Factors predicting initial career choices in gastroenterology fellows

BACKGROUND AND GOALS: As academic gastroenterology (GI) fellowship programs often gear trainee recruitment to those displaying potential for academic careers, the aim of the study was to determine whether predictive factors exist that determine whether GI fellows pursue academia versus private practice. STUDY: Educational file review was conducted on all GI fellows from Mayo Clinic-Rochester from 1990 through 2003, with demographic variables extracted. The outcome of interest was whether the first job after fellowship was in academics or private practice. RESULTS: Of 92 fellows completing training, 60 accepted academic positions (65%) (P=0.005, 95% confidence interval: 0.55-0.74), whereas 32 (35%) pursued private practice. Those of Asian descent were significantly more likely to enter academics versus those of African American (P=0.02) or Hispanic (P=0.01) descent. There were nonsignificant trends of more women than men (85% vs. 62%), military than non-military (86% vs. 63%), bachelors of arts than science degrees (70% vs. 50%) and advanced fellowship training than not (74% vs. 61%) going into academics. There was no significant difference in career choices between fellows entering the National Institutes of Health training tract versus the Clinical Scholar or Clinical Investigator tracts. There were no significant associations between age, marital status, hometown population, foreign medical degree, research mentor factors or type of research during fellowship and practice choice. CONCLUSIONS: Although there seem to be predictive variables in determining whether GI fellows enter private practice or academia, the initial practice choice likely results from multiple combined factors.     

Educational experiences and quality of life of gastroenterology fellows in the United States

OBJECTIVE: The objective of this study was to investigate the education and quality of life of United States gastroenterology fellows. METHODS: A 3-page, 74-question survey incorporating a 5-point Likert scale was designed. All US gastroenterology fellowship program directors were contacted by mail and asked to distribute the survey to graduating fellows. Surveys were sent on 3/29/1998 and collected until 6/1/98. RESULTS: Fellows who would not train at the same institution again had less supervision, clinical instruction, research mentorship, and support services than those who would. Fellows who had loans had lower personal satisfaction scores than those who did not. Fellows who did not hold second jobs (moonlight) had higher job satisfaction scores. Those with vision or dental insurance had higher job and personal satisfaction scores. Regarding quality of life, only 23% of fellows agreed they were not overworked, 23% agreed they were not stressed, 25% agreed they were financially stable, 54% agreed they were happy with fellowship, and 84% agreed they were happy with their career choice. Regarding education, 56% agreed there was more emphasis on productivity than on education, 39% agreed they received adequate mentorship for research, 86% agreed there was adequate supervision, 48% of fellows agreed they had autonomy in making clinical decisions, and 41% agreed they had continuity of care in seeing patients. CONCLUSIONS: Most fellows were happy about their career choice and clinical instruction, but there were deficiencies regarding quality of life (stress, overwork, financial security), education (research support, continuity of care) and job benefits (health coverage).     

Computer simulator training enhances the competency of gastroenterology fellows at colonoscopy: results of a pilot study

OBJECTIVES: Computer-based colonoscopy simulation (CBCS) is being utilized in endoscopy training without supporting evidence that it improves patient-based colonoscopy performance. The goal of this pilot study was to determine if CBCS training improves gastroenterology (GI) fellows' patient-based colonoscopy skills. METHODS: Competency at colonoscopy among 4 novice GI fellows who completed a 6-h CBCS curriculum was compared with 4 novice fellows who were not CBCS-trained. Measurements of competency were rendered by supervising faculty by recording "insertion time,"depth of unassisted insertion,"independent procedure completion,"ability to identify endoscopic landmarks,"inserts in a safe manner,"adequately visualizes mucosa on withdrawal," and "responds appropriately to patient discomfort" with each colonoscopy. RESULTS: Simulator-trained fellows outperformed traditionally trained fellows during their initial 15 colonoscopies in all performance aspects except "insertion time" (pp < 0.05). Simulator-trained fellows inserted the endoscope significantly further and reached the cecum independently nearly twice as often during this early training period. Three parameters ("depth of insertion,"independent completion," and "ability to identify landmarks") demonstrated a continued advantage out to 30 colonoscopies. Beyond 30 procedures, there was no difference in the performance of the two groups. CONCLUSION: In this pilot study, a 6-h CBCS curriculum provides an early training advantage by enhancing competency at the early stages of patient-based colonoscopy. These advantages are negligible after approximately 30 patient-based procedures. CBCS-enhanced training may allow faculty to be more efficient with their colonoscopy practice.     

Challenges and opportunities in the application of artificial intelligence in gastroenterology and hepatology

Artificial intelligence (AI) is an umbrella term used to describe a cluster of interrelated fields. Machine learning (ML) refers to a model that learns from past data to predict future data. Medicine and particularly gastroenterology and hepatology, are data-rich fields with extensive data repositories, and therefore fruitful ground for AI/ML-based software applications. In this study, we comprehensively review the current applications of AI/ML-based models in these fields and the opportunities that arise from their application. Specifically, we refer to the applications of AI/ML-based models in prevention, diagnosis, management, and prognosis of gastrointestinal bleeding, inflammatory bowel diseases, gastrointestinal premalignant and malignant lesions, other nonmalignant gastrointestinal lesions and diseases, hepatitis B and C infection, chronic liver diseases, hepatocellular carcinoma, cholangiocarcinoma, and primary sclerosing cholangitis. At the same time, we identify the major challenges that restrain the widespread use of these models in healthcare in an effort to explore ways to overcome them. Notably, we elaborate on the concerns regarding intrinsic biases, data protection, cybersecurity, intellectual property, liability, ethical challenges, and transparency. Even at a slower pace than anticipated, AI is infiltrating the healthcare industry. AI in healthcare will become a reality, and every physician will have to engage with it by necessity.     

Teacher training for rheumatology fellows: a national needs assessment of fellows and program directors

Clinical Rheumatology - Teaching is an integral part of what we do as physicians, and exposure to training on how to effectively teach is not consistently implemented in the curricula within...     

Creutzfeldt-Jakob disease: implications for gastroenterology

The current clinical views regarding variant Creutzfeldt-Jakob disease, and in particular transmission via endoscopy, of those representing both gastroenterology and the Spongiform Encephalopathy Advisory Committee are presented in an attempt to guide clinicians as to "best practice" given the current state of our knowledge.     

New leadership in Washington: Implications for gastroenterology

GASTROENTEROLOGY 2001;120:333     

Training with the compactEASIE biologic endoscopy simulator significantly improves hemostatic technical skill of gastroenterology fellows: a randomized controlled comparison with clinical endoscopy training alone

BACKGROUND: The Erlangen Active Simulator for Interventional Endoscopy (EASIE) was introduced in 1997 for interventional endoscopy training. compactEASIE developed in 1998 is a modified, light-weight version of the original model. Objective evidence of the benefits of training with these models is limited. A randomized controlled study, therefore, was conducted to compare the effects of intensive 7-month, hands-on training in hemostatic techniques by using the compactEASIE model (in addition to clinical endoscopic training) vs. pure clinical training in endoscopic hemostatic methods. METHODS: Thirty-seven fellows in gastroenterology in New York City area training programs were enrolled. Baseline skills were assessed on the simulator for the following techniques: manual skills, injection and electrocoagulation, hemoclip application, and variceal ligation. Twenty-eight fellows were then randomized into two comparable groups. Those randomized to Group A received purely clinical training in endoscopic hemostatic techniques at their hospitals. Those in Group B, in addition, were trained by experienced tutors in 3 full-day hemostasis workshops over 7 months. Both groups underwent a final evaluation on the compactEASIE simulator conducted by their tutors and additional evaluators who were blinded to the method of training. Initial and final evaluation scores were compared for each group and between groups. Outcomes of actual clinical hemostatic procedures performed during the study period also were analyzed. RESULTS: Ten of 14 fellows randomized to Group A (standard training) and 13 of 14 in Group B (intensive training) returned for the final evaluation. For Group B, scores for all techniques were significantly improved. In Group A, a significant improvement was noted for variceal ligation alone. CONCLUSIONS: compactEASIE simulator training (3 sessions over 7 months), together with clinical endoscopic training resulted in objective improvement in the performance by fellows of all 4 endoscopic hemostatic techniques, whereas significant improvement was noted for variceal ligation alone for fellows who had standard clinical training. In clinical practice, fellows who had intensive simulator/clinical training had a significantly higher success rate and a nonsignificant reduction in the frequency of occurrence of complications.     

COVID-19 and gastroenterology: clinical insights and recommendations for gastroenterology care providers.

Abstract

While the COVID-19 pandemic evolves, we are beginning to understand the role the gastrointestinal tract plays in the disease and the impact of the infection on the care of patients with gastrointestinal (GI) and liver diseases. We review the data and understanding around the virus related to the digestive tract, impact of the pandemic on delivery of GI services and daily gastroenterology clinical practice, and the effects on patients with pre-existing GI diseases.