out. Effective communication is key –
oftentimes, the advanced endoscopist
is the first person to tell a patient they
have cancer. Qualities of compassion
and empathy are essential in all aspects of medicine but are particularly
important during these critical conversations. Finally, after a procedure,
communication with the patient’s oncologist, surgeon, radiation oncologist,
or primary care doctor to discuss next
steps in management occupies a considerable amount of time.
What can fellows do during their
training to best prepare for a future
advanced endoscopy fellowship?
Once you are committed to an AEF,
I would spend as much time as pos-
sible with an advanced endoscopist
at your institution, even if it means
just observing procedures. Many
techniques are repetitive and gain-
ing a general understanding of the
available tools and tactics can help
you strategize prior to a procedure.
Get to know your endoscopy technician well; watch them do their job,
and ask them questions about how
things work. It will greatly contribute to your understanding of why
an attending chooses a specific tool
or technique. Do as many general GI
procedures as you can; the better
your general endoscopic skills are,
the more likely your mentors will be
to allot you more scope time. Think
about a research project and start
planning it ahead of time, even before you start your AEF year. It can
be hard to start and complete a project during such an intense year, but
it is much easier to work on something that you have already started.
Additionally, pass a side-viewing
duodenoscope or EUS scope as
many times as you can into the du-
odenum. While prior experience in
EUS or ERCP is not necessary for
an advanced fellowship, these ba-
sic endoscopic skills certainly help
your confidence early on and allow
you to focus on the next set of skills
you want to acquire. Finally, look at
as many CT scans and MRIs as you
can to become more familiar with
cross-sectional anatomy and also
consider attending a tumor board
conference at your institution. n
Acknowledgements: Gene Bakis,
Nisa Kubiliun, Vinay Chandrasekhara,
M. Brian Fennerty
Heller, S.J. and Tokar J.L. Adv. Med. Educ. Pract.
Xiong X., et al, Can. J. Gastroenterol.
Coyle W.J., et al, Gastrointest Endosc. 2012
December;76:1211-3. doi: 10.1016/j.
gie.2012.08.026. Epub 2012 Oct. 6.
Q1: Constipation is more common after which of the following bariatric surgical procedures?
A. Roux-en-Y gastric bypass
B. Gastric banding
C. Biliopancreatic diversion
D. Vertical-banded gastroplasty
E. Sleeve gastrectomy
Q2: A 44-year-old female with a history of short bowel syndrome presents to the office with complaints of a scaly
red rash on her face, groin, and hands and progressive
alopecia. What is the most likely etiology?
A. Vitamin B12 deficiency
B. Zinc deficiency
C. Vitamin D deficiency
D. Copper deficiency
E. Vitamin E deficiency
QUESTIONS // Answers on page 25