Fellow's Corner
Perspectives from fellows in the field of gastroenterology


GI Training in the 21st Century
A Fellow's Perspective
Michael Connor, MD
Fellow, University of Kansas Medical Center
March 12, 2001

The landscape of gastroenterology is changing at a rate never seen before. New technology, new pharmacology, new diagnostics, transplant medicine, and an ever-evolving public perception have greatly increased the need for well-trained GI physicians. Job opportunities for gastroenterologists are plentiful, too.

As the discipline continues to evolve, so has the training. Basic scientific and clinical research has become an important aspect of every fellow's training. The field of advanced therapeutic and diagnostic endoscopy also provides new challenges for the gastroenterologist of the 21st century.

As the newest member of the Advisory Board of GastroenterologyWeb.com, I have been assigned the task of addressing these and other issues for gastroenterology fellows. I will explore current issues within the practice of GI medicine and training, as well as new advances and therapeutics, from a fellow's perspective. My hope is that current and prospective fellows, academic physicians, and community physicians will all find this column informative and useful.

To prepare for this column I did several things. First, I considered my own experiences as an internal medicine resident, chief resident, and first-year gastroenterology fellow. What lured me into internal medicine in the first place? Why did I choose gastroenterology as my career? What did I learn during a busy, stimulating, and often frustrating year as a chief resident? What best prepared me for fellowship, a role in many ways different from my medicine residency training? How could I have prepared myself more effectively for this transition?

I asked other fellows, including those in other subspecialties, about their own issues. I discovered several common threads in their attitudes, needs, and concerns.

Overall, subspecialty fellows seem to be a fairly satisfied group. We are fairly entrenched in our career path. In most cases, fellows are learning the skills they will need to be successful in the future. Fellows are entrusted with much more responsibility now, and are generally respected by residents and other staff members. Call is somewhat easier and less frequent.

Despite this rosy picture, fellows did have some significant concerns. Within the smaller, more intimate confines of a gastroenterology division, the departure of a mentor to another institution has much more impact than it would for an internal medicine resident. How does a fellow adapt when attending physicians come and go?

Another concern for current gastroenterology fellows is the challenge of learning advanced endoscopic procedures. We are in the midst of a virtual explosion in technological advances within gastroenterology-ERCP, endoscopic ultrasound, and other therapeutic endoscopic procedures. The role of these procedures within the confines of a traditional, three-year gastroenterology fellowship is certainly unclear, and so-called Advanced Endoscopic Training fellowships are very few. In addition, financial, family, and time constraints prevent many fellows from pursuing further training.

Finally, I asked faculty members about the current state of gastroenterology training. They voice many of the same issues as the fellows do. Changing faculty rosters and its impact on current trainees is of utmost importance. Faculty members also place a great deal of emphasis on recruiting current fellows into an academic position. Finally, molding a gastroenterology program within the stringent guidelines of the Residency and Fellowship Review Committee is challenging.

I hope to address these issues and more during the upcoming months. I am looking forward to showing my perspective, as well as that of my colleagues, on gastroenterology training in the 21st century.

I certainly am open to suggestions and feedback about this column, and welcome your input! I hope this site will become a sounding board for issues and concerns. Please do not hesitate to contact me at Please do not hesitate to contact me: mconnor@kumc.edu