In this article, current Ohio State University advanced endoscopy fellow Dr. Steve Serrao and incoming advanced endoscopy fellow Dr. Vanisha Patel discuss their journey from advanced endoscopy fellowship match through the fourth year of training.
In your last year of general training, how did you prepare for advanced endoscopy fellowship?
VP: After matching into an advanced endoscopy fellowship, I am utilizing my final year of general gastroenterology training as a dedicated period of preparation. My goals are to gain familiarity with new procedures and equipment, deepen my understanding of procedural indications and decision-making, and strengthen my radiologic interpretation skills.
SS: I entered the advanced endoscopy fellowship differently than most. Four and a half years of independent practice stood between my general GI training and my AEF year. General fellowship had given me a foothold in ERCP, enough to appreciate the anatomy on fluoroscopic images, and recognize the nuances/complexity of the procedure. That early exposure was valuable precisely because it made the gaps visible for me to focus on. EUS was an entirely new territory. Between match day and my start date, I deliberately worked through EUS videos, annotated cases, systematic station reviews, and image interpretation before ever holding the scope. Dedicated EUS and ERCP courses then put me on the path for focused mechanics: cannulation, wire control, fluoroscopic decision-making in a no-pressure environment. Lastly, I focused on endoscopic suturing, the final gap I wanted to close. The Endo bariatric courses I attended delivered exactly that, hands-on repetition with suturing devices that observation alone cannot replicate.
What experiences have you found to be particularly valuable in your training and preparation?
VP: Spending time in the advanced endoscopy rooms has been very valuable with all the new terminology, different endoscopes, imaging modalities, and tools to learn. While it is new and exciting to immerse oneself in the world of Advanced endoscopy, I also have found it valuable to intentionally split my time with general gastroenterology cases to continue optimizing the fundamentals of endoscopy.
In parallel, by working closely with advanced endoscopy faculty in both inpatient and outpatient settings and focused study of societal guidelines, I have started to develop a strong clinical framework for approaching complex pancreaticobiliary diseases both in and out of the endoscopy suite.
SS: Volume and repetition are irreplaceable. There is no shortcut to the case numbers, and the learning curve is steepest early. Show up, do the cases, and resist the urge to wait until you feel ready. Readiness comes through doing.
Faculty mentorship is equally formative. The AEF year is short, and the attendings you work with shape not just your technical development but your entire clinical philosophy. Be intentional about learning from each one; they think differently, approach cases differently (resist the urge to judge), and remember that each perspective adds something to your repertoire.
What challenges during the advanced year did you not anticipate and how did you deal with them?
SS: What I did not fully anticipate was how much guided autonomy would define the year. The best learning happened in that space between supervision and independence, cases where I was expected to lead, with an attending present but not intervening. That tension is where real growth lives. Lean into it and learn to feel comfortable, feeling uncomfortable.
And then there is resilience. The AEF year will test your physical and mental capacity. There will be cases that do not go as planned, days where the learning curve feels vertical, and moments where doubt creeps in. You will ask yourself, “Is this what I really want?” What carries you through is not talent, it is the ability to reset, reflect, and return to the room the next day with the same commitment you had on day one.
Any final thoughts for current and future trainees?
VP: Be intentional. This period of intentional preparation has been so important in building my technical foundation and clinical confidence as I transition into my advanced endoscopy training, and the personal and professional growth from building early relationships with advanced faculty cannot be understated.
SS: My personal mantra: Recognize your wins; don't be overjoyed by them. Recognize your losses; don't bemoan them. The AEF year has a way of making both feel larger than they are. Your barometer of success is never the number of native ampullae you have cannulated. It should be the sense of fulfillment and gratitude you discover as you close out each day.
Authors
Vanisha Patel, MD, is currently a third-year Gastroenterology Fellow at The Ohio State University, where she will stay for a fourth-year Advanced Endoscopy Fellowship. Her clinical and research interests include management of pancreatic cysts and therapeutic EUS.
Steve Serrao, MD, MPH, PhD, is an Advanced Endoscopy Fellow at The Ohio State University Wexner Medical Center and a gastroenterologist with expertise in clinical operations and health policy. He previously served as Section Chief of Gastroenterology at Riverside University Health System and holds board certifications in Internal Medicine and Gastroenterology. Nationally he serves as a member on the ASGE Health Policy Committee and internationally on the World Gastroenterology Organization Endoscopy Committee, and the African Esophageal Cancer Consortium Practice Committee, advising on innovation and technology as a member of the ProVation advisory board.