Division of Digestive Care & Endoscopy

Department of Medicine

Advanced Endoscopy Fellowship

Outstanding training for practitioners and clinical teachers

Program Director

Therapeutic Endoscopy Group

Overview

Dalhousie University has previously trained fellows in advanced endoscopy. In 2021, we are pleased to formally establish an Advanced Endoscopy Fellowship program.

This advanced endoscopy fellowship offers further training in Endoscopic Retrograde Cholangiopancreatography (ERCP). There may be opportunity in diagnostic EUS, complex polypectomy, luminal stenting, and capsule endoscopy. However, ERCP will remain the primary focus. This one-year fellowship will be designed for Adult Gastroenterologists who are planning a career as an investigative and consultant therapeutic endoscopist.

Throughout this one-year program, the Advanced Endoscopy Fellow will be required to complete several objectives with regard to clinical care, education, and research. To achieve these goals, the fellow should expect to work closely with the advanced endoscopists within the department.

Training will take place primarily at the Victoria General Hospital, Queen Elizabeth II Health Sciences Centre, Halifax. This is the referral tertiary and quaternary care centre for the Maritime Provinces. There is ample exposure to Grades 3-4 difficulty ERCP procedures at this site.

Eligibility

Candidate is required to meet the following pre-requisites:

  1. Have proof of salary support/external funding for the year
  2. Canadian Citizen or Permanent Resident
  3. The applicant must have achieved a pass for the Royal College of Physicians and Surgeons of Canada Internal Medicine exam
  4. Completion of Core Gastroenterology Residency at an approved institution


Documents to be submitted

Candidate is required to meet the following pre-requisites:

  1. Letter of interest
  2. CV
  3. 3 letters of reference, one from program director – this should be sent to Dr Ali Kohansal ali.kohansal@nshealth.ca directly from your referees.
  4. Copy of certificate of RCPSC Internal Medicine by examination
  5. Proof of funding

Please send the application directly to ali.kohansal@nshealth.ca

Clinical care

The department performs at least 600 ERCPs and 200 EUS during the year. The expectation is that the fellow should be familiar with the clinical cases for the day. The fellow will be performing these procedures under close supervision of a skilled faculty preceptor.

The fellow will be responsible for the pre-, peri-, and post-procedural preparations for the patient.

The fellow may be required to cover city-wide GI weekend call with therapeutic staff (maximum 4 weekends per year).

Education

The fellow is expected to be an active member of the Division of Digestive Care & Endoscopy. Attendance at biweekly Journal Clubs, and Grand Rounds are mandatory. Therapeutic Journal Club is to be led by the fellow, occurring once every three months. Clinical teaching is expected while the advanced endoscopy fellow is on call with junior residents. There is opportunity to participate as an endoscopy teacher for core GI resident simulation sessions.

Research

A research component is mandatory, with the general expectation of at least 1-2 abstract submissions to national or international conferences. Completion of a research project suitable for completion within one year with the aim of a submitted manuscript is recommended. The candidate may bring their own research idea, or continue any existing projects with the department. Acceptable projects include retrospective/prospective analysis, meta-analyses, quality improvement projects. If a research protocol is required for the study, it is strongly recommended that the protocol be approved before the commencement of their fellowship year to avoid delays. There is video-recording infrastructure available for video case-reports.

Assessment of procedural skill

Procedural aptitude will be assessed objectively with the Direct Observation of Procedural Skills (DOPS)1 proposed by the Joint Advisory Group of GI Endoscopy in the United Kingdom.

Fellows will also be expected to keep a log of procedures performed. A simplified log template has been designed and can be provided for the fellow.

Final evaluation

At the end of training, these aforementioned objectives should translate to the following goals:

  1. Learn the indications, contraindications, and procedural preparation for ERCP and other areas of therapeutic endoscopy.
  2. Recognize and respond to the complications of diagnostic and therapeutic procedures.
  3. Procedural competence in complex polypectomy, and ascertain the best management steps for complex polyps based on best available evidence.
  4. Achieve procedural competence in the performance of ERCP.
  5. Correlate visual and pathologic findings at endoscopy/ERCP with clinical conditions
  6. Learn how to safely administer conscious sedation to provide for patient comfort during procedures, and when General Anesthesia is indicated for a case.
  7. Research: Minimum abstract publication.

References

  1. Siau K, Crossley J, Dunckley P, et al. Colonoscopy Direct Observation of Procedural Skills Assessment Tool for Evaluating Competency Development During Training. Am J Gastroenterol. 2020;115(2):234-243. doi:10.14309/ajg.0000000000000426