The first year of fellowship is an exciting time, with a steep learning curve for both procedural skills and new knowledge. It also forms a foundation for the rest of the fellowship, thus making it imperative to find a balance between patient care and the learning process, as well as positioning oneself for the future. Although many will be fortunate to have senior fellows guide them, it may not be universal. With this in mind, we invited Dr. Gaurav Aggarwal to share with us his experiences and the lessons that he learned from his first year of gastroenterology fellowship in this month's Fellows' Corner; he is helped in this endeavor by his faculty advisor Dr. Amy Oxentenko. We hope that our readers will find this article useful. To suggest future topics for this section, please send an e-mail to [email protected] . Gaurav Arora, MD, MS Fellows' Corner Editor Gastroenterology Fellow University of Texas Medical School Houston, Texas, USA You are finally finished with residency and ready to start fellowship. It is a time of both excitement and trepidation. As you look forward to working in the specialty that you aspired to match into, the transition can seem daunting. We hope to provide a roadmap (summary in Table 1) to facilitate this journey.TABLE 1Summary of recommendations• Build management algorithms for common GI symptoms.• Incorporate endoscopic, histologic, and radiologic references into your reading plan.• Use board review resources.• Register for the American Society of Gastrointestinal Endoscopy first-year fellows course in spring of the third year of residency.• Review basic anatomy before starting endoscopy.• Use your program's endoscopy simulator, if available.• Invest in an atlas of GI endoscopy.• Develop a system of tracking pathology results of biopsies that you performed.• Learn endoscopy in an ergonomic manner (good posture, comfortable shoes).• Learn the skill to counsel patients on difficult diagnoses.• Seek feedback on presentations (before and after).• Identify mentors, both at your home institution or elsewhere, for advice on clinical practice, research, and work-life balance.• Network, network, network!• Apply for travel awards to attend conferences.• Become a trainee member of the American College of Gastroenterology, American Society for Gastrointestinal Endoscopy, American Gastroenterological Association, and American Association for the Study of Liver Diseases.• Serve on society committees as a fellow representative, if interested.• Attend American College of Gastroenterology and Digestive Disease Week career selection forums.• Begin to solidify your career path by the end of the first year of fellowship.• Have fun! Open table in a new tab Residency teaches you when to call on someone with specialized knowledge regarding the medical problem at hand; fellowship is the time to gain this knowledge. As such, you will now be the one consulted to see patients with challenging diagnostic or therapeutic issues. The first step in preparing for this transition is to expand your fund of knowledge. This does not mean that you have to learn the literature in depth on every topic at this early point in subspecialty training. Although the latter might be the eventual goal, you need to lay a foundation before building a house. Develop your own approach to common GI problems such as diarrhea, constipation, nausea, and abdominal pain. Use a basic gastroenterology textbook such as Sleisenger and Fordtran's Gastrointestinal and Liver Disease as your guide. Integrate relevant endoscopic, histologic, and radiologic references into your study plan. To add variety to your reading, you should incorporate board review materials and questions such as those found in the American College of Gastroenterology (ACG) Self-Assessment Program, American Gastroenterological Association (AGA) Gastrointestinal Self Assessment Modules, and American Society for Gastrointestinal Endoscopy (ASGE) Gastrointestinal Endoscopy Self-Assessment Program. Guidelines for management of common GI diagnoses are available as open resources on the websites of these societies. Once you have this knowledge base, you can build on it for years to come. While interviewing for fellowship, most of us professed our love for gastroenterology without ever having held an endoscope in our hands. Now that the time has come to actually learn endoscopy, you might find yourself unprepared. Here are a few suggestions that might be helpful.1Review basic anatomy (eg, Netter Anatomy) for identifying landmarks.2Check with your program to see whether they have a simulation center where you might be able to practice.3The ASGE sponsors a first-year fellows endoscopy course in early fall, where you can get hands-on experience in basic endoscopy.1Wilson S.A. The American Society for Gastrointestinal Endoscopy first-year fellows' endoscopy course: see one, do one, teach one?.Gastrointest Endosc. 2008; 67: 513-514Abstract Full Text Full Text PDF Scopus (1) Google Scholar The weekend course includes a lecture series that addresses complications of endoscopy, consenting patients, etc. Register early because the timing often overlaps with the American Board of Internal Medicine certification examination, and space is limited.4Invest in a textbook of endoscopy such as Cotton's Practical Gastrointestinal Endoscopy.5The ASGE has learning DVDs on endoscopy that your program might have in their library.6Open source videos on endoscopic techniques are available on www.daveproject.org.7Develop a system of tracking pathology results for patients in whom you performed a biopsy to develop a correlation between the endoscopic findings and the histologic diagnosis.8While performing an endoscopy, pay careful attention to your posture and wear comfortable shoes. It is not uncommon for gastroenterologists to develop work-related injuries in the form of joint and back problems.2Pedrosa M.C. Farraye F.A. Shergill A.S. et al.ASGE Technology CommitteeMinimizing occupational hazards in endoscopy: personal protective equipment, radiation safety, and ergonomics.Gastrointest Endosc. 2010 May 25; ([Epub ahead of print])Google Scholar, 3Shergill A.K. McQuaid K.R. Rempel D. Ergonomics and GI endoscopy.Gastrointest Endosc. 2009; 70: 145-153Abstract Full Text Full Text PDF PubMed Scopus (65) Google Scholar9Observe the different styles of performing endoscopy from different teachers before you finally decide on what style works best for you. As a specialist, it is important to recognize and manage patient expectations. When a patient is referred to you, it is likely because of questions that the primary physician was unable to answer. A few extra minutes spent explaining the diagnosis, discussing your recommendations, and answering questions will go a long way in optimizing patient rapport and satisfaction. You will be challenged at times when counseling patients with difficult diagnoses (eg, irritable bowel syndrome, pelvic floor dysfunction). Observe an experienced staff having such discussions with patients early in your training so that you may develop your own style. As a fellow, you will be giving presentations more often than you did in residency, such as resident teaching sessions, peer journal clubs, and divisional conferences. Seek feedback before your presentation by having a staff member who has expertise in the field review your slides to make sure that you have adequately covered the topic and kept it to the level appropriate for the audience. It is also worthwhile to get feedback after your presentation from a staff member who has outstanding presentation skills to get his or her input on the quality of your slides, pace of delivery, and podium habits. Mentors play a critical role in your education and professional development. As such, your mentors will know many other physicians in the field, which will be particularly important when you are looking for a job because they can reach out to their contacts at other institutions. Even after you have completed training, you will likely continue to collaborate with your mentor(s) on research projects or seek their opinion on challenging cases. It is a good idea to identify mentors from both clinical practice and research. In addition, find someone who can be an advisor for work-life balance issues, as fellowship training is often a time of transition and change outside of work. It is also reasonable to identify mentors outside your home institution. Both the AGA and the ACG have mentoring programs that are available to connect mentors and mentees based on similar interests (http://www.gastro.org/careers/career-advisory-program). Before selecting a mentor, determine the specific qualities that you are looking for. An ideal mentor should have a good track record of mentoring, and talking with past mentees can be invaluable to assess mentoring style and see whether it fits with your personality and expectations. Regardless of your anticipated career path, networking is an essential ingredient for success. Digestive Diseases Week, the ACG annual meeting, and the American Association for the Study of Liver Diseases (AASLD) annual meeting are excellent venues for meeting colleagues and fostering new friendships. These conferences also host forums that offer a sounding board for job-related questions and career development. These venues can be great for identifying future research collaborators or practice partners. Travel awards are typically available on a competitive basis, so the cost of attendance can be minimized. You may consider joining the following organizations as a trainee member; this membership category usually has a nominal membership fee and will qualify you for a reduced registration fee at national meetings: AGA, ACG, ASGE, and AASLD. As an added benefit, you will receive a subscription to their flagship journal(s). These societies often have positions for fellows on various committees (eg, research, education, advocacy), which may provide you with another opportunity to network. If this is something you are interested in, discuss it with staff at your institution who are already involved with these societies. Once you start your fellowship, begin to define your career pathway in more tangible ways. By the end of the first year, you should carve out the path that you want your career to follow and tailor the remainder of your fellowship accordingly. Panel discussions on career pathways take place at both Digestive Diseases Week and the ACG annual meeting. For most of us, fellowship is the final step before stepping into the real world, so make the most out of this time. Along the way, meet colleagues and build relationships that will have a lasting impact on your life and career.