// EDUCATION
DR. RUCHIT SHAH’S QUESTIONS TO DR. MOHAMMAD BILAL As GI fellows, we are developing into roles of a consultant. What do you believe makes for a good consultant? The old saying goes, “a good consultant is a good internist.” However, as fellow, it is also important to understand what being a consultant means. First and foremost, you are now considered an expert in the field (as a first year fellow, I remember many times not feeling that way), so every consult or question that comes to you is a call for help. While, as a busy internal medicine resident, a night without pages or admissions is a pleasant break, to build your reputation as a consultant, you have to get into a mindset of being available and ready to help. If a consult seems too simple to you, take it as a compliment for your skillset and knowledge, and use as an opportunity to educate and teach the consulting teams. The other goal is to aim to “answer the question you have been asked.” While, as an internal medicine resident, your goal is to manage everything, as a consultant your main focus should be to provide expertise in the area where you have been asked for help. This means that your notes should outline a clear plan of action for the referring physicians and primary services. Residents should feel welcomed to call you and reach out to you for your expertise and help. Developing these skills during fellowship will also help in building a great practice whether you choose to stay in academia or go into private practice. Endoscopic training is an integral part of GI fellowship. Endoscopic skills cannot be taught via books or words, but by actions. For endoscopic training, what are some pearls of wisdom you have for new fellows? Well, truly, endoscopy is a combination of both technical and non-technical skills. I am sure we have all heard as fellows, “don’t worry, eventually you will learn endoscopy.” Yet, every fellow (including me during my fellowship) worries about learning endoscopic skills. Remember, that the goal is to have fellows proficient in endoscopic skills over the course of three years. Every fellow has a unique learning curve, and one should only compare their growth to themselves. I always tell my junior fellows that every time you feel like you are not learning endoscopy fast enough, think about the procedural skills you are competent in today as compared to July of your first year (remember the first time navigating the
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sigmoid or even those mid esophageal biopsies). So never proceed with a procedural step that you don’t feel comfortable with—it’s always better to err on the side of caution and NEVER be afraid to ask for help. Meanwhile, focus on learning non-technical skills. Mastering the principles of informed consent, procedural indications, and even understanding the concepts of some endoscopic skills is helpful. For instance, while you might struggle with performing polypectomy in a difficult location, understanding how to do a proper polypectomy can still be achieved. Lastly, you don’t only learn from your attendings, but also from experienced endoscopy technicians and nurses whose insights can be so helpful as you learn the equipment, sizes of snares, basics of electrocautery, etc.
“The beauty of fellowship is that you get to work with several different faculty members, each with a different path, interest and style. You can learn something from everyone.”
How has COVID-19 affected GI fellowship? What suggestions do you have for GI fellows in navigating GI fellowship through the pandemic? I can’t even imagine how challenging it is to start GI fellowship during the SARS-CoV-2 pandemic. Fellowship presents so many new changes in the day-to-day work and life, and pandemic adds a whole new set of challenges. I guess most first year fellows will not even know how it was to do endoscopy without an N95 mask (used in most places currently). It certainly affects in-room communication and education. I believe it is also up to the trainers to be mindful of the new realities of doing procedures during a pandemic, set expectations with fellows ahead of time, and be clear during the procedure. Many experts have predicted that there will be a “new normal” after the pandemic, and there are several aspects of medicine and GI training that we have adopted during the pandemic such as telemedicine or virtual conferences that will be here to stay. I would urge fellows to use a systematic approach to your learning. There is an ocean of virtual learning opportunities available, which is great, but also can be overwhelming. The ACG Virtual GI Grand Rounds are great and cover basic topics (gi.org/ACGVGR). Also, if you have resources and your endoscopy volumes are low due to the pandemic, using endoscopy simulators and working with your fellowship program to incorporate other validated tools that improve non-technical skills will be important parts of your training. There are several resources such as the ACG Education Universe, ASGE Video Tip of the Week library, and YouTube channels of master endoscopists which provide excellent knowledge and endoscopy education. Social media has also emerged as a great tool for medical education.