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International Opportunities for Obtaining Endoscopy Training

Mostafa Ibrahim^1,2, Fabian Emura^3,4, Amerah Taleb⁵, Noran Roshdy⁶, Ryan Law⁷, and Todd H. Baron⁸

¹ Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, Erasme Hospital, Universite Libre de Bruxelles, Brussels, Belgium

² Department of Gastroenterology and Hepatology, Theodor Bilharz Research Institute, Cairo, Egypt

³ Gastroenterology Division, Universidad de La Sabana, Bogotá, DC, Colombia

⁴ Advanced GI Endoscopy, EmuraCenter LatinoAmerica, Bogotá, DC, Colombia

⁵ New Giza University, Cairo, Egypt

⁶ Roeya Gastroenterology and Endoscopy center, Cairo, Egypt

⁷ Division of Gastroenterology, University of Michigan, Ann Arbor, MI, USA

⁸ Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC, USA

Introduction

Endoscopic training within any particular country generally provides a solid foundation of basic endoscopic skills; however, subsequent development of advanced skills may be limited due to regional and national adoption of specific techniques, available accessories, and exposure to certain pathology. Therefore, an opportunity to visit endoscopy units outside one’s native country can provide exciting and interesting opportunities to explore. All the authors of this chapter have experienced endoscopic training through observation and some hands‐on exposure outside of the United States. We aim to share our reasons for pursuing potential training opportunities outside the United States and solutions to some of the challenges that trainees typically face.

Available opportunities

For gastroenterologists wishing to pursue additional academic or procedural training, there are several pathways currently available. Several national/international gastroenterology societies offer opportunities ranging from competitive training grants to programs aimed at pairing a potential trainee with training institution abroad.

The American Society for Gastrointestinal Endoscopy (ASGE) offers multiple avenues to obtain training abroad. The ASGE Cook Medical Don Wilson Award (https://www.asge.org/home/about‐asge/grants‐awards) was designed to provide advanced fellows or junior faculty to opportunity to obtain training outside of their home country. This competitive training grant supports up to three physicians per year by providing a cash stipend up to $7500 to defray travel costs. In contrast, the ASGE International Pairing Program (https://www.asge.org/home/education‐meetings/international‐programs/international‐pairing‐program) was designed to match trainees with institutions or mentors who can provide adequate exposure to the desired tools or techniques. While this service connects interested individuals with recognized experts, all expenses (i.e., airfare, room, and board) are the sole responsibility of the trainee.

The American College of Gastroenterology (ACG) offers two training grants: (1) the North American International GI Training Grant Award for US/Canadian gastroenterologists wishing to obtain additional training or education outside of North America (http://gi.org/research‐and‐awards/na‐intl‐training‐grant/) and (2) the International GI Training Grant Award for gastroenterologists outside of North America to obtain supplementary training at select centers within North America (http://gi.org/research‐and‐awards/intl‐training‐grant/). Both grants are competitive and require completion of a lengthy application; however, up to $10,000 can be obtained to offset the costs of travel, housing, and expenses incurred during the training experience. While the training opportunities offered through ASGE are focused on endoscopic training, training grants funded through ACG are frequently utilized to develop the understanding of disease processes, such as celiac disease, colorectal cancer, inflammatory bowel disease, and related cutting‐edge management strategies.

The World Gastroenterology Organisation (WGO) has established the Scholar and Trainee Funding Program at WGO Training Centers worldwide (http://www.worldgastroenterology.org/education‐and‐training/training‐centers). This program provides financial support to trainees to allow for training experiences up to 12 months (trainee) or greater than 12 months (scholar) in various areas of focus.

When considering endoscopic training abroad, there are several clear benefits and drawbacks that must be weighed.

Benefits

Immersion

In the United States, therapeutic endoscopists commonly perform a wide array of procedures requiring a high level of skill (i.e., ERCP, EUS, esophageal/colon mucosal resection). However, therapeutic endoscopists abroad tend to be more focused, only routinely performing one or two procedures with skilled mastery. This constitutes a major reason why many choose to train abroad. Trainees who pursue these opportunities often do so with a very specific goal in mind, such as learning endoscopic submucosal dissection (ESD) or EUS‐guided biliary drainage. Most who pursue training abroad do so with a recognized expert in the field who is well known nationally and internationally. It is not to say that you cannot gain exposure to these technically challenging procedures in the United States, but the vast majority of providers with this skill set do not have seemingly limitless access to patients in need. For example, in Japan, a stay of 4–5 weeks may yield the observance of 25+ ESD procedures at any number of academic medical centers, whereas very few US‐based centers have such volume. When learning such procedures, complete immersion in the skills being learned is imperative, incorporating observation of cases, familiarity of available literature, watching available videos on the topic, etc., to develop true mastery.