GI fast track and endoscopy competency

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sallyhasanidea

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Hi I am a fourth year medical student applying to fast track positions.

Do you think the 1 year of GI training is enough to become confident and well trained in EGD and colonoscopy? Do you think in that 1 year we would be able to achieve the 3 minute time to cecum without affecting our ADR? Have you had fast track colleagues who just don't match up to par clinically with people who go through the full 3 years of training, do these fast trackers eventually catch up clinically anyway?

How many scopes does it take to get to the 3 minutes to cecum mark?

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Hi I am a fourth year medical student applying to fast track positions.

Do you think the 1 year of GI training is enough to become confident and well trained in EGD and colonoscopy? Do you think in that 1 year we would be able to achieve the 3 minute time to cecum without affecting our ADR? Have you had fast track colleagues who just don't match up to par clinically with people who go through the full 3 years of training, do these fast trackers eventually catch up clinically anyway?

How many scopes does it take to get to the 3 minutes to cecum mark?

forget the 3 minute cecum... that's urban legend... only happens in movies and sweat shops...

if you are a PSTP guy , it means you are going to be 80% lab and 20% clinical when you are an attending... and you are committed to academics... so your question is moot...

if you want to do private practice , you should not be applying for PSTP.
 
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Hi I am a fourth year medical student applying to fast track positions.

Do you think the 1 year of GI training is enough to become confident and well trained in EGD and colonoscopy? Do you think in that 1 year we would be able to achieve the 3 minute time to cecum without affecting our ADR? Have you had fast track colleagues who just don't match up to par clinically with people who go through the full 3 years of training, do these fast trackers eventually catch up clinically anyway?

How many scopes does it take to get to the 3 minutes to cecum mark?

100% agree with @cabergoline2 . Lets get rid of this 3 min cecum notion. This might happen to someone once a year in those with perfect anatomy. Watch any of the ASGE Masters at courses and they are NOT using this 3 min as a benchmark.

Time to cecum has nothing to do with ADR (unless you are someone who looks actively for polyps on the way in, which is not standard).

Physician scientists I have worked out often are hyperfocused on a specific area within GI and are usually do just fine clinically especially if they are within a niche (which is usually not endoscopy), however they are operating on strict timelines and don't have the luxury of extra clinical electives, and clinical loads as faculty for them usually are lighter since they have so much research and grant support they need to maintain or NIH imposed limits. With fellow support they are often excellent. Overall for bread and butter GI endoscopy they do just fine. As stated above though you may not be very comfortable doing general private practice after an abim research pathway. With taht said, if you look at the grads of very research heavy programs (eg MGH) many fellows go into private practice.
 
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100% agree with @cabergoline2 . Lets get rid of this 3 min cecum notion. This might happen to someone once a year in those with perfect anatomy. Watch any of the ASGE Masters at courses and they are NOT using this 3 min as a benchmark.

Time to cecum has nothing to do with ADR (unless you are someone who looks actively for polyps on the way in, which is not standard).

Physician scientists I have worked out often are hyperfocused on a specific area within GI and are usually do just fine clinically especially if they are within a niche (which is usually not endoscopy), however they are operating on strict timelines and don't have the luxury of extra clinical electives, and clinical loads as faculty for them usually are lighter since they have so much research and grant support they need to maintain or NIH imposed limits. With fellow support they are often excellent. Overall for bread and butter GI endoscopy they do just fine. As stated above though you may not be very comfortable doing general private practice after an abim research pathway. With taht said, if you look at the grads of very research heavy programs (eg MGH) many fellows go into private practice.
agree on all points. also agree that many fellows of research-heavy, prestigious programs DO go into private practice. however, my question has always been - how do those fellows end up doing in private practice? are they crushing it? or are they scraping by. fellows doing 500+ colons in fellowship are going to be very different than those getting 300 such as is likely the case if you went to MGH, hopkins, or a similar program.

this 3-minute cecum nonsense is never gonna die...
 
agree on all points. also agree that many fellows of research-heavy, prestigious programs DO go into private practice. however, my question has always been - how do those fellows end up doing in private practice? are they crushing it? or are they scraping by. fellows doing 500+ colons in fellowship are going to be very different than those getting 300 such as is likely the case if you went to MGH, hopkins, or a similar program.

this 3-minute cecum nonsense is never gonna die...
I am interested in hearing more opinion on this since I am also starting on the fast track.

Essentially the plan is to do 18 months of clinical which is the minimum and then research which is 4 days research and 1 day clinic/scopes.

I guess its program dependent but how many cases in general does it take to feel okay doing basic EGD Colon? I don't want to give up that skill entirely...
 
I am interested in hearing more opinion on this since I am also starting on the fast track.

Essentially the plan is to do 18 months of clinical which is the minimum and then research which is 4 days research and 1 day clinic/scopes.

I guess its program dependent but how many cases in general does it take to feel okay doing basic EGD Colon? I don't want to give up that skill entirely...

Basic EGD/colon you should do just fine. We have many heavily NIH funded researchers who even do great on complex cases if they happen to encounter it. A substantial amount of improvement continues to happen once out in practice. Probably takes at least a few thousand colons to really obtain fluency, which will happen once in practice as no program will get you that during fellowship alone. Agree that it is program and also fellow dependent, some just 'get it' more quickly than others, or really push themselves. You will pass boards and see basic consults just fine. But if you want to hit the ground running in PP or take on a 100% clinical role you may struggle more than the average, something to consider. Full fledge private practice is intense even for the most clinically strong/ efficient fellow, but it is certainly possible. Certainly a good question if people are scraping by or not, lets see if we can get one of our PSTP colleagues on the forum to fill us in.
 
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I am interested in hearing more opinion on this since I am also starting on the fast track.

Essentially the plan is to do 18 months of clinical which is the minimum and then research which is 4 days research and 1 day clinic/scopes.

I guess its program dependent but how many cases in general does it take to feel okay doing basic EGD Colon? I don't want to give up that skill entirely...
basic EGD, again just 'basic' i'd say 150
basic colon, again stressing the 'basic' and likely to have a suboptimal cecal intubation rate, I'd say 300
 
Ideally, you'd have at least 500 of each. but that will not be possible in your research fellowship but if you hustle you might get close. just don't be cut-throat about it
 
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I think you should try 500 colons .may or may not be possible... Try to get outpatient experience and pick some calls in your research time.. If you remain a researcher , you have 2 months of clinical responsibilities a year...that ll usually be consults in which you ll have a fellow ..typically involve 4-5 scopes a day...you ll have a bunch of clinical colleagues around to ask for help for complex cases... I think you ll be fine... unlike private folks you are not expected to do 20 scopes a day from 8am -3pm with good turnaround time and quality...
 
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Basic EGD/colon you should do just fine. We have many heavily NIH funded researchers who even do great on complex cases if they happen to encounter it. A substantial amount of improvement continues to happen once out in practice. Probably takes at least a few thousand colons to really obtain fluency, which will happen once in practice as no program will get you that during fellowship alone. Agree that it is program and also fellow dependent, some just 'get it' more quickly than others, or really push themselves. You will pass boards and see basic consults just fine. But if you want to hit the ground running in PP or take on a 100% clinical role you may struggle more than the average, something to consider. Full fledge private practice is intense even for the most clinically strong/ efficient fellow, but it is certainly possible. Certainly a good question if people are scraping by or not, lets see if we can get one of our PSTP colleagues on the forum to fill us in.
basic EGD, again just 'basic' i'd say 150
basic colon, again stressing the 'basic' and likely to have a suboptimal cecal intubation rate, I'd say 300
I think you should try 500 colons .may or may not be possible... Try to get outpatient experience and pick some calls in your research time.. If you remain a researcher , you have 2 months of clinical responsibilities a year...that ll usually be consults in which you ll have a fellow ..typically involve 4-5 scopes a day...you ll have a bunch of clinical colleagues around to ask for help for complex cases... I think you ll be fine... unlike private folks you are not expected to do 20 scopes a day from 8am -3pm with good turnaround time and quality...

Thanks, that is reassuring. Am hopeful that the 1 day of clinic/scopes will allow me to stay comfortable. I'll try and tack on some extra cases where I can.

I know there's a intro course to endoscopy for first year fellows, are there any other online resources to better understand basic endoscopic techniques?
 
Thanks, that is reassuring. Am hopeful that the 1 day of clinic/scopes will allow me to stay comfortable. I'll try and tack on some extra cases where I can.

I know there's a intro course to endoscopy for first year fellows, are there any other online resources to better understand basic endoscopic techniques?

If you want to do something use the ASGE stuff for fellows, that should be all you do
 
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A recent PSTP graduate here. Starting PP work right after fellowship last year. I had the same worry before starting the fellowship. I ended up hit the 500 colon and 400 EGD in my clinical years. Maybe I was a fast learner. After becoming attending I felt my clinical skills are at the same level with others. Now I am one of the fastest endoscopists in our practice. I feel your endoscopy skills will have a big jump when you are out by your self. So no worries. Just scope as much as you can during fellowship. Hope this helps.
 
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A recent PSTP graduate here. Starting PP work right after fellowship last year. I had the same worry before starting the fellowship. I ended up hit the 500 colon and 400 EGD in my clinical years. Maybe I was a fast learner. After becoming attending I felt my clinical skills are at the same level with others. Now I am one of the fastest endoscopists in our practice. I feel your endoscopy skills will have a big jump when you are out by your self. So no worries. Just scope as much as you can during fellowship. Hope this helps.
Could you comment on the transition from PSTP to clinical practice?

What were your reasons for switching out of academics?
 
How many do gi midlevels do before then doing scopes themselves?

Mid levels don’t scope. Shouldn’t scope. Don’t try and make it a thing, enough encroachment as it is. Mid levels see clinic patients or consults to help the flow so physicians can scope more, not less.
 
Mid levels don’t scope. Shouldn’t scope. Don’t try and make it a thing, enough encroachment as it is. Mid levels see clinic patients or consults to help the flow so physicians can scope more, not less.
 
Could you comment on the transition from PSTP to clinical practice?

What were your reasons for switching out of academics?
I mean it's the same as everyone else's, sick of doing bull**** research and wanting to get paid
 
How many do gi midlevels do before then doing scopes themselves?
Outside of Hopkins don't know of any nurses performing endoscopy, so can't answer any more then your investigation as to the literature of experimental isolated academic centers experience. It's not a question we can answer because the rest of us don't experience it. Midlevels don't scope in the rest of mainstream US. Good luck
 
 
not really saying anything other than "it may be possible for you to scope..." and in the end why would any pp gi doc want them scoping lol. only in academia, and ironically these big names want mid levels rampant and running around. makes you question the values of these big name academic docs.
 
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