ERCP/EUS in 3 yeats

[ms1guru]

Is it truly worth taking a fellowship programs word if they are saying that they can certify you in EUS and ERCP within the 3 year GI fellowship time? Is it worth taking that offer? Note that the program is a mid-tier university program that does not have an advanced fellowship; and if you do not feel comfortable or still want to do academics, you will still need a 4th year. If I go here and end up wanting to do a 4th year, will it ruin my chances of going to a 4th year program since there is no internal spot there and majority of the other programs take people internally?

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[Biliary Tree]

Is it truly worth taking a fellowship programs word if they are saying that they can certify you in EUS and ERCP within the 3 year GI fellowship time? Is it worth taking that offer? Note that the program is a mid-tier university program that does not have an advanced fellowship; and if you do not feel comfortable or still want to do academics, you will still need a 4th year. If I go here and end up wanting to do a 4th year, will it ruin my chances of going to a 4th year program since there is no internal spot there and majority of the other programs take people internally?

I think it's a myth that most programs take internal candidates for 4th year spots. My experience with colleagues and researching programs has actually been the contrary. For example, my university program has a 4th year fellow position and rarely, if ever, takes internal candidates. That being said, our fellows have historically had great success in matching for advanced positions elsewhere at well respected institutions. I plan on heading elsewhere for my 4th year. Our advanced staff is very helpful advocating for us and helping with the application and match process.

I find it nearly impossible to believe that you could graduate from a 3 year GI program feeling comfortable doing EUS in clinical practice. ERCP potentially, but most larger medical groups (even outside of academics) won't even look at credentialing you for ERCP privileges unless you do a 4th year. Fellowships will tell you what you want to hear. If you want to go into academics and wish to be proficient in EUS and ERCP, going to a fellowship where you get significant exposure to those procedures will be of benefit and is not a deal breaker for obtaining a 4th year spot.

 

[Gastrapathy]

Totally disagree. That's the ivory tower talking. Private groups just want people who have done the requisite number of cases to be credentialed. Fellowships are different and the ASGE statement on the subject basically says that you need to get the volume somehow. There are programs that have fellows end up with more numbers after 3 years than others get in their 4th year. If a fellowship says they can get you trained in both, just ask them how many cases the fellows get. If its 300+ for both, you may not be the world's expert but you'll be fine in clinical practice. Remember, most endosonographers aren't doing EUS-guided interventional procedures, cyst gastrostomies, etc. They are sticking and staging cancers.

Now, you want to be faculty in an advanced endoscopy university environment with access to the cutting edge, then you better do a 4th year.

 

[jabreal00]

If one finishes with 200 ERCPs and EUS they shouldn't have problems getting credentialed at most hospitals. That person would be competent with bread and butter advanced cases (biliary and cancer staging).

However, if one wants to go to a tertiary referral center or get an academic position they would be more competitive with a 4th year. In a fourth year, one learns not just EUS/ERCP but other advanced endoscopic cases (endoluminal stents, EMR, Barrett's ablation etc) where they're considered experts.