1. Small GI Training
Programs: Problems
March 2013
Walter J. Coyle MD, FACG, FASGE

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. 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. 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. 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. 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. 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. 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. 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