Presidential farewell address: A surgeon looks at training in gastroenterology

Abstract

It is with some trepidation that I stand before you today to consider some aspects of training in gastroenterology, perhaps as a mirror of the broader problem of training in general internal medicine. Most of you could legitimately demand the credentials of a surgeon who might be so bold as to venture into these murky waters which have lately swirled with so much controversy. My close association with fellows in gastroenterology who have rotated through my own service for many years, a stint on the American Board of Surgery, and a long-standing interest in teaching and training in surgery provide some license. I am provoked in addition by the current evolution or revolution, if you will, of gastroenterology into more and more of a procedure-oriented surgical-like specialty, much akin to latter day changes in cardiology and pulmonary medicine. One could also invoke the principle of external audit or review which can be highly effective therapy for the myopia to which we all may fall prey. Having borrowed for my own service much from the example of academic training in internal medicine, I hope you will consider my thoughts as constructive rather than pejorative, and as given with a tentativeness which emphasizes their offering as a framework for fruitful discussion and possible future action. The many analogies between surgery and gastroenterology which might appear in my discussion can be attributed to the limitations of my own horizons. It is the character and quality of training in gastroenterology to which I will address my remarks, hopefully a logical sequence to those on the manpower problem in our specialty, discussed so clearly and ably by my predecessor John Benson. One of the many fundamental questions before us now is whether all specialists should undergo the same types of training, or whether there should be specific tracks for those who provide special serv-