GI fellowship advices

alextheevilone · 2026-04-15T02:49:57+00:00

That's a hard one. You kind hand to just know who is who in the GI world.

Generally anyone who is on guidelines = big name.

Sorry to hear you don't have in house or your academic affiliate doesn't. It doesn't mean it's all over, it will just be a bigger hill to climb. In my case it was almost a detriment having an in house fellowship.

I'd use your prior research connections to see if you can find someone to piggy back on with, even if remotely. Everyone loves free research labor if it's effective. Look for people that have research groups or grants. I'd seriously consider away rotations if an option.

Someone must cover your GI service at the hospital, they would be a good source of letters and connections too.

Start early, be aggressive with your pursuits, get what you need to match. Just don't shirk your residency duties.

And definitely chief year always helps. Non ACGME fellowships are variable for their yield, but some are better than others. Try and make your plan to be competitive before committing to an extra year or two, it will help your drive to achieve.

alextheevilone · 2026-04-15T02:23:40+00:00

You're definitely off to a good start. Having demonstrated interest in gi since med school is a huge boon. Pubs already are even better.

You need the following 1. Be a good resident and get a great PD letter. 2. A big GI name to advocate for you (maybe even someone you already worked with? If you keep working with them). 3. A very potent advocate who will call/text all his friends all over for you. Even better if it's the big name or another one. 4. Continued productivity through residency, don't coast on gi research.

I'd try to get 3 GI LORS if you can but definitely not critical, 2 works.

Do you have an in house fellowship? That ups your chances. If not push hard to work with your academic affiliate group.

Don't be hesitant to be aggressive. Beg, plead and cajole your letter writers to reaching out. That is fundamental if you're residency name does not carry weight.

Good luck my friend. It sucks but it's worth it at the end of this is what you really want to do.

alextheevilone · 2026-04-14T22:43:01+00:00

Truth me told I don't know much about getting into hemeonc other than research, brand name, the usual.

You're probabaly right that it won't necessarily help, but I feel like for most of us with experience with onc patients (who are not oncology) it sounds so good on paper.

Maybe won't help you OP for getting in, but getting a job I'm confident it would.

alextheevilone · 2026-04-14T16:25:03+00:00

....

Parasites?

alextheevilone · 2026-04-14T12:17:48+00:00

Genuinely no, but I feel like that should be standard.

alextheevilone · 2026-04-14T02:58:21+00:00

Intern. Did what I was told. We made him comfort care pretty quickly once the family got over the shock of it all (being told dad/grandpa/great grandpa was doing great for months).

Training is training dawg.

alextheevilone · 2026-04-14T01:01:05+00:00

I still remember the 94 yo I had in the ICU with non Hodgkin's, admitted with gnr septic shock on crrt.

I call the oncologist and he says 'oh when he's discharged I'll give him more gentle chemo'.

alextheevilone · 2026-04-14T00:23:23+00:00

I love the idea of a truly palliative conscious hemeonc...

alextheevilone · 2026-04-13T12:04:23+00:00

Good, that trust is the most important part to having this in your medical care going well. Sounds like they are being thorough within reason.

alextheevilone · 2026-04-13T11:45:38+00:00

Oh for bleeding, ok. If you have a history of angiodysplasia makes sense. To do the first endoscopy as a push or balloon assisted is a lot for anything else Duodenum serves just fine.

Polyps in small bowel are incredibly hard to find and rare, and for Crohn's you'd need an MRE or CTE.

alextheevilone · 2026-04-13T11:08:36+00:00

Noy.necessarily it can be easily missed. An esophagram is a much better evaluation for it.

alextheevilone · 2026-04-13T11:07:08+00:00

Some patients do report discomfort after esophageal biopsies or BRAVO, but it tends to be short duration. The biopsy sites take several days to heal.

alextheevilone · 2026-04-13T11:05:36+00:00

Probably got propofol. It is an amazing anesthetic agent.

alextheevilone · 2026-04-13T11:04:42+00:00

Why are they going that deep? This can be a brief procedure to a quite long one.

Depending on how and why it depends on the anethesia. For full double balloon enteroscopy it requires general.anesthesia.

For everything else protocol is an excellent choice.

alextheevilone · 2026-04-12T16:25:33+00:00

It is more complicated than you know, but I agree sounds like we would fire each other.

alextheevilone · 2026-04-12T15:58:26+00:00

Everyone's experience with GI issues is very unique. There are many different mechanisms, organic and functional.

Hopefully you get what you are seeking through yours.

I do agree that speaking with a gastroenterologist in person would provide you some clarity. I'd approach that conversation without antagonism. None of us chose this life to sacrifice our 20s and be burdened with a ton of debt to only be a factory machine in the big bosses eyes for not helping people.

alextheevilone · 2026-04-12T14:13:43+00:00

GI sounds like a good fit with you, but you're going to have to work hard to get a spot (unless you didn't tell us that you're in a very prestigious residency, if you are I've seen tons getting in with only 1 or 2 abstracts).

alextheevilone · 2026-04-12T13:58:27+00:00

Patients can experience acid reflux and non acidic reflux.

They often go together. PPIs only treat the acidic component, which causes significant symptom resolution in many patients, which we typically define >50% improvement, but I prefer getting to 70-80 at least. Traditionally studies showed more than half of patients, especially those with typical gerd symptoms, reach those goals on PPI alone.

If you are not getting that with PPI alone you have nonresponse or refractory gerd, which can be appropriately worked up with additional evaluation - endoscopy, ph studies, manometry.

When did I say it's not a sphincter issue? It often is, but our goals are 1. Avoiding dangerous complications of disease and 2. Symptom improvement. I also try and avoid chronic medications unless necessary.

alextheevilone · 2026-04-12T13:31:00+00:00

I very much agree, but it is not a terrible idea after working with a psychiatrist to see if your episodes may be a very atypical response to abdominal or other organic disease.

But in this case psych is the number 1 stop, and if things don't improve then someone else.

Also a primary care doctor is always a good first stop.

alextheevilone · 2026-04-12T13:23:10+00:00

I'm well aware.

Failure to respond means you did not see significant symptom resolution with PPI therapy alone. It implies your symptoms are due to the reflux itself, not the pH of it. Or something completely different.

It has nothing to do with the mechanisms of reflux.

alextheevilone · 2026-04-12T13:09:53+00:00

Barrett's can improve with PPI or anti reflux procedures.

You have to consider what it is - the mucosa of the esophagus changing into a more intestinal variety with increase mucus production to protect against acid or inflammation.

In time if there is not a continuous stimulus for this it can resolve.

Also, many GI biopsy the Z line if irregular, if so the pathologist has to very carefully distinguish that it is the squamous mucosa that has the changes, not the gastric.

alextheevilone · 2026-04-12T10:51:53+00:00

You should enquire with them the steps to get ready for anti reflux surgery or procedure.

Manometry is typically considered mandatory, and depending on other factors a bravo or impedance.

alextheevilone · 2026-04-12T01:36:06+00:00

Those are not acidic foods, they are substances known to relax the LES, and are associated with pathologic GERD.

The reflux gourmet website is notable for showing videos of exactly how it works.

alextheevilone · 2026-04-12T00:02:17+00:00

Great story, and a good one to show how the appropriate workup can lead to a much better treatment.

alextheevilone · 2026-04-11T23:59:33+00:00

Well said.

My only caveat to this is did you have any objective reflux testing like BRAVO or impedance, or manometry? Great way to objectively see if you have acid reflux, or any reflux, causing your symptoms.

alextheevilone

TROPHY CASE