|As the field of gastroenterology steps forward, we have seen tremendous scientific progress in understanding the pathogenesis and mechanisms of multiple diseases. We have also seen significant advances in how we diagnose, monitor, and treat gastrointestinal conditions.While these advances ultimately benefit our patients, implementing such progress in daily patient care represents a significant challenge. While general gastroenterology fellowship should prepare a physician to manage what is most frequently in typical practice, progress in many areas has triggered the development and growth of focused advanced training programs. These areas include transplant hepatology, advanced endoscopy, inflammatory bowel diseases (IBD), nutrition, and neurogastroenterology/motility.In particular, advanced IBD training has experienced remarkable growth as the development of new diagnostic tests and novel therapies have improved long-term outcomes but also increased the complexity of care. Through exposure to complex therapeutic regimens and the comprehensive variety of IBD disease phenotypes, dedicated training in a large-volume referral center enhances the knowledge a general gastroenterology fellow acquires during standard training.
Though I had a significant exposure to IBD patients during my gastroenterology fellowship, I decided to pursue advanced IBD fellowship after discussion with my mentor at the University of Miami (Dr. Maria Abreu). After one year at the University of Chicago as an advanced IBD fellow, I believe that the extra time spent focused in a specific area of interest is beneficial. I had the opportunity of training in one of the biggest IBD centers in the world, and met two extraordinary new mentors (Drs. Russell Cohen and David Rubin). As a fourth year fellow, I took an active role in the care of patients from around the country through a multidisciplinary team of heath care providers specializing in IBD care. Advanced fellowship also allowed me to contribute to clinical research trials, conduct my own studies, and participate in academic collaborations with other institutions and as part of national societies.
Choosing a program may be difficult as there are so many outstanding institutions in the U.S. and abroad. Some programs are research-oriented while others focus on clinical experience. The specific curriculum of each fellowship varies by institution, and each have different requirements regarding schedules and research time. It is important to research all programs for academic requirements and deadlines, and to note that the application process varies depending on the specialty. Final decisions may be influenced by extracurricular variables as much as program requirements.
Advanced fellowships are relatively new and will likely evolve over time. Programs will improve how future experts in each sub-specialty are trained, ultimately translating into better patient care and long-term outcomes.
Andres Yarur, MD
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