Congratulations on your interviews! Few points from my perspective:
1) The year is very short and busy. Unless you come in with good ERCP and EUS numbers from your general GI program, in most programs you will only be able to achieve competency in EUS and ERCP. Anything beyond that will only be in the form of exposure, including ESD, POEM and interventional EUS. Obviously exposure is better than no exposure, and would allow you to have something to build on in the future. Some programs (think University of Florida) offer 18 months of training in order for you to actually learn some third space endoscopy, but even that will depend on how you progress with ERCP and EUS.
2) The 'brand name' of institutions matters much less at this point in training. While some brand name institutions will still offer you stellar training (think Beth Israel Deaconess in Boston), others may not. Instead of the name, factors to consider are:
- Do they have enough faculty so that you are learning different techniques and approaches from the most number of people? The higher the number of advanced faculty you work with, the less chance that you are stuck with one or two faculty members that may be poor teachers and the higher the chance of you finding someone that you are able to learn from - after all, we all have different ways of learning.
- What percentage of their papillas are native? Many 'brand names' in big cities are referral centers and have a large proportion of either failed ERCP referred from the community, complex hepatobiliary anatomy cases and non-native papillas which is great to learn from, but not the best for fellow training as you will often be observing (rather than scoping) a lot of the time. You need sufficient numbers of bread and butter ERCP (think straightforward choledocholithiasis) to achieve competency.
- Speak to the current advanced fellow. How much autonomy does the fellow have? Are the attendings 'scope-grabbers' (which many in advanced endoscopy tend to be)? Do they give the scope back? How comfortable is the advanced fellow now with ERCP and EUS?
- Call: this can make or break the year. How much advanced endoscopy call do you take? Does the fellow see the consults or is there general GI or NP/PA support? Every minute outside of the endoscopy suite (while great cognitive learning) is less scope time in an already short year.
- General GI responsibility: how is the position funded? Will you be doing general GI cases? Sharing general GI call? Attending on the general GI consult service? Again as above, great learning, but not really why you are there. You are there to learn EUS and ERCP and every minute away from the endoscopy suite is lost opportunity from a hands-on training perspective.
3) Attending reputation: national reputation of attendings is great, but tells you nothing about how good of a teacher they are. Again, if you are looking to continue in academics, it will certainly help to have the support of internationally renowned faculty. However, it happens more often than not that those very same 'well-known' attendings are the same people either not spending much time with the fellows, or the ones with the poorest teaching skills.
Hope this helps, I'm sure others have helpful thoughts as well. Feel free to send me a direct message if you'd like to discuss in private.Thanks so much for your reply. I am hearing a from current fellows at various programs that they are picking up EMR, ESD, and POEM during their year. Obviously the degree of competency will vary, but sounds like pretty good exposure at least. The Stonybrook fellow One of the fellows at Mayo told me that essentially his only responsibilities are to scope all
