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Gastroenterology – a trainee’s perspective
Trainee
Gastroenterology – a trainee’s perspective
Endoscopy appeals to most who are considering a career in gastroenterology. While manual dexterity is essential, a clear understanding of the indications and contra-indications for endoscopic intervention is equally important. It is a valuable technique that allows us to visually inspect and intervene in disease processes, for example banding of bleeding varices and injecting bleeding ulcers. There are very few medical specialities where doing an emergency procedure will save someone’s life. As new treatments emerge, gastroenterology is becoming an increasingly outpatient-based speciality. My current commitments include two outpatient clinics and two endoscopy daycase lists a week. A proportion of patients will require inpatient treatment, for example acute colitis, GI bleeders and decompensated cirrhotics, and this consumes the rest of my time. Inpatients can deteriorate rapidly and require prompt, intensive management, often in close conjunction with surgical colleagues. Consequently, gastroenterologists need to be composed and decisive in stressful situations. The training of gastroenterologists has evolved even during my relatively short time as a doctor. Structured training in the form of mini-CEX, DOPS, MSF and, more recently, knowledge-based assessments are designed to ensure all future consultants are of the same standard. Entry into a programme is highly competitive. It is simply not enough to possess the MRCP. In order to get ahead, ‘budding’ gastroenterologists will need to make inroads at an early stage. Exposure to outpatient clinics and endoscopy units, undertaking an audit/research project or writing up a case report are all worthwhile. Attendance at courses and demonstration of practical capabilities are also requirements. The future of gastroenterology is exciting. Research at a genetic, immunological and molecular level is progressing and will hopefully identify the aetiology of a number of conditions that have been elusive for so long; it also raises the possibility of novel targeted therapy. Advances in endoscopic technology, such as chromoendoscopy and narrow-band imaging, will lead to the earlier detection and removal of sinister lesions and negate the need for surgery, particularly as the population ages. Subspecialization is becoming increasingly more commonplace, and I suspect that future gastroenterology departments will be made up of gastroenterologists with an interest in a particular field, such as luminal, hepatobiliary, nutrition or endoscopy. ◆
Nishchay Chandra
Gastroenterology is an immensely stimulating and rapidly evolving speciality. Its appeal lies in its ability to combine both theoretical and practical aspects in a manner that very few medical or surgical specialities are able to provide. Many gastrointestinal (GI) disorders are readily treatable and therefore professionally rewarding. I have trained within the speciality at PRHO, SHO and now SpR level, and the fundamental clinical skills required remain unchanged. Detailed history taking and a thorough examination with the formulation of a relevant differential diagnosis are integral to the gastroenterologist. Endoscopy is often used as an adjunct to confirm clinical suspicion. A broad knowledge base is essential by virtue of the anatomical and functional diversity of the gastrointestinal tract, and the multisystemic nature of the speciality. I am still perplexed at how neighbouring yet continuous structures can possess such different histological, physiological and biochemical properties, yet this forms the basis of much of the intellectual stimulation that gastroenterology provides. Excellent communication skills and the ability to work as part of a multidisciplinary team are vital. Close interaction with other medical/surgical/oncological specialities, general practitioners, radiologists, pathologists, specialist nurses, nutritionists, dieticians, pharmacists and social workers occur on a daily basis. GI disorders can be challenging as they can affect patients of any age, ethnicity and social class. For example, young patients with inflammatory bowel disease often present with symptoms that they perceive as embarrassing, and they are frightened at the thought of undergoing invasive endoscopic procedures. Establishing their trust and a good rapport can be challenging, but rewarding when successful.
Nishchay Chandra MBBS MRCP is a 3rd year Specialist Registrar in Gastroenterology and General Medicine, currently working at the John Radcliffe Hospital, Oxford, UK. His interests within the speciality include inflammatory bowel disease and therapeutic endoscopy. Conflicts of interest: none declared.
THE FOUNDATION YEARS 4:7
299
© 2008 Elsevier Ltd. All rights reserved.
Gastroenterology – a trainee’s perspective
Endoscopy appeals to most who are considering a career in gastroenterology. While manual dexterity is essential, a clear understanding of the indications and contra-indications for endoscopic intervention is equally important. It is a valuable technique that allows us to visually inspect and intervene in disease processes, for example banding of bleeding varices and injecting bleeding ulcers. There are very few medical specialities where doing an emergency procedure will save someone’s life. As new treatments emerge, gastroenterology is becoming an increasingly outpatient-based speciality. My current commitments include two outpatient clinics and two endoscopy daycase lists a week. A proportion of patients will require inpatient treatment, for example acute colitis, GI bleeders and decompensated cirrhotics, and this consumes the rest of my time. Inpatients can deteriorate rapidly and require prompt, intensive management, often in close conjunction with surgical colleagues. Consequently, gastroenterologists need to be composed and decisive in stressful situations. The training of gastroenterologists has evolved even during my relatively short time as a doctor. Structured training in the form of mini-CEX, DOPS, MSF and, more recently, knowledge-based assessments are designed to ensure all future consultants are of the same standard. Entry into a programme is highly competitive. It is simply not enough to possess the MRCP. In order to get ahead, ‘budding’ gastroenterologists will need to make inroads at an early stage. Exposure to outpatient clinics and endoscopy units, undertaking an audit/research project or writing up a case report are all worthwhile. Attendance at courses and demonstration of practical capabilities are also requirements. The future of gastroenterology is exciting. Research at a genetic, immunological and molecular level is progressing and will hopefully identify the aetiology of a number of conditions that have been elusive for so long; it also raises the possibility of novel targeted therapy. Advances in endoscopic technology, such as chromoendoscopy and narrow-band imaging, will lead to the earlier detection and removal of sinister lesions and negate the need for surgery, particularly as the population ages. Subspecialization is becoming increasingly more commonplace, and I suspect that future gastroenterology departments will be made up of gastroenterologists with an interest in a particular field, such as luminal, hepatobiliary, nutrition or endoscopy. ◆
Nishchay Chandra
Gastroenterology is an immensely stimulating and rapidly evolving speciality. Its appeal lies in its ability to combine both theoretical and practical aspects in a manner that very few medical or surgical specialities are able to provide. Many gastrointestinal (GI) disorders are readily treatable and therefore professionally rewarding. I have trained within the speciality at PRHO, SHO and now SpR level, and the fundamental clinical skills required remain unchanged. Detailed history taking and a thorough examination with the formulation of a relevant differential diagnosis are integral to the gastroenterologist. Endoscopy is often used as an adjunct to confirm clinical suspicion. A broad knowledge base is essential by virtue of the anatomical and functional diversity of the gastrointestinal tract, and the multisystemic nature of the speciality. I am still perplexed at how neighbouring yet continuous structures can possess such different histological, physiological and biochemical properties, yet this forms the basis of much of the intellectual stimulation that gastroenterology provides. Excellent communication skills and the ability to work as part of a multidisciplinary team are vital. Close interaction with other medical/surgical/oncological specialities, general practitioners, radiologists, pathologists, specialist nurses, nutritionists, dieticians, pharmacists and social workers occur on a daily basis. GI disorders can be challenging as they can affect patients of any age, ethnicity and social class. For example, young patients with inflammatory bowel disease often present with symptoms that they perceive as embarrassing, and they are frightened at the thought of undergoing invasive endoscopic procedures. Establishing their trust and a good rapport can be challenging, but rewarding when successful.
Nishchay Chandra MBBS MRCP is a 3rd year Specialist Registrar in Gastroenterology and General Medicine, currently working at the John Radcliffe Hospital, Oxford, UK. His interests within the speciality include inflammatory bowel disease and therapeutic endoscopy. Conflicts of interest: none declared.
THE FOUNDATION YEARS 4:7
299
© 2008 Elsevier Ltd. All rights reserved.