA is that it allows for a maximum pretax contribution of up to $54,000 or 25% of your total income, whichever is less.

Cash balance plans. For very-high-earning business owners or sole proprietors, saving $24,500 a year pretax in a 401(k) isn’t necessarily going to move the needle all that much. However, there is a plan available that may help tremendously. The cash balance plan is a little known hybrid retirement plan that allows high-earning practices and business owners to put away a serious amount of money in a short amount of time. For instance, an optimally set up cash balance plan would allow a 59 year old to save up to $278,000 in qualified pretax dollars in a single year. Undoubtedly, such plans are one of the most effective and efficient ways to save money for retirement for those who qualify.

Check out the maximum contributions limits of some retirement strategies below based on your age group.

Mr. Bellamah is a registered investment advisor with BNB Wealth Management http://www.bnbinc.com/.

Approaching the concept of retirement savings is particularly unique for medical professionals: Balancing a tremendously demanding career with family life and personal time allows few to have the luxury of extra time to address financial planning. Many in the field have higher priorities than saving for retirement on their minds, which compounds the issue.

According to the Association of American Medical Colleges, 76% of medical students will have student debt by the time they graduate. Among those students, the average debt is a staggering $190,000. The average American couple has only about $163,000 in savings by the time they are about 60 years old, so coming out of school, the average doctor will have more in debt than most have saved in their lifetimes. This means that many doctors can’t really start saving significantly until the latter half of their careers. With that in mind, consider these tips to help you on your journey to financial security.
 

Pay off debt or start saving for retirement?

When it comes to the decision of investing toward retirement or paying off debt more aggressively, there is really only one question that needs to be answered: “Can I make more investing than the loan is costing me?” Given the fact that Direct Graduate Plus Loans are now sitting at about 7% interest rates, an investment would have to make more than 7% per year to make sense. While we can look back at the historical performance of the stock market over time, it is pretty safe to say that in this scenario paying off the student loans as aggressively as possible is the best choice. The reason being is that the loans have a guaranteed cost of 7% per year in accrued interest, whereas an investment is never fully guaranteed to grow.

Make no mistake: High-interest debt is a financial dead weight; the longer it sits, the more it will attempt to sink you financially. A general rule of thumb is that the higher the interest rate on the loan, the more aggressively it should be paid off. Once the high interest loans are taken care of, saving for retirement can reenter the equation.
 

The company match

That being said, there is one caveat to this rule that you should strongly consider if the opportunity exists: the 401(k) or 403(b) company match. If you work in a position that offers a match on retirement plan contributions, taking advantage of this could substantially benefit you. In a typical safe harbor retirement plan, you will see something like a 3.5% company match for a 6% salary contribution. While there is no one formula that applies to every situation, an opportunity such as this shouldn’t be passed up.

Saving for retirement can be difficult enough. Why not take advantage of a situation in which you are getting free money? You should think about contributing enough to get the maximum match and putting the rest toward student debt. If you are unsure about your particular course of action, I’d suggest speaking to your financial professional to assist in coming up with a suitable game plan.

Roth deferral option

While many folks understand the general ins and outs of how retirement plans work, they fail to realize that there are actually two different types of contributions that can be made in most 401(k)s and 403(b)s: traditional deferrals and Roth deferrals. A traditional deferral is the standard pretax contribution option that lets you skip paying taxes now. Instead, you get taxed at your normal income tax bracket when the money is withdrawn in retirement. This is the option that most people use.

Roth deferrals are posttax contributions. Every dollar contributed gets taxed as ordinary income. Why would one do this, you ask? While there are a variety of different benefits, the primary advantage is that you never have to pay taxes on this money again. To reiterate, you pay taxes on this money now and never have to pay any taxes on it again. This can be extraordinarily helpful in retirement because it gives you the flexibility to choose between taxable and tax-free income.

While you can contribute to personal Roth IRAs to the tune of $5,500 a year if you are under 50 years old and $6,500 if you are 50 years and older, high income earners can be hampered by income limits. For instance, if you make over $135,000 a year as a single person or over $199,000 as a married couple, you are ineligible to make Roth IRA contributions. However, a benefit to Roth contributions in your company 401(k) or 403(b) plan is that these income limits don’t apply. Regardless of your level of income, you can make Roth deferrals in company sponsored retirement plans that allow them.

This strategy is best fit for, but not limited to, those who are earlier on in their careers and can reasonably expect to make much more in the future than they do now. Younger investors have the benefit of time: The more time an investment has to grow, the more it should be worth later on. Also, younger professionals are probably going to be paying the least amount of taxes early in their careers. While not all retirement plans allow for Roth deferrals, if the option is available, why not get taxes out of the way while it’s still relatively cheaper to do so?

AJ Bellamah

More aggressive strategies for those who need to “catch up” on retirement savings

Because many in the medical field have burdensome student loans, saving for retirement is often something that is pushed off by necessity. That being said, there are different ways to start saving more aggressively the closer you get toward retirement.

Catch up contributions. 401(k)s, 403(b)s, and IRAs all have built in “catch up” contributions that allow those aged 50 or older to save more. For instance, up to age 49 years, the maximum annual contribution in a 401(k) or 403(b) is $18,500 for 2018. At age 50 years, you are allowed to add an additional $6000 “catch up” contribution for a total of $24,500 per year. Likewise, IRAs allow for an additional $1000 per year contribution at age 50 years for a $6500 total yearly contribution.

Spousal IRAs. If you have a nonworking spouse, you may be able to contribute to an IRA on his or her behalf. To be eligible for a spousal IRA contribution, you must be married, file a joint income tax return, and have an earned income of at least what is being contributed to the IRAs. This would allow an additional $5,500 to $6,500 in retirement savings per year depending on your spouse’s age.

Simplified Employee Pension IRAs. For those who are self-employed, it could be worthwhile to look into opening up a Simplified Employee Pension (SEP) IRA. These types of retirement plans are similar to traditional IRAs except that they can only be opened up by an employer. The benefit of a SEP IRA is that it allows for a maximum pretax contribution of up to $54,000 or 25% of your total income, whichever is less.

Cash balance plans. For very-high-earning business owners or sole proprietors, saving $24,500 a year pretax in a 401(k) isn’t necessarily going to move the needle all that much. However, there is a plan available that may help tremendously. The cash balance plan is a little known hybrid retirement plan that allows high-earning practices and business owners to put away a serious amount of money in a short amount of time. For instance, an optimally set up cash balance plan would allow a 59 year old to save up to $278,000 in qualified pretax dollars in a single year. Undoubtedly, such plans are one of the most effective and efficient ways to save money for retirement for those who qualify.

Check out the maximum contributions limits of some retirement strategies below based on your age group.

Mr. Bellamah is a registered investment advisor with BNB Wealth Management http://www.bnbinc.com/.

For more information about upcoming events and award deadlines, please visit http://www.gastro.org/education and http://www.gastro.org/research-funding.

June 2-5, 2018
DIGESTIVE DISEASE WEEK^® (DDW) 2018 – WASHINGTON, DC
DDW^® is the premier meeting for the GI professional. Every year, it attracts approximately 15,000 physicians, researchers, and academics from around the world who desire to stay up to date in the field.

AGA Trainee and Early-Career GI Sessions

Join your colleagues at special sessions to meet the unique needs of physicians who are new to the field. Participants will learn about all aspects of starting a career in clinical practice or research, have the opportunity to network with mentors and peers, and review board material.

• June 2, 8:15 a.m.–5:30 p.m.; June 3, 8:30 a.m.–12:35 p.m.
  AGA Postgraduate Course: From Abstract to Reality
  Attend this multi-topic course to get practical, useful information to push your practice to the next level. The 2018 course will provide a comprehensive look at the latest medical, surgical, and technological advances over the past 12 months that aim to keep you up to date in a field that is rapidly changing. Each presenter will turn abstract ideas into concrete action items that you can immediately implement in your practice. AGA member trainees and early-career GIs receive discounted pricing for this course.
• June 3, 4–5:30 p.m.
  Difficult Conversations: Navigating People, Negotiations, Promotions, and Complications
  During this session, attendees will obtain effective negotiation techniques and learn how to navigate difficult situations in clinical and research environments.
• June 3, 6-7 p.m.
  AGA Early Career Networking Hour
  This event is open to all DDW trainee and early career GI attendees and provides a casual atmosphere to bond with your peers. Complimentary food and drinks will be available. 
• June 4, 4–5:30 p.m.
  Advancing Clinical Practice: Gastroenterology Fellow–Directed Quality-Improvement Projects
  This trainee-focused session will showcase selected abstracts from GI fellows based on quality improvement with a state-of-the-art lecture. Attendees will be provided with information that defines practical approaches to quality improvement from start to finish. A limited supply of coffee and tea will be provided during the session.
• June 5, 1:30–5:30 p.m.
  Board Review Course
  This session, designed using content from DDSEP^® 8, serves as a primer for third-year fellows preparing for the board exam as well as a review course for others wanting to test their knowledge. Session attendees will receive a $50 coupon to use at the AGA Store at DDW to purchase DDSEP 8.

UPCOMING EVENTS
 

June 4-8, 2018
Exosomes/Microvesicles: Heterogeneity, Biogenesis, Function, and Therapeutic Developments (E2)
Deepen your understanding of the structural and functional complexity of extracellular vesicles, their biogenesis and function in health and disease, cargo enrichment, potential as ideal biomarkers, and breakthroughs in their use as therapeutic targets/agents.
Breckenridge, CO

June 13-14; Aug. 15-16; Sept. 19-20; Oct. 10-11, 2018
Two-Day, In-Depth Coding and Billing Seminar
Become a certified GI coder with a two-day, in-depth training course provided by McVey Associates, Inc.
Nashville, TN (6/13-6/14); Baltimore, MD (8/15-8/16); Atlanta, GA (9/19-9/20); Las Vegas, NV (10/10-10/11)

Aug. 10–12, 2018
Principles of GI for the NP and PA
Hear from the experts as they provide you with critical updates on treating and managing patients with a variety of GI disorders.
Chicago, IL

Aug. 18-19, 2018
James W. Freston Conference: Obesity and Metabolic Disease – Integrating New Paradigms in Pathophysiology to Advance Treatment
Collaborate with researchers and clinicians to help advance obesity treatment and enhance the continuum of obesity care.
Arlington, VA

Feb. 7-9, 2019
Crohn’s & Colitis Congress™ (A Partnership of the Crohn’s & Colitis Foundation and American Gastroenterological Association)
Expand your knowledge, network with IBD leaders, spark innovative research and get inspired to improve patient care.
Las Vegas, NV

For more information about upcoming events and award deadlines, please visit http://www.gastro.org/education and http://www.gastro.org/research-funding.

June 2-5, 2018
DIGESTIVE DISEASE WEEK^® (DDW) 2018 – WASHINGTON, DC
DDW^® is the premier meeting for the GI professional. Every year, it attracts approximately 15,000 physicians, researchers, and academics from around the world who desire to stay up to date in the field.

AGA Trainee and Early-Career GI Sessions

Join your colleagues at special sessions to meet the unique needs of physicians who are new to the field. Participants will learn about all aspects of starting a career in clinical practice or research, have the opportunity to network with mentors and peers, and review board material.

• June 2, 8:15 a.m.–5:30 p.m.; June 3, 8:30 a.m.–12:35 p.m.
  AGA Postgraduate Course: From Abstract to Reality
  Attend this multi-topic course to get practical, useful information to push your practice to the next level. The 2018 course will provide a comprehensive look at the latest medical, surgical, and technological advances over the past 12 months that aim to keep you up to date in a field that is rapidly changing. Each presenter will turn abstract ideas into concrete action items that you can immediately implement in your practice. AGA member trainees and early-career GIs receive discounted pricing for this course.
• June 3, 4–5:30 p.m.
  Difficult Conversations: Navigating People, Negotiations, Promotions, and Complications
  During this session, attendees will obtain effective negotiation techniques and learn how to navigate difficult situations in clinical and research environments.
• June 3, 6-7 p.m.
  AGA Early Career Networking Hour
  This event is open to all DDW trainee and early career GI attendees and provides a casual atmosphere to bond with your peers. Complimentary food and drinks will be available. 
• June 4, 4–5:30 p.m.
  Advancing Clinical Practice: Gastroenterology Fellow–Directed Quality-Improvement Projects
  This trainee-focused session will showcase selected abstracts from GI fellows based on quality improvement with a state-of-the-art lecture. Attendees will be provided with information that defines practical approaches to quality improvement from start to finish. A limited supply of coffee and tea will be provided during the session.
• June 5, 1:30–5:30 p.m.
  Board Review Course
  This session, designed using content from DDSEP^® 8, serves as a primer for third-year fellows preparing for the board exam as well as a review course for others wanting to test their knowledge. Session attendees will receive a $50 coupon to use at the AGA Store at DDW to purchase DDSEP 8.

UPCOMING EVENTS
 

June 4-8, 2018
Exosomes/Microvesicles: Heterogeneity, Biogenesis, Function, and Therapeutic Developments (E2)
Deepen your understanding of the structural and functional complexity of extracellular vesicles, their biogenesis and function in health and disease, cargo enrichment, potential as ideal biomarkers, and breakthroughs in their use as therapeutic targets/agents.
Breckenridge, CO

June 13-14; Aug. 15-16; Sept. 19-20; Oct. 10-11, 2018
Two-Day, In-Depth Coding and Billing Seminar
Become a certified GI coder with a two-day, in-depth training course provided by McVey Associates, Inc.
Nashville, TN (6/13-6/14); Baltimore, MD (8/15-8/16); Atlanta, GA (9/19-9/20); Las Vegas, NV (10/10-10/11)

Aug. 10–12, 2018
Principles of GI for the NP and PA
Hear from the experts as they provide you with critical updates on treating and managing patients with a variety of GI disorders.
Chicago, IL

Aug. 18-19, 2018
James W. Freston Conference: Obesity and Metabolic Disease – Integrating New Paradigms in Pathophysiology to Advance Treatment
Collaborate with researchers and clinicians to help advance obesity treatment and enhance the continuum of obesity care.
Arlington, VA

Feb. 7-9, 2019
Crohn’s & Colitis Congress™ (A Partnership of the Crohn’s & Colitis Foundation and American Gastroenterological Association)
Expand your knowledge, network with IBD leaders, spark innovative research and get inspired to improve patient care.
Las Vegas, NV

For more information about upcoming events and award deadlines, please visit http://www.gastro.org/education and http://www.gastro.org/research-funding.

June 2-5, 2018
DIGESTIVE DISEASE WEEK^® (DDW) 2018 – WASHINGTON, DC
DDW^® is the premier meeting for the GI professional. Every year, it attracts approximately 15,000 physicians, researchers, and academics from around the world who desire to stay up to date in the field.

AGA Trainee and Early-Career GI Sessions

Join your colleagues at special sessions to meet the unique needs of physicians who are new to the field. Participants will learn about all aspects of starting a career in clinical practice or research, have the opportunity to network with mentors and peers, and review board material.

• June 2, 8:15 a.m.–5:30 p.m.; June 3, 8:30 a.m.–12:35 p.m.
  AGA Postgraduate Course: From Abstract to Reality
  Attend this multi-topic course to get practical, useful information to push your practice to the next level. The 2018 course will provide a comprehensive look at the latest medical, surgical, and technological advances over the past 12 months that aim to keep you up to date in a field that is rapidly changing. Each presenter will turn abstract ideas into concrete action items that you can immediately implement in your practice. AGA member trainees and early-career GIs receive discounted pricing for this course.
• June 3, 4–5:30 p.m.
  Difficult Conversations: Navigating People, Negotiations, Promotions, and Complications
  During this session, attendees will obtain effective negotiation techniques and learn how to navigate difficult situations in clinical and research environments.
• June 3, 6-7 p.m.
  AGA Early Career Networking Hour
  This event is open to all DDW trainee and early career GI attendees and provides a casual atmosphere to bond with your peers. Complimentary food and drinks will be available. 
• June 4, 4–5:30 p.m.
  Advancing Clinical Practice: Gastroenterology Fellow–Directed Quality-Improvement Projects
  This trainee-focused session will showcase selected abstracts from GI fellows based on quality improvement with a state-of-the-art lecture. Attendees will be provided with information that defines practical approaches to quality improvement from start to finish. A limited supply of coffee and tea will be provided during the session.
• June 5, 1:30–5:30 p.m.
  Board Review Course
  This session, designed using content from DDSEP^® 8, serves as a primer for third-year fellows preparing for the board exam as well as a review course for others wanting to test their knowledge. Session attendees will receive a $50 coupon to use at the AGA Store at DDW to purchase DDSEP 8.

UPCOMING EVENTS
 

June 4-8, 2018
Exosomes/Microvesicles: Heterogeneity, Biogenesis, Function, and Therapeutic Developments (E2)
Deepen your understanding of the structural and functional complexity of extracellular vesicles, their biogenesis and function in health and disease, cargo enrichment, potential as ideal biomarkers, and breakthroughs in their use as therapeutic targets/agents.
Breckenridge, CO

June 13-14; Aug. 15-16; Sept. 19-20; Oct. 10-11, 2018
Two-Day, In-Depth Coding and Billing Seminar
Become a certified GI coder with a two-day, in-depth training course provided by McVey Associates, Inc.
Nashville, TN (6/13-6/14); Baltimore, MD (8/15-8/16); Atlanta, GA (9/19-9/20); Las Vegas, NV (10/10-10/11)

Aug. 10–12, 2018
Principles of GI for the NP and PA
Hear from the experts as they provide you with critical updates on treating and managing patients with a variety of GI disorders.
Chicago, IL

Aug. 18-19, 2018
James W. Freston Conference: Obesity and Metabolic Disease – Integrating New Paradigms in Pathophysiology to Advance Treatment
Collaborate with researchers and clinicians to help advance obesity treatment and enhance the continuum of obesity care.
Arlington, VA

Feb. 7-9, 2019
Crohn’s & Colitis Congress™ (A Partnership of the Crohn’s & Colitis Foundation and American Gastroenterological Association)
Expand your knowledge, network with IBD leaders, spark innovative research and get inspired to improve patient care.
Las Vegas, NV

Who’s going to negotiate your contract: you or a professional? Lawyer Scott Roman – at a recent AGA Regional Practice Skills Workshop – explained that answering this question early on can help ensure you maximize your contract benefits. His advice for any negotiation is keep to the following in mind:

• Prepare, prepare, prepare. Employers know when you’re winging it.
•  Gain leverage. The more offers you have, the more leverage.
•  Give yourself adequate time to negotiate.
•  Establish your objectives and anticipate objectives of the employer.
•  Determine the best case, worst case, and most likely scenario before you start negotiating.
•  Try to define nonnegotiable issues.
•  Try to get something each time you give something.
•  Don’t negotiate against yourself.
•  Keep cool and remember that these are people you may have to work with.
•  Be flexible.

View the full presentation (login required), which also covers hot topics in negotiating your contract – more than 1-year base salary, bonuses, student loan repayment.

Visit www.gastro.org/education to see all on-demand education designed specifically for trainees and early career GIs.

Who’s going to negotiate your contract: you or a professional? Lawyer Scott Roman – at a recent AGA Regional Practice Skills Workshop – explained that answering this question early on can help ensure you maximize your contract benefits. His advice for any negotiation is keep to the following in mind:

• Prepare, prepare, prepare. Employers know when you’re winging it.
•  Gain leverage. The more offers you have, the more leverage.
•  Give yourself adequate time to negotiate.
•  Establish your objectives and anticipate objectives of the employer.
•  Determine the best case, worst case, and most likely scenario before you start negotiating.
•  Try to define nonnegotiable issues.
•  Try to get something each time you give something.
•  Don’t negotiate against yourself.
•  Keep cool and remember that these are people you may have to work with.
•  Be flexible.

View the full presentation (login required), which also covers hot topics in negotiating your contract – more than 1-year base salary, bonuses, student loan repayment.

Visit www.gastro.org/education to see all on-demand education designed specifically for trainees and early career GIs.

Who’s going to negotiate your contract: you or a professional? Lawyer Scott Roman – at a recent AGA Regional Practice Skills Workshop – explained that answering this question early on can help ensure you maximize your contract benefits. His advice for any negotiation is keep to the following in mind:

• Prepare, prepare, prepare. Employers know when you’re winging it.
•  Gain leverage. The more offers you have, the more leverage.
•  Give yourself adequate time to negotiate.
•  Establish your objectives and anticipate objectives of the employer.
•  Determine the best case, worst case, and most likely scenario before you start negotiating.
•  Try to define nonnegotiable issues.
•  Try to get something each time you give something.
•  Don’t negotiate against yourself.
•  Keep cool and remember that these are people you may have to work with.
•  Be flexible.

View the full presentation (login required), which also covers hot topics in negotiating your contract – more than 1-year base salary, bonuses, student loan repayment.

Visit www.gastro.org/education to see all on-demand education designed specifically for trainees and early career GIs.

How are you feeling today? Simple words but a bit of introspection can go a long way. Physician burnout is characterized by a state of mental exhaustion, depersonalization, and a decreased sense of accomplishment. It affects a physician’s well-being, effectiveness, productivity, and the ability to provide quality care. It also carries personal consequences for physicians including broken relationships, substance abuse, suicide, and depression.

Burnout may affect at least one-third of gastroenterologists. At greater risk are younger physicians, physicians performing high-risk procedures, and physicians experiencing work-life conflicts.

While the root cause of physician burnout varies from provider to provider, an overarching theme is work stress. Work stress may develop for a number of reasons, including issues at the level of the health care system (shifts in reimbursement or payment models, increasing clerical burden of the electronic medical record), organizational issues (e.g., dysfunctional administration, system-wide communication issues), and personal issues.

The key to preventing burnout is to first recognize that it can happen. Because initial symptoms build up internally, it can be easy to overlook. These seven steps can help you prevent burnout:

•  Be self-aware and stay vigilant.
•  Take care of yourself first.
•  Stay connected to family, friends, and coworkers.
•  Exercise.
•  Ensure adequate sleep.
•  Use your vacation time and ensure you disconnect yourself from work.
•  Learn to say no.

A case study published in Clinical Gastroenterology and Hepatology delves deeper into how burnout develops, why it matters, and provides pathways to successfully combat it.
 

How are you feeling today? Simple words but a bit of introspection can go a long way. Physician burnout is characterized by a state of mental exhaustion, depersonalization, and a decreased sense of accomplishment. It affects a physician’s well-being, effectiveness, productivity, and the ability to provide quality care. It also carries personal consequences for physicians including broken relationships, substance abuse, suicide, and depression.

Burnout may affect at least one-third of gastroenterologists. At greater risk are younger physicians, physicians performing high-risk procedures, and physicians experiencing work-life conflicts.

While the root cause of physician burnout varies from provider to provider, an overarching theme is work stress. Work stress may develop for a number of reasons, including issues at the level of the health care system (shifts in reimbursement or payment models, increasing clerical burden of the electronic medical record), organizational issues (e.g., dysfunctional administration, system-wide communication issues), and personal issues.

The key to preventing burnout is to first recognize that it can happen. Because initial symptoms build up internally, it can be easy to overlook. These seven steps can help you prevent burnout:

•  Be self-aware and stay vigilant.
•  Take care of yourself first.
•  Stay connected to family, friends, and coworkers.
•  Exercise.
•  Ensure adequate sleep.
•  Use your vacation time and ensure you disconnect yourself from work.
•  Learn to say no.

A case study published in Clinical Gastroenterology and Hepatology delves deeper into how burnout develops, why it matters, and provides pathways to successfully combat it.
 

How are you feeling today? Simple words but a bit of introspection can go a long way. Physician burnout is characterized by a state of mental exhaustion, depersonalization, and a decreased sense of accomplishment. It affects a physician’s well-being, effectiveness, productivity, and the ability to provide quality care. It also carries personal consequences for physicians including broken relationships, substance abuse, suicide, and depression.

Burnout may affect at least one-third of gastroenterologists. At greater risk are younger physicians, physicians performing high-risk procedures, and physicians experiencing work-life conflicts.

While the root cause of physician burnout varies from provider to provider, an overarching theme is work stress. Work stress may develop for a number of reasons, including issues at the level of the health care system (shifts in reimbursement or payment models, increasing clerical burden of the electronic medical record), organizational issues (e.g., dysfunctional administration, system-wide communication issues), and personal issues.

The key to preventing burnout is to first recognize that it can happen. Because initial symptoms build up internally, it can be easy to overlook. These seven steps can help you prevent burnout:

•  Be self-aware and stay vigilant.
•  Take care of yourself first.
•  Stay connected to family, friends, and coworkers.
•  Exercise.
•  Ensure adequate sleep.
•  Use your vacation time and ensure you disconnect yourself from work.
•  Learn to say no.

A case study published in Clinical Gastroenterology and Hepatology delves deeper into how burnout develops, why it matters, and provides pathways to successfully combat it.
 

AGA has developed special sessions at Digestive Disease Week^® (DDW) 2018 to meet the unique needs of physicians who are new to the field. Participants will learn about all aspects of starting a career in clinical practice or research, have the opportunity to network with mentors and peers, and review board material.

With the exception of the AGA Postgraduate Course, all of the sessions are free, but you must register for DDW to attend. Registration is open and is complimentary for AGA member trainees, students, medical residents, and postdoctoral fellows until April 18. Visit the AGA website for additional details about these sessions.

•  AGA Postgraduate Course: From Abstract to Reality

Saturday, June 2, and Sunday, June 3

•  Difficult Conversations: Navigating People, Negotiations, Promotions, and Complications

Sunday, June 3, 4-5:30 p.m.

•  Advancing Clinical Practice: GI Fellow-Directed Quality Improvement Projects

Monday, June 4, 4-5:30 p.m.

•  Board Review Course

Tuesday, June 5, 1:30-5:30 p.m.
 

AGA has developed special sessions at Digestive Disease Week^® (DDW) 2018 to meet the unique needs of physicians who are new to the field. Participants will learn about all aspects of starting a career in clinical practice or research, have the opportunity to network with mentors and peers, and review board material.

With the exception of the AGA Postgraduate Course, all of the sessions are free, but you must register for DDW to attend. Registration is open and is complimentary for AGA member trainees, students, medical residents, and postdoctoral fellows until April 18. Visit the AGA website for additional details about these sessions.

•  AGA Postgraduate Course: From Abstract to Reality

Saturday, June 2, and Sunday, June 3

•  Difficult Conversations: Navigating People, Negotiations, Promotions, and Complications

Sunday, June 3, 4-5:30 p.m.

•  Advancing Clinical Practice: GI Fellow-Directed Quality Improvement Projects

Monday, June 4, 4-5:30 p.m.

•  Board Review Course

Tuesday, June 5, 1:30-5:30 p.m.
 

AGA has developed special sessions at Digestive Disease Week^® (DDW) 2018 to meet the unique needs of physicians who are new to the field. Participants will learn about all aspects of starting a career in clinical practice or research, have the opportunity to network with mentors and peers, and review board material.

With the exception of the AGA Postgraduate Course, all of the sessions are free, but you must register for DDW to attend. Registration is open and is complimentary for AGA member trainees, students, medical residents, and postdoctoral fellows until April 18. Visit the AGA website for additional details about these sessions.

•  AGA Postgraduate Course: From Abstract to Reality

Saturday, June 2, and Sunday, June 3

•  Difficult Conversations: Navigating People, Negotiations, Promotions, and Complications

Sunday, June 3, 4-5:30 p.m.

•  Advancing Clinical Practice: GI Fellow-Directed Quality Improvement Projects

Monday, June 4, 4-5:30 p.m.

•  Board Review Course

Tuesday, June 5, 1:30-5:30 p.m.
 

It’s that time of the year again: Digestive Disease Week (DDW^®)! This event evolved out of the AGA annual meetings and was first advertised as DDW in the January 1969 issue of Gastroenterology.¹ Since that time, it has grown into a truly international event with over 14,000 attendees, 41% of whom attend from abroad.²

DDW is a collaborative event that is jointly sponsored by four professional GI/hepatology-related societies – the AGA, the American Association for the Study of Liver Diseases, the American Society for Gastrointestinal Endoscopy, and the Society for Surgery of the Alimentary Tract. The conference topics cover the gamut of GI and hepatology conditions and participants represent all types of professional settings, including private practice (37%), hospitals (33%), and academic medical centers (28%).² Whether you’re a first-time attendee or a seasoned participant, DDW offers something for everyone. Below are some tips on how to maximize the benefits of your attendance:
 

Plan ahead

Is there a new treatment or condition you’ve wanted to learn more about? Are you interested in testing the latest endoscopic devices or learning a new procedural technique? Experts from around the world come to DDW to showcase the latest developments in GI. However, with over 5,000 abstracts and lectures and almost 300 exhibition booths, it’s easy to feel overwhelmed by all the offerings. To make the most of your experience, plan ahead.

In the months prior to the conference, visit the DDW website to download the Preliminary Program. Pick out your can’t-miss lectures and events, and put them on your calendar right away. As DDW approaches, invitations from colleagues, societies, and industry grow, so preplanning is a necessity.

Approximately 1 month before DDW, the DDW Mobile App will become available for free download in the Apple and Google Play stores. You can highlight events of interest and place them on a personalized calendar. Allow for push notifications to get the latest updates and schedule changes throughout the event. In addition, the in-app maps of the venue are a fantastic way to locate where scheduled events will take place. Try to attend talks that are located close to one another. The conference center is expansive and you may miss your intended presentations by trying to catch overlapping sessions situated far from each other. If you prefer planning on a desktop or laptop, use the DDW Online Planner (available mid-April) to create your schedule. The information can then be synced to your mobile device through the app.

Upon arrival, be sure to pick up your attendee conference bag. Before recycling the contents, look for any product theaters, satellite symposia, exhibitor booths, or other advertised activities you may want to add to your schedule.

Practical tips

a) Register ahead of time and pick up your conference bag during off-hours to avoid long lines.

b) Book your hotel early. Most have generous cancellation policies. Registration is required before booking housing.

c) Pack comfortable shoes and dress in layers to accommodate both unpredictable weather and indoor climate control.

Make new connections and nurture old ones

Is your professional hero giving a talk? Are you looking to land your first job or make a move? Do you need some face time with a mentor outside your institution? DDW is a wonderful opportunity to connect with advisers and possible employers as well as potential and established collaborators. Schedules fill up quickly though, so try your best to email requests for meetings well ahead of time. The app also has a messaging feature you can use to communicate with other attendees.

At the meeting, be an active participant and ask questions. One of the greatest benefits of attending the conference is the opportunity to interact with others. For trainees and early career attendees, DDW is your debutante ball! Introduce yourself and your work to the broader GI community. Bring your business cards as well as a notebook to write down questions and comments about your study. Look engaging when standing by your poster and offer to walk visitors through your research. There will also be an opportunity to have free headshots taken in the Early Career area this year.

Also take advantage of DDW’s big draw to reconnect with old friends and colleagues from around the U.S. and the world. Schedule a time to catch up and swap stories. Learn from each other’s successes and mistakes. It’s good for the soul and your career.
 

Post-DDW

Attending DDW is only the start! The most important part of the conference is what happens afterward. Send an email to individuals you met to establish a line of communication and thank them for their advice or insight. Did someone offer to share a protocol, start a collaboration, or introduce you to a colleague? Take them up on the offer! Notes that were taken in the app can also be emailed. In addition, registration includes 2 years of access to DDW On Demand, an online library of sessions. If there were any nonticketed presentations that you missed, you can watch them upon your return. Similarly, access missed posters at the DDW ePosters archive, where you can read poster abstracts and view ePosters, if submitted. Abstracts will still be viewable through the app and online planner as well. Reach out to colleagues if you have questions about their work!

Also, don’t forget to take what you learned back to your community. Share your new knowledge with your colleagues and trainees, and consider if there are any new concepts or approaches that should be implemented in your practice.

Practical tip

Before it falls off your radar, submit for CME credits for the sessions you attended. To claim CME, you may flag sessions for CME using the DDW Mobile App, visit a CME kiosk on site or access the DDW CME Claim Site after the meeting. Visit the DDW website for more information on claiming CME.

Refine, refocus, and recharge

DDW is the most comprehensive GI event in the world. Take advantage of the learning opportunities to improve your own work. Note how the landscape of GI is evolving and use it to reevaluate your own career development strategy and how you want to contribute to the field. Most importantly, get inspired. After exploring the most up-to-date advances and connecting with colleagues and thought leaders at DDW, you will hopefully return to your home institution feeling reinvigorated, refreshed, and ready to apply your newfound insights to your patient care or to your research.

See you at DDW!
 

References

1. Notices. Gastroenterology. 1969;569(1):188-9. http://www.gastrojournal.org/article/S0016-5085(69)80085-5/pdf.

2. Exhibitor Prospectus | Digestive Disease Week® 2018. https://higherlogicdownload.s3.amazonaws.com/GASTRO/44b1f1fd-aaed-44c8-954f-b0eaea6b0462/UploadedFiles/B4KUryNTNS5lEaFk6jBQ_DDW%202018%20Exhibitor%20Prospectus_Staffchanges.pdf

Dr. Chen is assistant professor of medicine, New York University School of Medicine.

It’s that time of the year again: Digestive Disease Week (DDW^®)! This event evolved out of the AGA annual meetings and was first advertised as DDW in the January 1969 issue of Gastroenterology.¹ Since that time, it has grown into a truly international event with over 14,000 attendees, 41% of whom attend from abroad.²

DDW is a collaborative event that is jointly sponsored by four professional GI/hepatology-related societies – the AGA, the American Association for the Study of Liver Diseases, the American Society for Gastrointestinal Endoscopy, and the Society for Surgery of the Alimentary Tract. The conference topics cover the gamut of GI and hepatology conditions and participants represent all types of professional settings, including private practice (37%), hospitals (33%), and academic medical centers (28%).² Whether you’re a first-time attendee or a seasoned participant, DDW offers something for everyone. Below are some tips on how to maximize the benefits of your attendance:
 

Plan ahead

Is there a new treatment or condition you’ve wanted to learn more about? Are you interested in testing the latest endoscopic devices or learning a new procedural technique? Experts from around the world come to DDW to showcase the latest developments in GI. However, with over 5,000 abstracts and lectures and almost 300 exhibition booths, it’s easy to feel overwhelmed by all the offerings. To make the most of your experience, plan ahead.

In the months prior to the conference, visit the DDW website to download the Preliminary Program. Pick out your can’t-miss lectures and events, and put them on your calendar right away. As DDW approaches, invitations from colleagues, societies, and industry grow, so preplanning is a necessity.

Approximately 1 month before DDW, the DDW Mobile App will become available for free download in the Apple and Google Play stores. You can highlight events of interest and place them on a personalized calendar. Allow for push notifications to get the latest updates and schedule changes throughout the event. In addition, the in-app maps of the venue are a fantastic way to locate where scheduled events will take place. Try to attend talks that are located close to one another. The conference center is expansive and you may miss your intended presentations by trying to catch overlapping sessions situated far from each other. If you prefer planning on a desktop or laptop, use the DDW Online Planner (available mid-April) to create your schedule. The information can then be synced to your mobile device through the app.

Upon arrival, be sure to pick up your attendee conference bag. Before recycling the contents, look for any product theaters, satellite symposia, exhibitor booths, or other advertised activities you may want to add to your schedule.

Practical tips

a) Register ahead of time and pick up your conference bag during off-hours to avoid long lines.

b) Book your hotel early. Most have generous cancellation policies. Registration is required before booking housing.

c) Pack comfortable shoes and dress in layers to accommodate both unpredictable weather and indoor climate control.

Make new connections and nurture old ones

Is your professional hero giving a talk? Are you looking to land your first job or make a move? Do you need some face time with a mentor outside your institution? DDW is a wonderful opportunity to connect with advisers and possible employers as well as potential and established collaborators. Schedules fill up quickly though, so try your best to email requests for meetings well ahead of time. The app also has a messaging feature you can use to communicate with other attendees.

At the meeting, be an active participant and ask questions. One of the greatest benefits of attending the conference is the opportunity to interact with others. For trainees and early career attendees, DDW is your debutante ball! Introduce yourself and your work to the broader GI community. Bring your business cards as well as a notebook to write down questions and comments about your study. Look engaging when standing by your poster and offer to walk visitors through your research. There will also be an opportunity to have free headshots taken in the Early Career area this year.

Also take advantage of DDW’s big draw to reconnect with old friends and colleagues from around the U.S. and the world. Schedule a time to catch up and swap stories. Learn from each other’s successes and mistakes. It’s good for the soul and your career.
 

Post-DDW

Attending DDW is only the start! The most important part of the conference is what happens afterward. Send an email to individuals you met to establish a line of communication and thank them for their advice or insight. Did someone offer to share a protocol, start a collaboration, or introduce you to a colleague? Take them up on the offer! Notes that were taken in the app can also be emailed. In addition, registration includes 2 years of access to DDW On Demand, an online library of sessions. If there were any nonticketed presentations that you missed, you can watch them upon your return. Similarly, access missed posters at the DDW ePosters archive, where you can read poster abstracts and view ePosters, if submitted. Abstracts will still be viewable through the app and online planner as well. Reach out to colleagues if you have questions about their work!

Also, don’t forget to take what you learned back to your community. Share your new knowledge with your colleagues and trainees, and consider if there are any new concepts or approaches that should be implemented in your practice.

Practical tip

Before it falls off your radar, submit for CME credits for the sessions you attended. To claim CME, you may flag sessions for CME using the DDW Mobile App, visit a CME kiosk on site or access the DDW CME Claim Site after the meeting. Visit the DDW website for more information on claiming CME.

Refine, refocus, and recharge

DDW is the most comprehensive GI event in the world. Take advantage of the learning opportunities to improve your own work. Note how the landscape of GI is evolving and use it to reevaluate your own career development strategy and how you want to contribute to the field. Most importantly, get inspired. After exploring the most up-to-date advances and connecting with colleagues and thought leaders at DDW, you will hopefully return to your home institution feeling reinvigorated, refreshed, and ready to apply your newfound insights to your patient care or to your research.

See you at DDW!
 

References

1. Notices. Gastroenterology. 1969;569(1):188-9. http://www.gastrojournal.org/article/S0016-5085(69)80085-5/pdf.

2. Exhibitor Prospectus | Digestive Disease Week® 2018. https://higherlogicdownload.s3.amazonaws.com/GASTRO/44b1f1fd-aaed-44c8-954f-b0eaea6b0462/UploadedFiles/B4KUryNTNS5lEaFk6jBQ_DDW%202018%20Exhibitor%20Prospectus_Staffchanges.pdf

Dr. Chen is assistant professor of medicine, New York University School of Medicine.

It’s that time of the year again: Digestive Disease Week (DDW^®)! This event evolved out of the AGA annual meetings and was first advertised as DDW in the January 1969 issue of Gastroenterology.¹ Since that time, it has grown into a truly international event with over 14,000 attendees, 41% of whom attend from abroad.²

DDW is a collaborative event that is jointly sponsored by four professional GI/hepatology-related societies – the AGA, the American Association for the Study of Liver Diseases, the American Society for Gastrointestinal Endoscopy, and the Society for Surgery of the Alimentary Tract. The conference topics cover the gamut of GI and hepatology conditions and participants represent all types of professional settings, including private practice (37%), hospitals (33%), and academic medical centers (28%).² Whether you’re a first-time attendee or a seasoned participant, DDW offers something for everyone. Below are some tips on how to maximize the benefits of your attendance:
 

Plan ahead

Is there a new treatment or condition you’ve wanted to learn more about? Are you interested in testing the latest endoscopic devices or learning a new procedural technique? Experts from around the world come to DDW to showcase the latest developments in GI. However, with over 5,000 abstracts and lectures and almost 300 exhibition booths, it’s easy to feel overwhelmed by all the offerings. To make the most of your experience, plan ahead.

In the months prior to the conference, visit the DDW website to download the Preliminary Program. Pick out your can’t-miss lectures and events, and put them on your calendar right away. As DDW approaches, invitations from colleagues, societies, and industry grow, so preplanning is a necessity.

Approximately 1 month before DDW, the DDW Mobile App will become available for free download in the Apple and Google Play stores. You can highlight events of interest and place them on a personalized calendar. Allow for push notifications to get the latest updates and schedule changes throughout the event. In addition, the in-app maps of the venue are a fantastic way to locate where scheduled events will take place. Try to attend talks that are located close to one another. The conference center is expansive and you may miss your intended presentations by trying to catch overlapping sessions situated far from each other. If you prefer planning on a desktop or laptop, use the DDW Online Planner (available mid-April) to create your schedule. The information can then be synced to your mobile device through the app.

Upon arrival, be sure to pick up your attendee conference bag. Before recycling the contents, look for any product theaters, satellite symposia, exhibitor booths, or other advertised activities you may want to add to your schedule.

Practical tips

a) Register ahead of time and pick up your conference bag during off-hours to avoid long lines.

b) Book your hotel early. Most have generous cancellation policies. Registration is required before booking housing.

c) Pack comfortable shoes and dress in layers to accommodate both unpredictable weather and indoor climate control.

Make new connections and nurture old ones

Is your professional hero giving a talk? Are you looking to land your first job or make a move? Do you need some face time with a mentor outside your institution? DDW is a wonderful opportunity to connect with advisers and possible employers as well as potential and established collaborators. Schedules fill up quickly though, so try your best to email requests for meetings well ahead of time. The app also has a messaging feature you can use to communicate with other attendees.

At the meeting, be an active participant and ask questions. One of the greatest benefits of attending the conference is the opportunity to interact with others. For trainees and early career attendees, DDW is your debutante ball! Introduce yourself and your work to the broader GI community. Bring your business cards as well as a notebook to write down questions and comments about your study. Look engaging when standing by your poster and offer to walk visitors through your research. There will also be an opportunity to have free headshots taken in the Early Career area this year.

Also take advantage of DDW’s big draw to reconnect with old friends and colleagues from around the U.S. and the world. Schedule a time to catch up and swap stories. Learn from each other’s successes and mistakes. It’s good for the soul and your career.
 

Post-DDW

Attending DDW is only the start! The most important part of the conference is what happens afterward. Send an email to individuals you met to establish a line of communication and thank them for their advice or insight. Did someone offer to share a protocol, start a collaboration, or introduce you to a colleague? Take them up on the offer! Notes that were taken in the app can also be emailed. In addition, registration includes 2 years of access to DDW On Demand, an online library of sessions. If there were any nonticketed presentations that you missed, you can watch them upon your return. Similarly, access missed posters at the DDW ePosters archive, where you can read poster abstracts and view ePosters, if submitted. Abstracts will still be viewable through the app and online planner as well. Reach out to colleagues if you have questions about their work!

Also, don’t forget to take what you learned back to your community. Share your new knowledge with your colleagues and trainees, and consider if there are any new concepts or approaches that should be implemented in your practice.

Practical tip

Before it falls off your radar, submit for CME credits for the sessions you attended. To claim CME, you may flag sessions for CME using the DDW Mobile App, visit a CME kiosk on site or access the DDW CME Claim Site after the meeting. Visit the DDW website for more information on claiming CME.

Refine, refocus, and recharge

DDW is the most comprehensive GI event in the world. Take advantage of the learning opportunities to improve your own work. Note how the landscape of GI is evolving and use it to reevaluate your own career development strategy and how you want to contribute to the field. Most importantly, get inspired. After exploring the most up-to-date advances and connecting with colleagues and thought leaders at DDW, you will hopefully return to your home institution feeling reinvigorated, refreshed, and ready to apply your newfound insights to your patient care or to your research.

See you at DDW!
 

References

1. Notices. Gastroenterology. 1969;569(1):188-9. http://www.gastrojournal.org/article/S0016-5085(69)80085-5/pdf.

2. Exhibitor Prospectus | Digestive Disease Week® 2018. https://higherlogicdownload.s3.amazonaws.com/GASTRO/44b1f1fd-aaed-44c8-954f-b0eaea6b0462/UploadedFiles/B4KUryNTNS5lEaFk6jBQ_DDW%202018%20Exhibitor%20Prospectus_Staffchanges.pdf

Dr. Chen is assistant professor of medicine, New York University School of Medicine.

The transition from gastroenterology fellowship to independent practice can be daunting. There may be concerns about procedural competency and increased levels of responsibility. Recent trainees have to manage their newly busy clinical schedules while trying to integrate evidence from a rapidly evolving landscape of medical literature into daily practice. Many recent graduates also are expected to participate in financial decisions or contribute to assessments about resource allocation regarding new technologies. These are challenges faced by those in both community and academic positions but may be more keenly felt in the first years of practice regardless of setting.

Without the benefit of experience, incorporating pertinent evidence from both within and outside of the field of gastroenterology as well as identifying disruptive technologies can be particularly difficult. There is scant guidance in this area, either during fellowship or from the existing literature¹. Yet these are skills that, when properly developed, can be lifelong assets and, as a result, an evaluation of this process is warranted. Herein, we identify recent developments relevant to gastroenterologists to illustrate a conceptual framework for judging novel information.

A practical concern for the new gastroenterologist is learning to efficiently evaluate the merits of the latest research and then implement this knowledge in the clinic. Maintaining active society membership often includes access to scholarly journals. For example, AGA members receive Gastroenterology, Clinical Gastroenterology and Hepatology, and Cellular and Molecular Gastroenterology and Hepatology as part of their member benefits and have the opportunity to receive alerts when new content is published. Social media outlets such as Twitter and Facebook also simplify the process for readers to identify high-impact studies² (see social media urls at the end of the story). In addition to reading, however, a critical review of these studies can prevent premature enthusiasm for modifying practice. The evolving evidence base for understanding proton pump inhibitor (PPI) risks is illustrative. Several studies attracted widespread media attention describing serious associated side effects, ranging from MI³ to dementia⁴ and stroke⁵. These studies were provocative but a decision to withhold PPIs from patients based on these concerns alone could lead to unintended consequences with poor outcomes. Ultimately, subsequent studies published only months later challenged these associations.^6-8 Instead, thoughtful disclosure to patients of known risks and appropriate indications for PPI therapy based on resources such as the AGA Best Practice Advice⁹ is prudent. Reading more may be necessary but is insufficient; finding a forum to discuss novel research topics, such as in a monthly journal club¹⁰ or group practice meeting, can lead to stimulating discussion about how to apply pertinent research to change practice. The AGA Community is an excellent venue for this kind of interaction.

In many situations, keeping informed of updates about the risks and safety of medications prescribed by nongastroenterologists, particularly as they relate to GI conditions, can be even more difficult. A prime example of this is the rapidly expanding literature on indications and risks of direct oral anticoagulants. Rotating on the inpatient consultation service, with the chance to interact with multiple non-GI providers, affords an excellent opportunity to stay up to date. With the increased prevalence of atrial fibrillation as well as the potential expanded indications for direct oral anticoagulants based on recent randomized, controlled trials^11,12, practicing gastroenterologists will be comanaging increasing numbers of patients hospitalized with gastrointestinal bleeding (GIB). Our understanding of the availability and indication for targeted reversal agents, such as idarucizumab, as well as nonspecific reversal agents, such as prothrombin complex concentrates, for those with life-threatening GIB is critical to optimal management of these patients. Multidisciplinary collaborations, such as with cardiogastroenterology clinics¹³, can be leveraged for optimal management of direct oral anticoagulants in the periendoscopy period.

Traditional outpatient consultative approaches are sometimes necessary but frequent reference to consensus societal guidelines on endoscopy in patients on antithrombotics¹⁴ should be made, particularly if they are printed and readily available in the ambulatory clinic and endoscopy suites. When information may be too new or sparse to utilize a national guideline, employing local data or experience to create a hospital-specific algorithm can ensure the delivery of high-quality, collaborative patient care.

Much like reviewing the literature, evaluating new technologies poses its own challenges. Changes in clinical practice may be slow, as in the adoption of noninvasive methods for Barrett’s esophagus screening.¹⁵ But in an age when news of advances and updates in management spreads at tremendous speed through the use of social media, the ability to pivot or assimilate new discoveries and techniques will become increasingly relevant and important. A professional society’s endorsement can provide a framework for a decision, but other principles at play include sensible, critical analyses of the outcomes and costs as well as a balance of organizational and societal perspectives.¹⁶ The use of impedance planimetry is one such example. This is a relatively new technology, but it has received increasing interest recently.¹⁷ The first questions when considering adopting this type of device likely will be about its supporting evidence and the risk for causing harm. The pace of publications regarding its use for measuring esophageal distensibility has accelerated¹⁸. But good data does not necessarily translate into extensive uptake. Other important factors also are practical, e.g., whether a technology committee’s approval is needed and what is the learning curve, available technical support, need for capital purchases, reimbursement, etc. Functional luminal imaging probe (FLIP^®) technology was developed to assess compliance in primary esophageal disorders and now has been applied to several other areas including anorectal disease, bariatric surgery, and therapeutic endoscopy^19,20. Although seemingly a niche market, there is potential widespread application and an opportunity for collaborations that might not have been evident at first blush. Ultimately, any evaluation of new technology is to a certain extent speculation. Is the technology mature or novel? If it is the latter, this may provide a marketing advantage and facilitate a relationship that could lead to academic partnerships.

Embracing new devices and modifications to existing practice paradigms happens on a spectrum²¹. We are reminded of the maxim, “never be the first or last to adopt change.” One must be on the lookout for revolutionary or game-changing advances but be cautious to avoid irresponsible enthusiasm. Whether it is incorporating evidence from a recent study into everyday practice or judging the potential of new equipment, a balance must be achieved between detailed evaluation of the literature and understanding the practical consequences and feasibility of implementing change. Although these may be competing interests, achieving this is a pivotal step in success for the new gastroenterologist.

AGA journals' social media accounts

http://twitter.com/aga_gastro

http://twitter.com/aga_cgh

http://twitter.com/aga_cmgh

https://www.facebook.com/gastrojournal/

https://www.facebook.com/cghjournal/

https://www.facebook.com/cmghjournal/

References

1. Arora V et al. Closing the gap between internal medicine training and practice: Recommendations from recent graduates. Am J Med. 2005 Jun;118(6):685-7.

2. Gray DM et al. Making social media work for your practice. Clin Gastroenterol Hepatol. 2017 Nov;15:1651-4.

3. Shah NH et al. Proton pump inhibitor usage and the risk of myocardial infarction in the general population. PLoS One. 2015 Jun 10;10:e0124653.

4. Gomm W et al. Association of proton pump inhibitors with risk of dementia: A pharmacoepidemiological claims data analysis. JAMA Neurol. 2016 Apr;73(4):410-6.

5. Wang YF et al. Proton-pump inhibitor use and the risk of first-time ischemic stroke in the general population: A nationwide population-based study. Am J Gastroenterol. 2017 Jul;112:1084-93.

6. Nguyen LH et al. No significant association between proton pump inhibitor use and risk of stroke after adjustment for lifestyle factors and indication. Gastroenterology. 2018 Apr; 154(5):1290-7.

7. Lochhead P et al. Association between proton pump inhibitor use and cognitive function in women. Gastroenterology. 2017 Oct;153(4):971-9.

8. Landi SN et al. No increase in risk of acute myocardial infarction in privately insured adults prescribed proton pump inhibitors vs histamine-2 receptor antagonists (2002-2014). Gastroenterology 2018 Mar;154(4):861-73.

9. Freedberg DE et al. The risks and benefits of long-term use of proton pump inhibitors: Expert review and best practice advise from the American Gastroenterological Association. Gastroenterology. 2017 Mar;152:706-15.

10. Judd S et al. Approach to presenting a clinical journal club. Gastroenterology. 2014 Jun;146(7):1591-3.

11. Weitz JI et al. Rivaroxaban or aspirin for extended treatment of venous thromboembolism. N Engl J Med. 2017 Mar 30;376:1211-22.

12. Eikelboom JW et al. Rivaroxaban with or without aspirin in stable cardiovascular disease. N Engl J Med. 2017 Oct. 5;377:1319-30.

13. Abraham NS. Novel oral anticoagulants and gastrointestinal bleeding: a case for cardiogastroenterology. Clin Gastroenterol Hepatol. 2013;11(4):324-8.

14. Acosta RD et al. The management of antithrombotic agents for patients undergoing GI endoscopy. Gastrointest Endosc. 2016;83:3-16.

15. Sami SS et al. Screening for Barrett’s esophagus and esophageal adenocarcinoma: rationale, recent progress, challenges and future directions. Clin Gastroenterol Hepatol. 2015 Apr;13:623-34.

16. Laupacis A et al. How attractive does a new technology need to be to warrant adoption and utilization? Tentative guidelines for using clinical and economic evaluations. CMAJ. 1992 Feb 15;146:473-81.

17. Hirano I et al. Functional lumen imaging probe for the management of esophageal disorders: Expert review from the clinical practice updates committee of the AGA Institute. Clin Gastroenterol Hepatol. 2017 Mar;15:325-34.

18. Kwiatek MA et al. Esophagogastric junction distensibility assessed with an endoscopic functional luminal imaging probe (EndoFLIP). Gastrointest Endosc. 2010 Aug;72:272-82.

19. Leroi AM et al. The diagnostic value of the functional lumen imaging probe versus high-resolution anorectal manometry in patients with fecal incontinence. Neurogastroenterol Motil. 2018 Jan 18; doi: 10.1111/nmo.13291.

20. Reynolds JL et al. Intraoperative assessment of the effects of laparoscopic sleeve gastrectomy on the distensibility of the lower esophageal sphincter using impedance planimetry. Surg Endosc. 2016 Nov;30:4904-9.

21. Aisenberg J. Optical biopsy for colorectal polyps: moving along the S-shaped curve. Gastrointest Endosc. 2014 Mar;79:399-401.

Dr. Leiman, assistant professor of medicine, division of gastroenterology, Duke University, Durham, N.C.; Dr. Sengupta, assistant professor of medicine, section of gastroenterology, hepatology, and nutrition, University of Chicago Medical Center.

The transition from gastroenterology fellowship to independent practice can be daunting. There may be concerns about procedural competency and increased levels of responsibility. Recent trainees have to manage their newly busy clinical schedules while trying to integrate evidence from a rapidly evolving landscape of medical literature into daily practice. Many recent graduates also are expected to participate in financial decisions or contribute to assessments about resource allocation regarding new technologies. These are challenges faced by those in both community and academic positions but may be more keenly felt in the first years of practice regardless of setting.

Without the benefit of experience, incorporating pertinent evidence from both within and outside of the field of gastroenterology as well as identifying disruptive technologies can be particularly difficult. There is scant guidance in this area, either during fellowship or from the existing literature¹. Yet these are skills that, when properly developed, can be lifelong assets and, as a result, an evaluation of this process is warranted. Herein, we identify recent developments relevant to gastroenterologists to illustrate a conceptual framework for judging novel information.

A practical concern for the new gastroenterologist is learning to efficiently evaluate the merits of the latest research and then implement this knowledge in the clinic. Maintaining active society membership often includes access to scholarly journals. For example, AGA members receive Gastroenterology, Clinical Gastroenterology and Hepatology, and Cellular and Molecular Gastroenterology and Hepatology as part of their member benefits and have the opportunity to receive alerts when new content is published. Social media outlets such as Twitter and Facebook also simplify the process for readers to identify high-impact studies² (see social media urls at the end of the story). In addition to reading, however, a critical review of these studies can prevent premature enthusiasm for modifying practice. The evolving evidence base for understanding proton pump inhibitor (PPI) risks is illustrative. Several studies attracted widespread media attention describing serious associated side effects, ranging from MI³ to dementia⁴ and stroke⁵. These studies were provocative but a decision to withhold PPIs from patients based on these concerns alone could lead to unintended consequences with poor outcomes. Ultimately, subsequent studies published only months later challenged these associations.^6-8 Instead, thoughtful disclosure to patients of known risks and appropriate indications for PPI therapy based on resources such as the AGA Best Practice Advice⁹ is prudent. Reading more may be necessary but is insufficient; finding a forum to discuss novel research topics, such as in a monthly journal club¹⁰ or group practice meeting, can lead to stimulating discussion about how to apply pertinent research to change practice. The AGA Community is an excellent venue for this kind of interaction.

In many situations, keeping informed of updates about the risks and safety of medications prescribed by nongastroenterologists, particularly as they relate to GI conditions, can be even more difficult. A prime example of this is the rapidly expanding literature on indications and risks of direct oral anticoagulants. Rotating on the inpatient consultation service, with the chance to interact with multiple non-GI providers, affords an excellent opportunity to stay up to date. With the increased prevalence of atrial fibrillation as well as the potential expanded indications for direct oral anticoagulants based on recent randomized, controlled trials^11,12, practicing gastroenterologists will be comanaging increasing numbers of patients hospitalized with gastrointestinal bleeding (GIB). Our understanding of the availability and indication for targeted reversal agents, such as idarucizumab, as well as nonspecific reversal agents, such as prothrombin complex concentrates, for those with life-threatening GIB is critical to optimal management of these patients. Multidisciplinary collaborations, such as with cardiogastroenterology clinics¹³, can be leveraged for optimal management of direct oral anticoagulants in the periendoscopy period.

Traditional outpatient consultative approaches are sometimes necessary but frequent reference to consensus societal guidelines on endoscopy in patients on antithrombotics¹⁴ should be made, particularly if they are printed and readily available in the ambulatory clinic and endoscopy suites. When information may be too new or sparse to utilize a national guideline, employing local data or experience to create a hospital-specific algorithm can ensure the delivery of high-quality, collaborative patient care.

Much like reviewing the literature, evaluating new technologies poses its own challenges. Changes in clinical practice may be slow, as in the adoption of noninvasive methods for Barrett’s esophagus screening.¹⁵ But in an age when news of advances and updates in management spreads at tremendous speed through the use of social media, the ability to pivot or assimilate new discoveries and techniques will become increasingly relevant and important. A professional society’s endorsement can provide a framework for a decision, but other principles at play include sensible, critical analyses of the outcomes and costs as well as a balance of organizational and societal perspectives.¹⁶ The use of impedance planimetry is one such example. This is a relatively new technology, but it has received increasing interest recently.¹⁷ The first questions when considering adopting this type of device likely will be about its supporting evidence and the risk for causing harm. The pace of publications regarding its use for measuring esophageal distensibility has accelerated¹⁸. But good data does not necessarily translate into extensive uptake. Other important factors also are practical, e.g., whether a technology committee’s approval is needed and what is the learning curve, available technical support, need for capital purchases, reimbursement, etc. Functional luminal imaging probe (FLIP^®) technology was developed to assess compliance in primary esophageal disorders and now has been applied to several other areas including anorectal disease, bariatric surgery, and therapeutic endoscopy^19,20. Although seemingly a niche market, there is potential widespread application and an opportunity for collaborations that might not have been evident at first blush. Ultimately, any evaluation of new technology is to a certain extent speculation. Is the technology mature or novel? If it is the latter, this may provide a marketing advantage and facilitate a relationship that could lead to academic partnerships.

Embracing new devices and modifications to existing practice paradigms happens on a spectrum²¹. We are reminded of the maxim, “never be the first or last to adopt change.” One must be on the lookout for revolutionary or game-changing advances but be cautious to avoid irresponsible enthusiasm. Whether it is incorporating evidence from a recent study into everyday practice or judging the potential of new equipment, a balance must be achieved between detailed evaluation of the literature and understanding the practical consequences and feasibility of implementing change. Although these may be competing interests, achieving this is a pivotal step in success for the new gastroenterologist.

AGA journals' social media accounts

http://twitter.com/aga_gastro

http://twitter.com/aga_cgh

http://twitter.com/aga_cmgh

https://www.facebook.com/gastrojournal/

https://www.facebook.com/cghjournal/

https://www.facebook.com/cmghjournal/

References

1. Arora V et al. Closing the gap between internal medicine training and practice: Recommendations from recent graduates. Am J Med. 2005 Jun;118(6):685-7.

2. Gray DM et al. Making social media work for your practice. Clin Gastroenterol Hepatol. 2017 Nov;15:1651-4.

3. Shah NH et al. Proton pump inhibitor usage and the risk of myocardial infarction in the general population. PLoS One. 2015 Jun 10;10:e0124653.

4. Gomm W et al. Association of proton pump inhibitors with risk of dementia: A pharmacoepidemiological claims data analysis. JAMA Neurol. 2016 Apr;73(4):410-6.

5. Wang YF et al. Proton-pump inhibitor use and the risk of first-time ischemic stroke in the general population: A nationwide population-based study. Am J Gastroenterol. 2017 Jul;112:1084-93.

6. Nguyen LH et al. No significant association between proton pump inhibitor use and risk of stroke after adjustment for lifestyle factors and indication. Gastroenterology. 2018 Apr; 154(5):1290-7.

7. Lochhead P et al. Association between proton pump inhibitor use and cognitive function in women. Gastroenterology. 2017 Oct;153(4):971-9.

8. Landi SN et al. No increase in risk of acute myocardial infarction in privately insured adults prescribed proton pump inhibitors vs histamine-2 receptor antagonists (2002-2014). Gastroenterology 2018 Mar;154(4):861-73.

9. Freedberg DE et al. The risks and benefits of long-term use of proton pump inhibitors: Expert review and best practice advise from the American Gastroenterological Association. Gastroenterology. 2017 Mar;152:706-15.

10. Judd S et al. Approach to presenting a clinical journal club. Gastroenterology. 2014 Jun;146(7):1591-3.

11. Weitz JI et al. Rivaroxaban or aspirin for extended treatment of venous thromboembolism. N Engl J Med. 2017 Mar 30;376:1211-22.

12. Eikelboom JW et al. Rivaroxaban with or without aspirin in stable cardiovascular disease. N Engl J Med. 2017 Oct. 5;377:1319-30.

13. Abraham NS. Novel oral anticoagulants and gastrointestinal bleeding: a case for cardiogastroenterology. Clin Gastroenterol Hepatol. 2013;11(4):324-8.

14. Acosta RD et al. The management of antithrombotic agents for patients undergoing GI endoscopy. Gastrointest Endosc. 2016;83:3-16.

15. Sami SS et al. Screening for Barrett’s esophagus and esophageal adenocarcinoma: rationale, recent progress, challenges and future directions. Clin Gastroenterol Hepatol. 2015 Apr;13:623-34.

16. Laupacis A et al. How attractive does a new technology need to be to warrant adoption and utilization? Tentative guidelines for using clinical and economic evaluations. CMAJ. 1992 Feb 15;146:473-81.

17. Hirano I et al. Functional lumen imaging probe for the management of esophageal disorders: Expert review from the clinical practice updates committee of the AGA Institute. Clin Gastroenterol Hepatol. 2017 Mar;15:325-34.

18. Kwiatek MA et al. Esophagogastric junction distensibility assessed with an endoscopic functional luminal imaging probe (EndoFLIP). Gastrointest Endosc. 2010 Aug;72:272-82.

19. Leroi AM et al. The diagnostic value of the functional lumen imaging probe versus high-resolution anorectal manometry in patients with fecal incontinence. Neurogastroenterol Motil. 2018 Jan 18; doi: 10.1111/nmo.13291.

20. Reynolds JL et al. Intraoperative assessment of the effects of laparoscopic sleeve gastrectomy on the distensibility of the lower esophageal sphincter using impedance planimetry. Surg Endosc. 2016 Nov;30:4904-9.

21. Aisenberg J. Optical biopsy for colorectal polyps: moving along the S-shaped curve. Gastrointest Endosc. 2014 Mar;79:399-401.

Dr. Leiman, assistant professor of medicine, division of gastroenterology, Duke University, Durham, N.C.; Dr. Sengupta, assistant professor of medicine, section of gastroenterology, hepatology, and nutrition, University of Chicago Medical Center.

The transition from gastroenterology fellowship to independent practice can be daunting. There may be concerns about procedural competency and increased levels of responsibility. Recent trainees have to manage their newly busy clinical schedules while trying to integrate evidence from a rapidly evolving landscape of medical literature into daily practice. Many recent graduates also are expected to participate in financial decisions or contribute to assessments about resource allocation regarding new technologies. These are challenges faced by those in both community and academic positions but may be more keenly felt in the first years of practice regardless of setting.

Without the benefit of experience, incorporating pertinent evidence from both within and outside of the field of gastroenterology as well as identifying disruptive technologies can be particularly difficult. There is scant guidance in this area, either during fellowship or from the existing literature¹. Yet these are skills that, when properly developed, can be lifelong assets and, as a result, an evaluation of this process is warranted. Herein, we identify recent developments relevant to gastroenterologists to illustrate a conceptual framework for judging novel information.

A practical concern for the new gastroenterologist is learning to efficiently evaluate the merits of the latest research and then implement this knowledge in the clinic. Maintaining active society membership often includes access to scholarly journals. For example, AGA members receive Gastroenterology, Clinical Gastroenterology and Hepatology, and Cellular and Molecular Gastroenterology and Hepatology as part of their member benefits and have the opportunity to receive alerts when new content is published. Social media outlets such as Twitter and Facebook also simplify the process for readers to identify high-impact studies² (see social media urls at the end of the story). In addition to reading, however, a critical review of these studies can prevent premature enthusiasm for modifying practice. The evolving evidence base for understanding proton pump inhibitor (PPI) risks is illustrative. Several studies attracted widespread media attention describing serious associated side effects, ranging from MI³ to dementia⁴ and stroke⁵. These studies were provocative but a decision to withhold PPIs from patients based on these concerns alone could lead to unintended consequences with poor outcomes. Ultimately, subsequent studies published only months later challenged these associations.^6-8 Instead, thoughtful disclosure to patients of known risks and appropriate indications for PPI therapy based on resources such as the AGA Best Practice Advice⁹ is prudent. Reading more may be necessary but is insufficient; finding a forum to discuss novel research topics, such as in a monthly journal club¹⁰ or group practice meeting, can lead to stimulating discussion about how to apply pertinent research to change practice. The AGA Community is an excellent venue for this kind of interaction.

In many situations, keeping informed of updates about the risks and safety of medications prescribed by nongastroenterologists, particularly as they relate to GI conditions, can be even more difficult. A prime example of this is the rapidly expanding literature on indications and risks of direct oral anticoagulants. Rotating on the inpatient consultation service, with the chance to interact with multiple non-GI providers, affords an excellent opportunity to stay up to date. With the increased prevalence of atrial fibrillation as well as the potential expanded indications for direct oral anticoagulants based on recent randomized, controlled trials^11,12, practicing gastroenterologists will be comanaging increasing numbers of patients hospitalized with gastrointestinal bleeding (GIB). Our understanding of the availability and indication for targeted reversal agents, such as idarucizumab, as well as nonspecific reversal agents, such as prothrombin complex concentrates, for those with life-threatening GIB is critical to optimal management of these patients. Multidisciplinary collaborations, such as with cardiogastroenterology clinics¹³, can be leveraged for optimal management of direct oral anticoagulants in the periendoscopy period.

Traditional outpatient consultative approaches are sometimes necessary but frequent reference to consensus societal guidelines on endoscopy in patients on antithrombotics¹⁴ should be made, particularly if they are printed and readily available in the ambulatory clinic and endoscopy suites. When information may be too new or sparse to utilize a national guideline, employing local data or experience to create a hospital-specific algorithm can ensure the delivery of high-quality, collaborative patient care.

Much like reviewing the literature, evaluating new technologies poses its own challenges. Changes in clinical practice may be slow, as in the adoption of noninvasive methods for Barrett’s esophagus screening.¹⁵ But in an age when news of advances and updates in management spreads at tremendous speed through the use of social media, the ability to pivot or assimilate new discoveries and techniques will become increasingly relevant and important. A professional society’s endorsement can provide a framework for a decision, but other principles at play include sensible, critical analyses of the outcomes and costs as well as a balance of organizational and societal perspectives.¹⁶ The use of impedance planimetry is one such example. This is a relatively new technology, but it has received increasing interest recently.¹⁷ The first questions when considering adopting this type of device likely will be about its supporting evidence and the risk for causing harm. The pace of publications regarding its use for measuring esophageal distensibility has accelerated¹⁸. But good data does not necessarily translate into extensive uptake. Other important factors also are practical, e.g., whether a technology committee’s approval is needed and what is the learning curve, available technical support, need for capital purchases, reimbursement, etc. Functional luminal imaging probe (FLIP^®) technology was developed to assess compliance in primary esophageal disorders and now has been applied to several other areas including anorectal disease, bariatric surgery, and therapeutic endoscopy^19,20. Although seemingly a niche market, there is potential widespread application and an opportunity for collaborations that might not have been evident at first blush. Ultimately, any evaluation of new technology is to a certain extent speculation. Is the technology mature or novel? If it is the latter, this may provide a marketing advantage and facilitate a relationship that could lead to academic partnerships.

Embracing new devices and modifications to existing practice paradigms happens on a spectrum²¹. We are reminded of the maxim, “never be the first or last to adopt change.” One must be on the lookout for revolutionary or game-changing advances but be cautious to avoid irresponsible enthusiasm. Whether it is incorporating evidence from a recent study into everyday practice or judging the potential of new equipment, a balance must be achieved between detailed evaluation of the literature and understanding the practical consequences and feasibility of implementing change. Although these may be competing interests, achieving this is a pivotal step in success for the new gastroenterologist.

AGA journals' social media accounts

http://twitter.com/aga_gastro

http://twitter.com/aga_cgh

http://twitter.com/aga_cmgh

https://www.facebook.com/gastrojournal/

https://www.facebook.com/cghjournal/

https://www.facebook.com/cmghjournal/

References

1. Arora V et al. Closing the gap between internal medicine training and practice: Recommendations from recent graduates. Am J Med. 2005 Jun;118(6):685-7.

2. Gray DM et al. Making social media work for your practice. Clin Gastroenterol Hepatol. 2017 Nov;15:1651-4.

3. Shah NH et al. Proton pump inhibitor usage and the risk of myocardial infarction in the general population. PLoS One. 2015 Jun 10;10:e0124653.

4. Gomm W et al. Association of proton pump inhibitors with risk of dementia: A pharmacoepidemiological claims data analysis. JAMA Neurol. 2016 Apr;73(4):410-6.

5. Wang YF et al. Proton-pump inhibitor use and the risk of first-time ischemic stroke in the general population: A nationwide population-based study. Am J Gastroenterol. 2017 Jul;112:1084-93.

6. Nguyen LH et al. No significant association between proton pump inhibitor use and risk of stroke after adjustment for lifestyle factors and indication. Gastroenterology. 2018 Apr; 154(5):1290-7.

7. Lochhead P et al. Association between proton pump inhibitor use and cognitive function in women. Gastroenterology. 2017 Oct;153(4):971-9.

8. Landi SN et al. No increase in risk of acute myocardial infarction in privately insured adults prescribed proton pump inhibitors vs histamine-2 receptor antagonists (2002-2014). Gastroenterology 2018 Mar;154(4):861-73.

9. Freedberg DE et al. The risks and benefits of long-term use of proton pump inhibitors: Expert review and best practice advise from the American Gastroenterological Association. Gastroenterology. 2017 Mar;152:706-15.

10. Judd S et al. Approach to presenting a clinical journal club. Gastroenterology. 2014 Jun;146(7):1591-3.

11. Weitz JI et al. Rivaroxaban or aspirin for extended treatment of venous thromboembolism. N Engl J Med. 2017 Mar 30;376:1211-22.

12. Eikelboom JW et al. Rivaroxaban with or without aspirin in stable cardiovascular disease. N Engl J Med. 2017 Oct. 5;377:1319-30.

13. Abraham NS. Novel oral anticoagulants and gastrointestinal bleeding: a case for cardiogastroenterology. Clin Gastroenterol Hepatol. 2013;11(4):324-8.

14. Acosta RD et al. The management of antithrombotic agents for patients undergoing GI endoscopy. Gastrointest Endosc. 2016;83:3-16.

15. Sami SS et al. Screening for Barrett’s esophagus and esophageal adenocarcinoma: rationale, recent progress, challenges and future directions. Clin Gastroenterol Hepatol. 2015 Apr;13:623-34.

16. Laupacis A et al. How attractive does a new technology need to be to warrant adoption and utilization? Tentative guidelines for using clinical and economic evaluations. CMAJ. 1992 Feb 15;146:473-81.

17. Hirano I et al. Functional lumen imaging probe for the management of esophageal disorders: Expert review from the clinical practice updates committee of the AGA Institute. Clin Gastroenterol Hepatol. 2017 Mar;15:325-34.

18. Kwiatek MA et al. Esophagogastric junction distensibility assessed with an endoscopic functional luminal imaging probe (EndoFLIP). Gastrointest Endosc. 2010 Aug;72:272-82.

19. Leroi AM et al. The diagnostic value of the functional lumen imaging probe versus high-resolution anorectal manometry in patients with fecal incontinence. Neurogastroenterol Motil. 2018 Jan 18; doi: 10.1111/nmo.13291.

20. Reynolds JL et al. Intraoperative assessment of the effects of laparoscopic sleeve gastrectomy on the distensibility of the lower esophageal sphincter using impedance planimetry. Surg Endosc. 2016 Nov;30:4904-9.

21. Aisenberg J. Optical biopsy for colorectal polyps: moving along the S-shaped curve. Gastrointest Endosc. 2014 Mar;79:399-401.

Dr. Leiman, assistant professor of medicine, division of gastroenterology, Duke University, Durham, N.C.; Dr. Sengupta, assistant professor of medicine, section of gastroenterology, hepatology, and nutrition, University of Chicago Medical Center.

Over the last decade, as diagnostic and therapeutic interventions have become more complex and liver transplant a larger part of advanced hepatology care, the training needs for hepatologists have changed significantly. Unlike previous hepatologists, who were trained through gastroenterology programs, most new practitioners seek advanced training in a fellowship year focused exclusively on hepatology.

Like practitioners in many medical subspecialties, transplant hepatologists have varied career goals and responsibilities. Hepatologists who continue to specifically practice transplant hepatology are affiliated with a liver transplant center, which is generally a hospital-based practice. However, most hepatologists also treat nontransplant hepatology patients and some who have completed advanced hepatology training focus exclusively on these patients or provide community-based care for transplant recipients from other centers. Caring for patients with end-stage liver disease and liver transplant recipients can be clinically demanding but also very rewarding. There are also many opportunities for academic pursuits within a hepatology career including areas in urgent need of clinical and basic investigation, clinical trials for novel agents to treat common diseases, education (including leadership in advanced hepatology training), and involvement in professional societies such as the American Gastroenterological Association (AGA) and American Association for the Study of Liver Disease (AASLD).
 

What are the opportunities for advanced hepatology training?

In 1999, the AASLD determined that the practice of transplant hepatology required its own specialized knowledge and that most practicing gastroenterologists did not consider themselves adequately prepared to care for patients with advanced liver disease.^1,2 The following year, the AASLD applied to the American Board of Internal Medicine (ABIM) to develop formalized liver transplant training. After several years of debate and development, the first ABIM certification exam in transplant hepatology was held in 2006 and is now offered every 2 years.²

There are currently three pathways to achieve advanced training in hepatology. The traditional pathway is a 1-year Accreditation Council for Graduate Medical Education (ACGME) transplant fellowship that is separate from, and must follow completion of, a gastroenterology fellowship. There are currently 51 ACGME-accredited 1-year transplant hepatology fellowships in the United States. These fellowships are only at institutions with ACGME-accredited training in internal medicine and gastroenterology as well. The full and updated list of programs can be found on the ACGME website.³ The second pathway is the relatively new ABIM “pilot” program during which the transplant hepatology fellowship year is combined with the third year of gastroenterology fellowship (discussed in detail below). Finally, there remain many 1-year training programs that are not ACGME-accredited, may not be associated with a gastroenterology fellowship program, and do have not regulated requirements for entry. Trainees who complete non-ACGME programs are not candidates for ABIM board certification.
 

How does one apply for transplant hepatology fellowship?

Transplant hepatology fellowships do not participate in a match system. Therefore, the interviews and offers for training spots may occur at different times depending on the program and the region of the country. In general, fellows apply by the fall of their second year of gastroenterology fellowship in order to begin training after graduating from the third year of fellowship. Each program has its individual approach to the application process and most have this information available on a website as to how to apply. A complete list of ACGME-accredited programs along with the program directors and contact information is available on the ABIM website.³

What is the gastroenterology/transplant hepatology pilot training program?

The AASLD and ABIM have developed a combined gastroenterology and transplant hepatology pilot fellowship training program that allows eligible gastroenterology fellows to spend their third year training in transplant hepatology. This approach has the potential to shorten the total training from 4 years to 3. In addition, if all gastroenterology and transplant hepatology competencies are achieved by the end of the third year, fellows approved to be in this program are eligible to take both gastroenterology and transplant hepatology ABIM certification exams.

Any ACGME-accredited gastroenterology fellowship program that has an accredited hepatology counterpart is eligible to participate in this pilot. Eligible programs and fellows must apply to AASLD during the fellow’s second year. The fellow applicant must complete all clinical gastroenterology requirements before the end of the second year of fellowship and be on a trajectory to meet competency milestones, as the majority of the third year will focus on hepatology.

Since 2012, 59 fellows from 31 programs have participated in this pilot program.⁴ If you are interested in participating in this pilot program at your institution, it is important to confer with program directors as early as possible to meet all training requirements. In addition, applications are submitted to the Pilot Steering Taskforce during the fellow’s second year for review. This is not meant to be a competitive process and all fellows who meet the criteria are approved.

This track may not be ideal for all fellows interested in advanced and transplant hepatology. In particular, there may be a trade-off between achieving clinical competency in a shortened training period and pursuing scholarly activity. This pilot program is designed to be an intensive clinical track, so fellows who wish to focus on research should discuss with their program directors whether this is the best approach.
 

What has been your career path after advanced training in hepatology?

I first became interested in hepatology during my inpatient rotations as a medical student. This interest led me to become involved in research in this area very early in my career. The current structure of the fellowship as well as the board certification exam were both developed while I was in training and I adjusted my plans to complete 3 years of gastroenterology fellowship followed by an ACGME-accredited liver transplant fellowship year. Since completing training, I have worked as an attending at an academic medical center in a large liver transplant program and continue to care for patients with all forms of liver disease. In addition, I continued to pursue research as a large component of my job and now have NIH funding and direct the Transplant Clinical Research Center at Columbia University. Finally, I have always been devoted to education and am the program director for the transplant hepatology fellowship at our institution.

What is the future of advanced hepatology training?

The current transplant hepatology training system has evolved significantly since its inception, including development of curricula, ongoing modification of training requirements, and the development of the innovative pilot program. However, there are issues that continue to be debated by the community. For example, it is not certain when or if the combined gastroenterology and transplant hepatology pilot program will become a permanent pathway for training or how best to select fellows for this approach.

Hepatology continues to be a very dynamic area of medicine. With diseases such as nonalcoholic fatty liver disease and hepatocellular carcinoma on the rise, the urgent need for training in HCV treatment to combat the global epidemic of viral hepatitis, and the growing number of patients on the liver transplant waiting list, there has never been a more exciting time to choose hepatology as a career.

References

1. Luxon BA. So you want to be a hepatologist? Gastroenterology. 2013;145(6):1182-5.

2. Bacon BR, Grosso LJ, Freedman N, Althouse LA. Subspecialty certification in transplant hepatology. Liver Transpl. 2007;13(11):1479-81.

3. https://apps.acgme.org/ads/public/reports/report/1.

4. https://www.aasld.org/events-professional-development/educational-learning-faq.

Dr. Verna is assistant professor of medicine, program director, transplant hepatology fellowship, director of clinical research, Transplant Clinical Research Center, Columbia University Medical Center, New York.

Over the last decade, as diagnostic and therapeutic interventions have become more complex and liver transplant a larger part of advanced hepatology care, the training needs for hepatologists have changed significantly. Unlike previous hepatologists, who were trained through gastroenterology programs, most new practitioners seek advanced training in a fellowship year focused exclusively on hepatology.

Like practitioners in many medical subspecialties, transplant hepatologists have varied career goals and responsibilities. Hepatologists who continue to specifically practice transplant hepatology are affiliated with a liver transplant center, which is generally a hospital-based practice. However, most hepatologists also treat nontransplant hepatology patients and some who have completed advanced hepatology training focus exclusively on these patients or provide community-based care for transplant recipients from other centers. Caring for patients with end-stage liver disease and liver transplant recipients can be clinically demanding but also very rewarding. There are also many opportunities for academic pursuits within a hepatology career including areas in urgent need of clinical and basic investigation, clinical trials for novel agents to treat common diseases, education (including leadership in advanced hepatology training), and involvement in professional societies such as the American Gastroenterological Association (AGA) and American Association for the Study of Liver Disease (AASLD).
 

What are the opportunities for advanced hepatology training?

In 1999, the AASLD determined that the practice of transplant hepatology required its own specialized knowledge and that most practicing gastroenterologists did not consider themselves adequately prepared to care for patients with advanced liver disease.^1,2 The following year, the AASLD applied to the American Board of Internal Medicine (ABIM) to develop formalized liver transplant training. After several years of debate and development, the first ABIM certification exam in transplant hepatology was held in 2006 and is now offered every 2 years.²

There are currently three pathways to achieve advanced training in hepatology. The traditional pathway is a 1-year Accreditation Council for Graduate Medical Education (ACGME) transplant fellowship that is separate from, and must follow completion of, a gastroenterology fellowship. There are currently 51 ACGME-accredited 1-year transplant hepatology fellowships in the United States. These fellowships are only at institutions with ACGME-accredited training in internal medicine and gastroenterology as well. The full and updated list of programs can be found on the ACGME website.³ The second pathway is the relatively new ABIM “pilot” program during which the transplant hepatology fellowship year is combined with the third year of gastroenterology fellowship (discussed in detail below). Finally, there remain many 1-year training programs that are not ACGME-accredited, may not be associated with a gastroenterology fellowship program, and do have not regulated requirements for entry. Trainees who complete non-ACGME programs are not candidates for ABIM board certification.
 

How does one apply for transplant hepatology fellowship?

Transplant hepatology fellowships do not participate in a match system. Therefore, the interviews and offers for training spots may occur at different times depending on the program and the region of the country. In general, fellows apply by the fall of their second year of gastroenterology fellowship in order to begin training after graduating from the third year of fellowship. Each program has its individual approach to the application process and most have this information available on a website as to how to apply. A complete list of ACGME-accredited programs along with the program directors and contact information is available on the ABIM website.³

What is the gastroenterology/transplant hepatology pilot training program?

The AASLD and ABIM have developed a combined gastroenterology and transplant hepatology pilot fellowship training program that allows eligible gastroenterology fellows to spend their third year training in transplant hepatology. This approach has the potential to shorten the total training from 4 years to 3. In addition, if all gastroenterology and transplant hepatology competencies are achieved by the end of the third year, fellows approved to be in this program are eligible to take both gastroenterology and transplant hepatology ABIM certification exams.

Any ACGME-accredited gastroenterology fellowship program that has an accredited hepatology counterpart is eligible to participate in this pilot. Eligible programs and fellows must apply to AASLD during the fellow’s second year. The fellow applicant must complete all clinical gastroenterology requirements before the end of the second year of fellowship and be on a trajectory to meet competency milestones, as the majority of the third year will focus on hepatology.

Since 2012, 59 fellows from 31 programs have participated in this pilot program.⁴ If you are interested in participating in this pilot program at your institution, it is important to confer with program directors as early as possible to meet all training requirements. In addition, applications are submitted to the Pilot Steering Taskforce during the fellow’s second year for review. This is not meant to be a competitive process and all fellows who meet the criteria are approved.

This track may not be ideal for all fellows interested in advanced and transplant hepatology. In particular, there may be a trade-off between achieving clinical competency in a shortened training period and pursuing scholarly activity. This pilot program is designed to be an intensive clinical track, so fellows who wish to focus on research should discuss with their program directors whether this is the best approach.
 

What has been your career path after advanced training in hepatology?

I first became interested in hepatology during my inpatient rotations as a medical student. This interest led me to become involved in research in this area very early in my career. The current structure of the fellowship as well as the board certification exam were both developed while I was in training and I adjusted my plans to complete 3 years of gastroenterology fellowship followed by an ACGME-accredited liver transplant fellowship year. Since completing training, I have worked as an attending at an academic medical center in a large liver transplant program and continue to care for patients with all forms of liver disease. In addition, I continued to pursue research as a large component of my job and now have NIH funding and direct the Transplant Clinical Research Center at Columbia University. Finally, I have always been devoted to education and am the program director for the transplant hepatology fellowship at our institution.

What is the future of advanced hepatology training?

The current transplant hepatology training system has evolved significantly since its inception, including development of curricula, ongoing modification of training requirements, and the development of the innovative pilot program. However, there are issues that continue to be debated by the community. For example, it is not certain when or if the combined gastroenterology and transplant hepatology pilot program will become a permanent pathway for training or how best to select fellows for this approach.

Hepatology continues to be a very dynamic area of medicine. With diseases such as nonalcoholic fatty liver disease and hepatocellular carcinoma on the rise, the urgent need for training in HCV treatment to combat the global epidemic of viral hepatitis, and the growing number of patients on the liver transplant waiting list, there has never been a more exciting time to choose hepatology as a career.

References

1. Luxon BA. So you want to be a hepatologist? Gastroenterology. 2013;145(6):1182-5.

2. Bacon BR, Grosso LJ, Freedman N, Althouse LA. Subspecialty certification in transplant hepatology. Liver Transpl. 2007;13(11):1479-81.

3. https://apps.acgme.org/ads/public/reports/report/1.

4. https://www.aasld.org/events-professional-development/educational-learning-faq.

Dr. Verna is assistant professor of medicine, program director, transplant hepatology fellowship, director of clinical research, Transplant Clinical Research Center, Columbia University Medical Center, New York.

Over the last decade, as diagnostic and therapeutic interventions have become more complex and liver transplant a larger part of advanced hepatology care, the training needs for hepatologists have changed significantly. Unlike previous hepatologists, who were trained through gastroenterology programs, most new practitioners seek advanced training in a fellowship year focused exclusively on hepatology.

Like practitioners in many medical subspecialties, transplant hepatologists have varied career goals and responsibilities. Hepatologists who continue to specifically practice transplant hepatology are affiliated with a liver transplant center, which is generally a hospital-based practice. However, most hepatologists also treat nontransplant hepatology patients and some who have completed advanced hepatology training focus exclusively on these patients or provide community-based care for transplant recipients from other centers. Caring for patients with end-stage liver disease and liver transplant recipients can be clinically demanding but also very rewarding. There are also many opportunities for academic pursuits within a hepatology career including areas in urgent need of clinical and basic investigation, clinical trials for novel agents to treat common diseases, education (including leadership in advanced hepatology training), and involvement in professional societies such as the American Gastroenterological Association (AGA) and American Association for the Study of Liver Disease (AASLD).
 

What are the opportunities for advanced hepatology training?

In 1999, the AASLD determined that the practice of transplant hepatology required its own specialized knowledge and that most practicing gastroenterologists did not consider themselves adequately prepared to care for patients with advanced liver disease.^1,2 The following year, the AASLD applied to the American Board of Internal Medicine (ABIM) to develop formalized liver transplant training. After several years of debate and development, the first ABIM certification exam in transplant hepatology was held in 2006 and is now offered every 2 years.²

There are currently three pathways to achieve advanced training in hepatology. The traditional pathway is a 1-year Accreditation Council for Graduate Medical Education (ACGME) transplant fellowship that is separate from, and must follow completion of, a gastroenterology fellowship. There are currently 51 ACGME-accredited 1-year transplant hepatology fellowships in the United States. These fellowships are only at institutions with ACGME-accredited training in internal medicine and gastroenterology as well. The full and updated list of programs can be found on the ACGME website.³ The second pathway is the relatively new ABIM “pilot” program during which the transplant hepatology fellowship year is combined with the third year of gastroenterology fellowship (discussed in detail below). Finally, there remain many 1-year training programs that are not ACGME-accredited, may not be associated with a gastroenterology fellowship program, and do have not regulated requirements for entry. Trainees who complete non-ACGME programs are not candidates for ABIM board certification.
 

How does one apply for transplant hepatology fellowship?

Transplant hepatology fellowships do not participate in a match system. Therefore, the interviews and offers for training spots may occur at different times depending on the program and the region of the country. In general, fellows apply by the fall of their second year of gastroenterology fellowship in order to begin training after graduating from the third year of fellowship. Each program has its individual approach to the application process and most have this information available on a website as to how to apply. A complete list of ACGME-accredited programs along with the program directors and contact information is available on the ABIM website.³

What is the gastroenterology/transplant hepatology pilot training program?

The AASLD and ABIM have developed a combined gastroenterology and transplant hepatology pilot fellowship training program that allows eligible gastroenterology fellows to spend their third year training in transplant hepatology. This approach has the potential to shorten the total training from 4 years to 3. In addition, if all gastroenterology and transplant hepatology competencies are achieved by the end of the third year, fellows approved to be in this program are eligible to take both gastroenterology and transplant hepatology ABIM certification exams.

Any ACGME-accredited gastroenterology fellowship program that has an accredited hepatology counterpart is eligible to participate in this pilot. Eligible programs and fellows must apply to AASLD during the fellow’s second year. The fellow applicant must complete all clinical gastroenterology requirements before the end of the second year of fellowship and be on a trajectory to meet competency milestones, as the majority of the third year will focus on hepatology.

Since 2012, 59 fellows from 31 programs have participated in this pilot program.⁴ If you are interested in participating in this pilot program at your institution, it is important to confer with program directors as early as possible to meet all training requirements. In addition, applications are submitted to the Pilot Steering Taskforce during the fellow’s second year for review. This is not meant to be a competitive process and all fellows who meet the criteria are approved.

This track may not be ideal for all fellows interested in advanced and transplant hepatology. In particular, there may be a trade-off between achieving clinical competency in a shortened training period and pursuing scholarly activity. This pilot program is designed to be an intensive clinical track, so fellows who wish to focus on research should discuss with their program directors whether this is the best approach.
 

What has been your career path after advanced training in hepatology?

I first became interested in hepatology during my inpatient rotations as a medical student. This interest led me to become involved in research in this area very early in my career. The current structure of the fellowship as well as the board certification exam were both developed while I was in training and I adjusted my plans to complete 3 years of gastroenterology fellowship followed by an ACGME-accredited liver transplant fellowship year. Since completing training, I have worked as an attending at an academic medical center in a large liver transplant program and continue to care for patients with all forms of liver disease. In addition, I continued to pursue research as a large component of my job and now have NIH funding and direct the Transplant Clinical Research Center at Columbia University. Finally, I have always been devoted to education and am the program director for the transplant hepatology fellowship at our institution.

What is the future of advanced hepatology training?

The current transplant hepatology training system has evolved significantly since its inception, including development of curricula, ongoing modification of training requirements, and the development of the innovative pilot program. However, there are issues that continue to be debated by the community. For example, it is not certain when or if the combined gastroenterology and transplant hepatology pilot program will become a permanent pathway for training or how best to select fellows for this approach.

Hepatology continues to be a very dynamic area of medicine. With diseases such as nonalcoholic fatty liver disease and hepatocellular carcinoma on the rise, the urgent need for training in HCV treatment to combat the global epidemic of viral hepatitis, and the growing number of patients on the liver transplant waiting list, there has never been a more exciting time to choose hepatology as a career.

References

1. Luxon BA. So you want to be a hepatologist? Gastroenterology. 2013;145(6):1182-5.

2. Bacon BR, Grosso LJ, Freedman N, Althouse LA. Subspecialty certification in transplant hepatology. Liver Transpl. 2007;13(11):1479-81.

3. https://apps.acgme.org/ads/public/reports/report/1.

4. https://www.aasld.org/events-professional-development/educational-learning-faq.

Dr. Verna is assistant professor of medicine, program director, transplant hepatology fellowship, director of clinical research, Transplant Clinical Research Center, Columbia University Medical Center, New York.

Dear Colleagues,

It is with great excitement that I introduce the first e-newsletter version of The New Gastroenterologist! As more content in medicine, and life in general, is moving toward digital platforms, we at the AGA believe this transition will improve both content dissemination and accessibility to all our readers. In this new format, we will continue to provide articles on topics of importance to the early-career community, expand our offerings by including the new “In Focus” articles (concise overviews of GI topics) both digitally and in GI & Hepatology News print issues, as well as increase the use of multimedia resources, such as videos, to further enhance our content.

In this issue of The New Gastroenterologist, our In Focus article provides a practical overview of the management of chronic constipation. This article, written by Nitin Ahuja and James Reynolds from the Neurogastroenterology and Motility Program at the University of Pennsylvania, Philadelphia, addresses a common topic in our field, and can also be found in the February print issue of GI & Hepatology News. To complement this article, there is a corresponding video abstract that can be viewed.

Also in this issue, Richard Peek (Vanderbilt University, Nashville, Tenn.) – one of the Coeditors in Chief of Gastroenterology – provides a summary of the newly created 1-year editorial fellowship for the AGA’s flagship journal. This is a fantastic new opportunity and you can learn firsthand about the experience of the inaugural editorial fellow, Eric Shah (University of Michigan, Ann Arbor), in an accompanying video. Additionally, as helping patients make a successful transition from a pediatric GI practice to an adult GI practice can be very challenging, in this issue Manreet Kaur and Allyson Wyatt (Baylor College of Medicine, Houston) provide a primer on how to successfully aid in this transition.

Are you considering a career in hospital administration? If so, you will enjoy reading about pursuing a career in hospital administration from Brijen Shah, who is the chief medical officer of Mount Sinai Queens (Icahn School of Medicine at Mount Sinai, New York). Have you been to one of the AGA’s Regional Practice Skills Workshops? These workshops are sponsored by the AGA Trainee and Early Career Committee and held in a growing number of cities across the country. In this issue, Munish Ashat (University of Iowa, Iowa City) provides a recap of the workshop he attended, complete with many useful career pearls.

I hope that you also enjoy the other features in the new e-newsletter format of The New Gastroenterologist. I especially want to point out one of our new sections entitled “In Case You Missed It.” As we all undoubtedly experience information overload with so many new articles released each month, this section collects relevant articles from the numerous AGA publications and consolidates them to ensure you don’t miss any of this great content.

If you are interested in contributing to future issues of The New Gastroenterologist or if there are topics that would interest you, please let us know. You can contact me ([email protected]) or the managing editor of The New Gastroenterologist, Ryan Farrell ([email protected]).

Sincerely,

Bryson W. Katona, MD, PhD
Editor in Chief

Dr. Katona is an instructor of medicine in the division of gastroenterology at the University of Pennsylvania, Philadelphia.

Dear Colleagues,

It is with great excitement that I introduce the first e-newsletter version of The New Gastroenterologist! As more content in medicine, and life in general, is moving toward digital platforms, we at the AGA believe this transition will improve both content dissemination and accessibility to all our readers. In this new format, we will continue to provide articles on topics of importance to the early-career community, expand our offerings by including the new “In Focus” articles (concise overviews of GI topics) both digitally and in GI & Hepatology News print issues, as well as increase the use of multimedia resources, such as videos, to further enhance our content.

In this issue of The New Gastroenterologist, our In Focus article provides a practical overview of the management of chronic constipation. This article, written by Nitin Ahuja and James Reynolds from the Neurogastroenterology and Motility Program at the University of Pennsylvania, Philadelphia, addresses a common topic in our field, and can also be found in the February print issue of GI & Hepatology News. To complement this article, there is a corresponding video abstract that can be viewed.

Also in this issue, Richard Peek (Vanderbilt University, Nashville, Tenn.) – one of the Coeditors in Chief of Gastroenterology – provides a summary of the newly created 1-year editorial fellowship for the AGA’s flagship journal. This is a fantastic new opportunity and you can learn firsthand about the experience of the inaugural editorial fellow, Eric Shah (University of Michigan, Ann Arbor), in an accompanying video. Additionally, as helping patients make a successful transition from a pediatric GI practice to an adult GI practice can be very challenging, in this issue Manreet Kaur and Allyson Wyatt (Baylor College of Medicine, Houston) provide a primer on how to successfully aid in this transition.

Are you considering a career in hospital administration? If so, you will enjoy reading about pursuing a career in hospital administration from Brijen Shah, who is the chief medical officer of Mount Sinai Queens (Icahn School of Medicine at Mount Sinai, New York). Have you been to one of the AGA’s Regional Practice Skills Workshops? These workshops are sponsored by the AGA Trainee and Early Career Committee and held in a growing number of cities across the country. In this issue, Munish Ashat (University of Iowa, Iowa City) provides a recap of the workshop he attended, complete with many useful career pearls.

I hope that you also enjoy the other features in the new e-newsletter format of The New Gastroenterologist. I especially want to point out one of our new sections entitled “In Case You Missed It.” As we all undoubtedly experience information overload with so many new articles released each month, this section collects relevant articles from the numerous AGA publications and consolidates them to ensure you don’t miss any of this great content.

If you are interested in contributing to future issues of The New Gastroenterologist or if there are topics that would interest you, please let us know. You can contact me ([email protected]) or the managing editor of The New Gastroenterologist, Ryan Farrell ([email protected]).

Sincerely,

Bryson W. Katona, MD, PhD
Editor in Chief

Dr. Katona is an instructor of medicine in the division of gastroenterology at the University of Pennsylvania, Philadelphia.

Dear Colleagues,

It is with great excitement that I introduce the first e-newsletter version of The New Gastroenterologist! As more content in medicine, and life in general, is moving toward digital platforms, we at the AGA believe this transition will improve both content dissemination and accessibility to all our readers. In this new format, we will continue to provide articles on topics of importance to the early-career community, expand our offerings by including the new “In Focus” articles (concise overviews of GI topics) both digitally and in GI & Hepatology News print issues, as well as increase the use of multimedia resources, such as videos, to further enhance our content.

In this issue of The New Gastroenterologist, our In Focus article provides a practical overview of the management of chronic constipation. This article, written by Nitin Ahuja and James Reynolds from the Neurogastroenterology and Motility Program at the University of Pennsylvania, Philadelphia, addresses a common topic in our field, and can also be found in the February print issue of GI & Hepatology News. To complement this article, there is a corresponding video abstract that can be viewed.

Also in this issue, Richard Peek (Vanderbilt University, Nashville, Tenn.) – one of the Coeditors in Chief of Gastroenterology – provides a summary of the newly created 1-year editorial fellowship for the AGA’s flagship journal. This is a fantastic new opportunity and you can learn firsthand about the experience of the inaugural editorial fellow, Eric Shah (University of Michigan, Ann Arbor), in an accompanying video. Additionally, as helping patients make a successful transition from a pediatric GI practice to an adult GI practice can be very challenging, in this issue Manreet Kaur and Allyson Wyatt (Baylor College of Medicine, Houston) provide a primer on how to successfully aid in this transition.

Are you considering a career in hospital administration? If so, you will enjoy reading about pursuing a career in hospital administration from Brijen Shah, who is the chief medical officer of Mount Sinai Queens (Icahn School of Medicine at Mount Sinai, New York). Have you been to one of the AGA’s Regional Practice Skills Workshops? These workshops are sponsored by the AGA Trainee and Early Career Committee and held in a growing number of cities across the country. In this issue, Munish Ashat (University of Iowa, Iowa City) provides a recap of the workshop he attended, complete with many useful career pearls.

I hope that you also enjoy the other features in the new e-newsletter format of The New Gastroenterologist. I especially want to point out one of our new sections entitled “In Case You Missed It.” As we all undoubtedly experience information overload with so many new articles released each month, this section collects relevant articles from the numerous AGA publications and consolidates them to ensure you don’t miss any of this great content.

If you are interested in contributing to future issues of The New Gastroenterologist or if there are topics that would interest you, please let us know. You can contact me ([email protected]) or the managing editor of The New Gastroenterologist, Ryan Farrell ([email protected]).

Sincerely,

Bryson W. Katona, MD, PhD
Editor in Chief

Dr. Katona is an instructor of medicine in the division of gastroenterology at the University of Pennsylvania, Philadelphia.