Issues Facing Small Programs

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Issues Facing Small Programs

  1. 1. Small GI TrainingPrograms: Problems March 2013Walter J. Coyle MD, FACG, FASGE
  2. 2. Small 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
  3. 3. Limited Resources: Motility Fellows required to have significant exposure Didactics insufficient but required Reading of manometry tracings Resurgence of need and interest – High resolution mano – Impedance – IBS and breath testing
  4. 4. Motility and US Navy Sixfellows, 4 staff Had 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
  5. 5. Motility and Scripps Clinic Sixfellows, 12 staff No 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
  6. 6. Small Program: problem staff Fair teacher, more interested in Golf Good endoscopist; patient with fellows Used fellows as service tools to make his life easier Refused to fill out evals despite all counselingOptions???
  7. 7. Small Program: problem staff With reluctant consent from Dept Head Informed 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
  8. 8. Small Program: Research Very difficult in US Navy Required that all fellows have paper submitted or national presentation Mix of case reports and retrospective studies mostly Motivated staff did several prospective studies – No incentives – Grants from ACG, AGA, ASGE
  9. 9. Research Recommendations Mandatory for fellows Try to compensate people – Time off – Less call – Less RVU demand – Awards and Recognition Lead by example: PD MUST DO RESEARCH

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