Third-tier fellowship training: advantages and program selection

Abstract

As new technology emerges and gastroenterology becomes more subspecialized, more fellows consider advanced endoscopy training. This month our guest author, Dr. Michael Kochman, will discuss the factors that underlie this new trend and the benefits of obtaining this training. Kevin J. Peifer, MD Fellow Division of Gastroenterology Washington University St. Louis, Missouri, USA In this opinion piece, I will briefly share with you some of my views concerning the advantages of advanced training and some comments on selecting an advanced training program. Clearly, there has been an explosive growth of technology in medicine, and a plethora of diagnostic and therapeutic options have come forward to both diagnose and treat patients with GI disease and other diseases that are either accessible from the GI tract or impact on the function of the GI tract. The correct selection of these various modalities, which run the gamut from simple laboratory tests that involve no more than phlebotomy to extraluminal procedures and the new frontiers of transluminal surgery, is key to good patient outcomes. Clearly the need for a specialized skill set to afford the best chance for good outcomes is paramount in the care of our patients. The purpose of the third-tier fellowships, which started in the 1980s has changed, from simply teaching diagnostic ERCP to now encompassing advanced techniques and technologies. The reasons to seek this training are widely varied. For example, some simply wish to gain expertise in a procedure, others wish to be able to expand the provision of a service into an underserved area, and others have specific research questions. The advantages offered by an advanced training position are numerous and as varied as are the programs themselves. Foremost, and one of the most common reasons to select an advanced training position, is so that one may be best positioned in a competitive market to offer a skill set, including clinical experience, technical expertise, and procedural competence. Most of the trainees, in our experience and that of others, tend to seek positions in academia, and the imprimatur of an advanced training program carries with it a significant competitive advantage. Many “graduates” of these programs are today's directors of endoscopy units and leaders in their fields. Additional advantages offered include the ability to “get in on the ground floor” of a new technical advance or clinical treatment, which may offer inherently unique challenges and afford research opportunities. The selection of an advanced training program should be approached with care and foresight, and requires two major steps: preparing yourself as a viable candidate and applying to the correct program(s). To help prepare yourself as a candidate, it is important to take your interests and enthusiasm and carefully focus them. Refine your clinical interests and career goals to ensure that they are congruent and clear. Research, hopefully accompanied by presentations and publications, will help set you apart and demonstrate that you are serious in your desired pursuit. For example, a clarity and focus on clinical questions, research/epidemiology projects, or techniques during your GI fellowship (and potentially before) will help to demonstrate that the training you desire is a long-term objective and not a passing whim. Seek the advice of your mentors and other successful therapeutic endoscopists; in some instances, they may be at other institutions. They will be able to help you and will provide wisdom, career advice, and aid in developing a research direction. When deciding upon which program(s) to apply to, it is important to gain an overall appreciation of what the program may offer and to attempt to dovetail your interests with your selections. Some programs may only train in one procedure or another, others train in multiple techniques, and some may not have any faculty expertise in a given clinical area. Determine how many attendings will participate in your training: dependency on a single trainer may not be as desirable as a number of trainers for a broad range of expertise. Clearly knowing what a program has to offer can be garnered by examining the past few years of publications and presentations at various local and national meetings by their therapeutic attending staff and trainees. Ascertainment of the involvement of faculty members with societies and journals can help in assessing their level of interest in teaching and research. The quality of the past advanced fellows and the positions that they are able to obtain will also help you gauge the quality of the program; speak with former trainees to get their candid opinions of their training experience. Taking some time and expending the effort to match your interests with the programs that you apply to will ease the selection process, even possibly making it enjoyable and will make for a better match in the end.