Small GI Training Small GI Training Programs: ProblemsPrograms: Problems

March 2013March 2013

Walter J. Coyle MD, FACG, FASGE

Small ProgramsSmall Programs

Limited resources– Nutrition, motility, advanced procedures,liver

transplant, etc..

Educational opportunities– Conferences, meetings

Small faculty– Not all good teachers or proceduralists

Service vs Training

Limited Resources: MotilityLimited Resources: Motility

Fellows required to have significant exposureDidactics insufficient but requiredReading of manometry tracingsResurgence of need and interest

– High resolution mano– Impedance– IBS and breath testing

Motility and US NavyMotility and US Navy

Six fellows, 4 staffHad old mano system with trained tech Only one staff felt “comfortable” reading

mano but not teaching it.Had motility expert in Navy

– Bring TAD 2 times per year for didactics– Reviewed interesting tracings– Sent one fellow every year to motility month

sponsored by ANMS

ANMS is Am Neurogastroenterology and Motility Society

Motility and Scripps ClinicMotility and Scripps Clinic

Six fellows, 12 staffNo mano system Have National expert at UCSD

– Pay for service>> $$$– Bring over 2 times per year for didactics– Fellows rotate for 4 weeks in 2nd year

Plus elective

– Send one fellow every year to motility month sponsored by ANMS

ANMS is Am Neurogastroenterology and Motility Society

Small Program: problem staffSmall Program: problem staff

Fair teacher, more interested in GolfGood endoscopist; patient with fellowsUsed fellows as service tools to make his

life easierRefused to fill out evals despite all

counseling

Options???

Small Program: problem staffSmall Program: problem staff

With reluctant consent from Dept HeadInformed him that the fellows would not be

taking call with him any more– Behavior changed– Fellows resumed work with him

Big stick, not for routine use

Small Program: ResearchSmall Program: Research

Very difficult in US NavyRequired that all fellows have paper

submitted or national presentationMix of case reports and retrospective

studies mostlyMotivated staff did several prospective

studies– No incentives – Grants from ACG, AGA, ASGE

Research RecommendationsResearch Recommendations

Mandatory for fellowsTry to compensate people

– Time off– Less call– Less RVU demand– Awards and Recognition

Lead by example: PD MUST DO RESEARCH