1. Program Directors’ Caucus
Update
TDW 2013
Art DeCross MD AGAF
Associate Professor
Gastroenterology and Hepatology Division
University of Rochester Medical Center

2. For the new guys…
The question might be:
Who are we?
Rafiki: The question is, who... are you?

3. We are this nation’s
156 GI Fellowship Training Programs#
30% 50% 20%
SMALL MEDIUM BIG
1-2 fellows/year 3 fellows/year > 4 /year*
*median 4
#Data from 2009 GI Fellowship Range 4-10
Training environment survey

4. Mission Environment
100
90 35
80 30
70
25
60 SMALL
50 Total 20
MEDIUM
40 Clinical 15 BIG
30
Research
20 10
10 5
0
0
CLINICAL RESEARCH
n=63 n=36

5. Why are we here?
(Why create a Caucus?)

6. One good reason: Programs self-identified*
with INADEQUATE OR MARGINAL RESOURCES
# of programs
100
90
80
70
Total
60 46%
AT RISK
50
40
30 60% 42%
20 37%
10
0
ALL SMALL MEDIUM BIG
* Data from 2009 GI Fellowship Training environment survey

7. Another good reason:
Because this is what training used to look like
July 1, every year GI FELLOW
Apprenticeship model: Spend 3 years as my GI fellow,
& you are a gastroenterologist.

8. And this is what someone wants it to
look like…
Yes, the “M” word.

9. And it is usually at this point you New guys realize
you need Indispensable Program Director Tools

10. How do we control our training environment?
Ideally…
AGA
ASGE Training
Training Committee
Committee
GI Training
Environment
AASLD ACG
Training Training
Committee Committee
Our profession would shape and guide the training
environment, robustly responsive and adaptive to changing needs.

11. In Reality…
ACGME
(“we’re here to help”)
ACGME
ASGE
AGA
GI Fellowship
Training Programs
Program Director ACG
AASLD
(“please stop helping”)
ACGME dictates rules and defines the training environment.
Programs are isolated. Input from the profession is well intentioned
but was prone to being slow, sporadic, unilateral and uncoordinated.

12. Why have a GI PD Caucus…
ACGME
Coordinate a
Provide a more uniform
more responsive
training environment Isolated
GI Training
and deliberate
through sharing. training programs
program environment
support from the
–-lonely GI PDs -
GI PD Caucus -
profession.
AASLD ACG ASGE AGA

13. Caucus Mission Statement
1. To serve the professional administrative
needs of all GI Fellowship Training Directors.
2. To more effectively promote the educational
and training goals of our Profession, as
advocated through all of our professional
colleges, societies and associations.
3. To create a more effective interaction
between our training programs and the
agencies of GME which regulate them.

14. Functional objectives
• Create a forum for rapid response to identifying and
addressing issues affecting training programs.
• Provide access to Training program directors’
perspective on agenda items advanced through our
Education and Training committees, and on ACGME
issues.
• Create a mechanism to more effectively
communicate and implement shared educational and
training goals of the Profession.
• Create standardized, validated tools and identify
resources for program administration.

15. Functional Objectives
- simplified -
• Identify the issues
• Facilitate communication
• Create the tools

16. Updated activities
• Communication:
– Match timeline shift finalized.
– Chris Bowlus MD, PD UC Davis, represented GI
– PD Caucus committed to measuring impact:
• 2011 Match PDs and 1st year fellows surveyed
• Same survey will be conducted following Dec 2012
Match for the entering class of July 2013.
• Major concern remains the potential impact of the
shortened interview season.

17. Just how healthy
is the Match?
(after timeline shift?)

18. GI Fellowship Match Participation
Start Date Tracks* Programs Positions Total Matched
Offered Applicants Applicants
2007 134 112 285 585 276
2008 150 123 325 622 313
2009 153 126 339 608 328
2010 153 127 361 627 345
2011 157 130 383 642 362
2012 162 134 399 664 387
2013 171 144 433 695 418
*The NRMP lists this column as certified programs, counting all of the participating tracks
in gastroenterology, as many as four for any single program. Excluding military
programs, there are approximately 156 GI fellowship programs that are eligible to
participate in the NRMP/SMS giving GI programs a 92% participation rate for positions
starting in July 2013.
NRMP and AGA Statistics (2013)
DATA from 2007-2012: courtesy of Deborah D. Proctor MD

19. Match survey (pre-timeline shift)
• Existing first year fellows surveyed on
Match kinetics
• 72 respondents of 362 matched first year
applicants (~20%)
• Recall: “old” Match completed application due
mid-R2 year, required
rotations, research, career plans, mentoring etc.
to solidify as an intern

20. (pre-timeline shift)
Did you feel rushed in making your
decision to enter the GI Match process?
20%
Yes No
80%

21. (pre-timeline shift)
Do you feel you had enough time to build
a solid CV for the GI Match process?
28% Yes No
72%

22. (pre-timeline shift)
How many programs did you apply to in the Match?
40
35
30
25
20
Percent total applicants
15
10
5
0
0 - 10 11 ~ 25 26 - 50 51 - 75 76 - 100 > 100
# of program applications per applicant

23. (pre-timeline shift)
How many programs did you get to interview at?
30
25
20
15
% of total applicants
10
5
0
1~3 4~6 7~9 10~12 13-15 >15
# of interviews per applicant

24. (pre-timeline shift)
Do you wish you had applied to:
7% More programs
Less programs
24%
I applied to just the
69% right number

25. (pre-timeline shift)
How many interviews did you decline due to
unavoidable conflicts or lack of duty coverage?
70
60
50
40
% of total applicants
30
20
10
0
0 1 2 3 4 5 >5
# of interviews declined, per applicant, due to conflicts

26. (pre-timeline shift)
• How many weeks were between your first
interview date and your last interview date?
– MEAN: 10.3 weeks (pre-timeline shift)
– MEDIAN: 10 weeks (pre-timeline shift)
Reminder: pre-timeline shift: Interview season
technically Jan 1 thru May 21 (20 weeks max)
practically Feb 1 thru May 1 (13 weeks)

27. (pre-timeline shift)
Did you feel rushed in formulating
your match list after you interviewed?
1.4%
Yes
No
98.6%

28. (pre-timeline shift)
What choice was your program (that you matched) on
your rank-order list?
70.00%
60.00%
50.00%
40.00%
% of matched fellows
30.00%
20.00%
10.00%
0.00%
1 2 3 4~5 >5
Which ranked program on your list did you match?

29. Match survey (pre-timeline shift)
• GI Program Directors surveyed
• 16/158 respondents = ~ 10%
• 1. How many positions were offered in the
clinical track? Mean: 2.6
• 2. How many applicants were interviewed for
your clinical track? Mean 37 (14.2 : 1)
• 3. How many applicants were ranked for your
clinical track? Mean 25 (9.6 : 1)

30. Match survey (pre-timeline shift)
• 8. What was the lowest rank # of the last
applicant to match at your program on your
rank order list? (i.e. how far down the list did
you go to fill the clinical positions at your
program)
6
5
4
3
# of program directors
2
1
0
rank 1-7 rank 8-15 rank 16-25 rank >25

31. Updated activities
• Creating the tools:
– Focusing on curriculum modules for niche areas
of the curriculum:
– Nutrition module: Completed!
– In various stages of progress:
• Practice Management (Ryan Madanick MD)
• Women’s Health Issues in GI (Kathryn Peterson MD)
• We need you to volunteer!
Geriatrics (Charlene Prather MD)
Join a• committee and share your expertise!
Motility (TBD)

32. Early Challenges for the Caucus

33. Early Challenges for the Caucus…
ACGME
Coordinate a
Provide a more uniform Isolated more responsive
training environment trainingTraining
GI programs and deliberate
through sharing. program environment
support from the
profession.
AASLD ACG ASGE AGA

34. Challenges
How do we go from this….
Program Director
(“please stop helping”)
To this…everyone on the same team?

35. Governance Redesign
of the GI Program Directors’ Caucus
Existing structure
GI Training
program environment
From the 156 GI programs, a demographically representative
steering committee body, selected based on program size and
training mission (clinical vs research)

36. PD Steering Committee
AASLD training AGA training
ACG training ASGE training
committee committee
committee committee
AGA
AASLD ACG governing ASGE governing board
governing board board governing board
G8

37. Existing structure
• Problems:
– Not nimble
– Not timely
– Competing agendas
– 5th wheel - most of the training committees not
consulting with us, not sure where we fit in.

38. Governance Redesign
of the GI Program Directors’ Caucus
Proposed Structure
Steering Committee
AASLD AASLD
2012-2014 2012-2013
ACG ACG
2012-2014 2012-2013
AGA AGA
2012-2014 2012-2013
ASGE ASGE
2012-2014 2012-2013

39. Advisory Board
Big Research Big Research
2012- 2013 2012-2014
Medium Medium Medium Medium Medium
Clinical Clinical Clinical Clinical Research
2012-2013 2012-2013 2012-2014 2012-2014 2012-2013
Small Small Small
Clinical Clinical Clinical
2012-2013 2012-2014 2012-2014

40. Advisory Board
Steering Committee
AASLD ACG training ASGE AGA
training cmt cmt training cmt training cmt
AASLD ACG GB ASGE AGA
GB GB GB

42. Incoming chair for
the GI Program Directors’ Caucus
Thomas J. Savides MD
• Professor, UC SanDiego
• Executive Vice Chairman, UCSD Dept of Medicine
• GI Program Director – June 2004 to present
• Advanced Endo Training Director – 2001 - present
• Clinical Services Chief, UCSD Gastroenterology
• ASGE Training Committee 2005-07
• ASGE Governing Board 2007-2010

43. Acknowledgements
• Course directors Walter Coyle and Jane Onken
• Robert Sandler MD, AGA president supportive of
initiating the GI PD Caucus
• AGA Education and Training committee which
nutured the development of the caucus
• AGA staff, most particularly Ms. Tamara Jones of
the AGA, principle administrator for the Caucus
• Countless volunteers among the GI Program
Directors