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Hi everyone. A fellow SDN member sent me a message with some questions regarding the journey to GI. I typed up some quick thoughts for him/her and thought the answers may be helpful for someone else pondering the same things. I will sit down and flesh these out a little more later (please feel free to add to them) but here are some quick "stream of consciousness" answers to common questions (please excuse misspellings and grammatical errors):
1. What made you want to go into IM--> GI ?
I initially wanted to be a surgeon. I love working with my hands, and even took up instrument building/repair to develop fine motor skills that would be applicable to surgery. I then did my SubI as a 4th year and found that I really could "take or leave" the OR...in other words, it wasn't my favorite place in the world and there were many times I would have rather been somewhere else. This, to me, meant that I would be a terrible surgical resident in terms of drive, as I wouldn't want to deal with the hierarchy and rigor of surgical life to moderately enjoy a portion of the job. I had never really considered anything else to that point, and Medicine became VERY attractive because it afforded me time to decide what I REALLY wanted to do as well as offer a vast amount of clinically imperative knowledge in managing patients. I love that IM covers just about everything in terms of knowledge (it's not that surgery or IM is better or worse than the other...simply 2 different specialties...it's like debating whether Bill Russell or Michael Jordan was the greatest basketball player. Both were excellent, both won multiple titles, one did it with stellar defense and the other with aggressive offense. Anyway, getting back to the question...IM gave me functional capability, clinical knowledge, time and OPTIONS! Did I like Critical Care? Did I want to tinker with electrolytes in Nephro? I had no idea really until I started taking care of patients. I always enjoyed Gastroenterology as a subject...I just understood it so much more than other subjects. If you consider every specialty in medicine, putting it simple, there is a spectrum of physiology<-------------->pathology. Of course, both are involved in every field, but what I mean is that some fields lean more to one than the other. Example: cardiology and pulmonology don't have a *vast* majority of derangement, but the positionality of the derangement determines its upstream and downstream effects...it is VERY physiology heavy. The GI tract, on the other hand, is a self-propogating tube that takes nutrients in on one end and turns out waste product on the other...not that difficult. However, WITHIN GI, you have different pathological occurrences in the esophagus, the pancreas, the liver, the colon, etc...a huge # of different possibilities. Is it cancer? infectious? psychological? GI affords you the ability to utilize your IM skills of differential diagnosis and then take it a step further and intervene! Now you CAN clip that bleed. You CAN find that adenoma. You CAN prove your suspicion of Crohn's. The combination of complexity of pathology and "thinking and doing" made GI the choice for me.
2. You talked about case reports. Is this simply typing up stuff from some other physicians data or what?
Case reports are exactly what they sound like...a formal presentation of an interesting case and its management. Example: Patient X presents with vertigo. Labs and physical exam were done, tests X, Y, Z were ordered, turns out patient had a stroke. This is an unusual presentation of stroke, but can happen, here is a short discussion of other times this occurred and how we might look for warning signs in future cases. Done, that's it...basically it's like a "History and Physical" write-up, featuring a discussion and a few implications at the end of the discussion. These are easy to come by. Ask your residents and attendings for INTERESTING cases that you can write up and present. Tell them of course their name will be on it. They will happily give you cases to write up and research. You can present these as posters at conferences, and submit them to peer review journals to get them published. These are "stat stuffers"...demonstration that you are willing and capable to perform academic inquiry and obtain information relevant to the practice of medicine.
3. I want to do "clinical research" but I've never done lab research. How would I go about doing clinical research?
I was in the same boat. You know what the secret of research is? THERE IS NO MAGIC TO IT! What I mean is, it does not matter if you know exactly what to do from the get go...you only learn by doing. The easiest thing to do is ask residents and attendings how you can help on current projects. Are you good at stats? Great, tell them you do their data number crunching. Are you a good writer? Excellent, then you'll go to the research office and find out what you need to do to write up the IRB and you'll do it. Are you good at teasing out research articles? Awesome, you'll do the literature review. Find a way to be a functional cog in a bigger machine, and learn from that machine as you go along! Eventually, you'll have an idea...hey, if eosinophilic esophagitis is in someone's throat, why do we give them their treatment (steroids) in their veins? What if we made it into a spray and sprayed it directly into their throat? Would that improve symptoms? Help their disease resolve faster? Do nothing at all? You figure out this question, fill out the paperwork, review the literature to see if it's been done already and, if so, how you can improve on what's been done or put a different twist to it, talk to an attending to have access to patients for your study, and then go do it!
4. I'm assuming the first step in getting into GI would just get into a great IM residency, yes?
The first step into getting a GI fellowship is to be the BEST INTERNAL MEDICINE RESIDENT YOU CAN BE! Does pedigree help? Yes. Will programs be more likely to pick you up from UPenn than a community hospital in Alaska? Probably, yes. Will they know if you are lazy and simply feel entitled because you come from a good program? YES!
Of course, do your best to find the program that best suits your needs. In this case, it is a program with:
- its own GI fellowship
- available research with willing attendings/professors that will guide and help you
- a place that you are happy to work at day in and day out, even when things are rough
Of course, there are much minutia that one can tease apart later on...letters, recs, phone calls, etc. First and foremost though, if you are a lazy resident, then you will be a lazy doctor, and that will not fly for fellowship. Smile, work hard, STUDY, go the extra mile for your patients, show that you are interested and demonstrate that interest by following through on some projects...a couple of case reports, a few presentations, contribute to a good study that is happening at your institution...maybe go to a national meeting with that attending, and you will be fine 🙂
Simply put, start by being the best damn IM doctor that ever was, and you will make a heck of a Gastroenterologist!
1. What made you want to go into IM--> GI ?
I initially wanted to be a surgeon. I love working with my hands, and even took up instrument building/repair to develop fine motor skills that would be applicable to surgery. I then did my SubI as a 4th year and found that I really could "take or leave" the OR...in other words, it wasn't my favorite place in the world and there were many times I would have rather been somewhere else. This, to me, meant that I would be a terrible surgical resident in terms of drive, as I wouldn't want to deal with the hierarchy and rigor of surgical life to moderately enjoy a portion of the job. I had never really considered anything else to that point, and Medicine became VERY attractive because it afforded me time to decide what I REALLY wanted to do as well as offer a vast amount of clinically imperative knowledge in managing patients. I love that IM covers just about everything in terms of knowledge (it's not that surgery or IM is better or worse than the other...simply 2 different specialties...it's like debating whether Bill Russell or Michael Jordan was the greatest basketball player. Both were excellent, both won multiple titles, one did it with stellar defense and the other with aggressive offense. Anyway, getting back to the question...IM gave me functional capability, clinical knowledge, time and OPTIONS! Did I like Critical Care? Did I want to tinker with electrolytes in Nephro? I had no idea really until I started taking care of patients. I always enjoyed Gastroenterology as a subject...I just understood it so much more than other subjects. If you consider every specialty in medicine, putting it simple, there is a spectrum of physiology<-------------->pathology. Of course, both are involved in every field, but what I mean is that some fields lean more to one than the other. Example: cardiology and pulmonology don't have a *vast* majority of derangement, but the positionality of the derangement determines its upstream and downstream effects...it is VERY physiology heavy. The GI tract, on the other hand, is a self-propogating tube that takes nutrients in on one end and turns out waste product on the other...not that difficult. However, WITHIN GI, you have different pathological occurrences in the esophagus, the pancreas, the liver, the colon, etc...a huge # of different possibilities. Is it cancer? infectious? psychological? GI affords you the ability to utilize your IM skills of differential diagnosis and then take it a step further and intervene! Now you CAN clip that bleed. You CAN find that adenoma. You CAN prove your suspicion of Crohn's. The combination of complexity of pathology and "thinking and doing" made GI the choice for me.
2. You talked about case reports. Is this simply typing up stuff from some other physicians data or what?
Case reports are exactly what they sound like...a formal presentation of an interesting case and its management. Example: Patient X presents with vertigo. Labs and physical exam were done, tests X, Y, Z were ordered, turns out patient had a stroke. This is an unusual presentation of stroke, but can happen, here is a short discussion of other times this occurred and how we might look for warning signs in future cases. Done, that's it...basically it's like a "History and Physical" write-up, featuring a discussion and a few implications at the end of the discussion. These are easy to come by. Ask your residents and attendings for INTERESTING cases that you can write up and present. Tell them of course their name will be on it. They will happily give you cases to write up and research. You can present these as posters at conferences, and submit them to peer review journals to get them published. These are "stat stuffers"...demonstration that you are willing and capable to perform academic inquiry and obtain information relevant to the practice of medicine.
3. I want to do "clinical research" but I've never done lab research. How would I go about doing clinical research?
I was in the same boat. You know what the secret of research is? THERE IS NO MAGIC TO IT! What I mean is, it does not matter if you know exactly what to do from the get go...you only learn by doing. The easiest thing to do is ask residents and attendings how you can help on current projects. Are you good at stats? Great, tell them you do their data number crunching. Are you a good writer? Excellent, then you'll go to the research office and find out what you need to do to write up the IRB and you'll do it. Are you good at teasing out research articles? Awesome, you'll do the literature review. Find a way to be a functional cog in a bigger machine, and learn from that machine as you go along! Eventually, you'll have an idea...hey, if eosinophilic esophagitis is in someone's throat, why do we give them their treatment (steroids) in their veins? What if we made it into a spray and sprayed it directly into their throat? Would that improve symptoms? Help their disease resolve faster? Do nothing at all? You figure out this question, fill out the paperwork, review the literature to see if it's been done already and, if so, how you can improve on what's been done or put a different twist to it, talk to an attending to have access to patients for your study, and then go do it!
4. I'm assuming the first step in getting into GI would just get into a great IM residency, yes?
The first step into getting a GI fellowship is to be the BEST INTERNAL MEDICINE RESIDENT YOU CAN BE! Does pedigree help? Yes. Will programs be more likely to pick you up from UPenn than a community hospital in Alaska? Probably, yes. Will they know if you are lazy and simply feel entitled because you come from a good program? YES!
Of course, do your best to find the program that best suits your needs. In this case, it is a program with:
- its own GI fellowship
- available research with willing attendings/professors that will guide and help you
- a place that you are happy to work at day in and day out, even when things are rough
Of course, there are much minutia that one can tease apart later on...letters, recs, phone calls, etc. First and foremost though, if you are a lazy resident, then you will be a lazy doctor, and that will not fly for fellowship. Smile, work hard, STUDY, go the extra mile for your patients, show that you are interested and demonstrate that interest by following through on some projects...a couple of case reports, a few presentations, contribute to a good study that is happening at your institution...maybe go to a national meeting with that attending, and you will be fine 🙂
Simply put, start by being the best damn IM doctor that ever was, and you will make a heck of a Gastroenterologist!
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