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Young GI angle: New starter GI residents
Commencing life as a GI resident is certainly daunting. Armed with general medical knowledge but little else, you are expected to function as a competent member of the ward team knowing how to recognise the acutely unwell GI patient and stabilise them accordingly. Not only do new starters in GI need to equip themselves with the practical side of their specialty translating their book knowledge to treating the patient in front of them, they also need to learn new endoscopic skills. Here, we highlight our tips for supporting and mentoring new doctors as they commence their gastroenterology training.
Neel Sharma (junior perspective)
As a new GI trainee there are times when I am faced with the unwell patient that, despite initial treatment, may not be responding as I had hoped. Here are some of my tips to survive your time as you begin your Gastroenterology training:
- Seek help early on. Once you have assessed the patient, be it an active GI bleed or unwell colitic and have commenced initial treatment, ensure your ward consultant/senior has been notified in a timely fashion. Often your initial management steps are valid yet your consultant can add that finesse based on their years of experience. Furthermore, they can often help expedite things such as an urgent scan or urgent endoscopy. As a junior it is often difficult to push for these things so early notification is certainly worthwhile. It is important to note that there may be times when your senior is not easy to reach due to them being busy with other unwell patients. In this case you can reach out to other seniors, such as internal medical doctors and intensivists who will still be able to support you in stabilising acute patients. It is also imperative to avoid having ‘tunnel vision’. When things are not progressing well from a management side, pause and start from scratch. Reassess the patient's history and re-examine. Think of things that could have easily been missed. It is all too common to follow the trend of thought laid out by seniors previously but be bold enough to suggest potential differentials and tests that could be relevant.
- Be organised. As a new doctor in the field of GI you will be dealing with many unwell patients. Once the ward round is complete, discuss with your consultant what are the tasks for the day and rank their priority. Organising imaging and endoscopy always takes priority over a discharge summary despite what the nurses may say. Ensuring investigations for the day are done early on ensures they can be actioned and management can be fine-tuned accordingly. It is also important to understand the art of delegation. As you continue in your specialty training, focus on what is relevant to your learning; tasks such as blood taking or cannula insertion should be undertaken by your juniors.
- Be open. It may be daunting to work for an expert senior consultant, particularly in large teaching centres. Yet it is important to let them know what your interests are. In GI, what areas interest you and how can they support this. Your interests may be in a particular area: luminal/hepatology/endoscopy/nutrition. You may have research interests or an interest in education or management. Without speaking up, you never know what opportunities are available to you. Senior consultants will always have exciting projects to engage you with or colleagues they can connect you with. And they are always willing to guide you accordingly. Even if their subspecialty interest is not one of interest to you, having broader connections can still be of merit to your learning and career trajectory. Transparency is also relevant when it comes to analysing your strengths and weaknesses. Mastering lower GI endoscopy is often difficult, hence asking your supervisor for added tips or extra endoscopy sessions is of huge value.
Jason Goh, Rachel Cooney, Shrikanth Pathmakanthan, Sheldon Cooper (senior perspectives)
- Read guidelines and review articles. Make time to do regular reading of published guidelines and expert review articles on common GI conditions including IBD, IBS, GI bleeding and liver diseases. From the European perspective, excellent publications and learning resources from UEG, ECCO, EASL and ESGE are widely available as open access articles or by society membership. If reading gets tiresome, podcasts are also a valuable option. With mobile technology, podcasts are easily downloadable and can provide a more fulfilling learning experience through auditory means as opposed to reading alone. At our institution, for example, the educational experience of trainees was completely revolutionised via podcasts (PodDoc). Arming yourself with solid knowledge will give you the confidence to manage these conditions and to adopt an evidence-based approach early on in your career.
- Set goals and milestones. Your fellowship will fly by and it is worthwhile setting realistic goals and achievements at 6-monthly intervals. There are obvious learning milestones that are guided and mandated in the form of personal development plans in your learning portfolio, but there are also personal ones that you can set, such as completing a small project, achieving a set number of endoscopic procedures, working on a paper, etc., and aiming to achieve these realistic goals in 6-monthly time frames. This can be morale boosting as you are often achieving and learning more than you think you are and it also brings out the best in you. To help with these goals, find a mentor with a similar vision to yours. It may take some time but they exist, and working with someone that inspires you makes things even more rewarding!
- Embrace collegiality. Your fellow trainees are your most important human source of support. Even if you are the ‘quiet’ type, you should make an effort to embrace your peer group, who can provide an invaluable sense of mutual support, learning and inspiration. We are fortunate in Gastroenterology that this collegiality is inter-disciplinary and encompasses surgeons, specialist nurses and scientists. Furthermore, engaging with registrars at different levels can offer an insight into the necessary milestones that need meeting later on and also of the difficulties they may have faced in their training journey. This is an essential ‘survival skill’ that will bring everything from personal support to collaborative research. Senior consultants should also embrace their juniors as they develop. Ensure you listen to their perspective when it comes to management approaches. It is all too common to assume a junior resident knows very little in reference to your experience. However this is not always true. Take a step back at times and allow your residents to lead. You may be pleasantly surprised.
Good Luck!
