Gastroenterology
A Career In Gastroenterology
Introduction
The specialty of Gastroenterology is almost unique in having both surgical and medical specialists with a common set of skills and being highly dependent on each other to manage patients with gastrointestinal disease. I am only qualified to advise on medical gastroenterology and in particular explain what attracted me to this specialty.
What is Medical Gastroenterology?
Medical Gastroenterology is the non-surgical specialty that diagnoses and manages patients with gastrointestinal symptoms within the secondary care (hospital) sector. Patients are referred from primary care for further investigation of symptoms frequently requiring endoscopy or other imaging techniques that are generally only available in secondary care. Unlike other medical specialties, Gastroenterologists deal with a wide spectrum of disease and have practical endoscopy skills unique to the specialty. Therefore as a specialty, gastroenterology appeals to doctors wishing to remain in hospital medicine with a primary role as diagnostician and expert clinician.
Patients
Patients broadly fall into one of two categories of interest to luminal gastroenterologists (investigation and treatment of bowel diseases) or hepatologists (investigation and treatment of liver disease). These two subspecialties may ultimately separate as in other countries but in the UK at present most Gastroenterologists still see both types of patient. However it is changing.
Career path
Doctors wishing to specialise in Gastroenterology currently undertake a 5-year training programme having first obtained the MRCP (UK) examination at the end of their general professional training. Training rotations are co-ordinated through the Postgraduate Deaneries and involve appointment to a regional training rotation involving both Teaching Hospital and District General Hospital posts. Unless individuals wish to sub specialise in hepatology from the outset the vast majority of trainees will attend the Foundation Endoscopy Course (basic skills in gastroscopy) at one of regional training centres during the first 6 months. Once competent, trainees progress over time to more complex endoscopy. Basic skills courses exist for colonoscopy and trainees are expected to attend these courses and more advanced courses as they progress through the training programme.
Clinically trainees are expected to see and diagnose increasingly complex patients with conditions such as Ulcerative Colitis, Crohn's Disease and Irritable Bowel Syndrome, as well as becoming proficient with the management of these conditions. Gastroenterologists also manage many patients with biliary tract disease (benign and malignant) as well as patients with chronic pancreatitis.
Liver disease still comprises a very significant proportion of the general gastroenterologists workload but as stated above this is becoming increasingly separate from luminal gastroenterology due to the large numbers of patients seen. Patients with chronic viral hepatitis (B and C), autoimmune hepatitis and alcohol related liver damage all require diagnosis and treatment by an experienced clinician with a detailed knowledge of these conditions.
On the emergency side medical gastroenterologists deal with acute upper gastrointestinal bleeding in close co-operation with surgical colleagues as well as patients with exacerbations of inflammatory bowel disease and jaundice. Surgical gastroenterologists usually manage acute abdominal pain.
Final comments
Gastroenterology has provided me with a very satisfying career with a unique mixture of practical and theoretical skills. The breadth of conditions managed by medical gastroenterology is one of the main attractions of the specialty. Unlike many other branches of medicine, gastroenterologists also require good hand-eye co-ordination skills necessary for endoscopy. However, the ability to investigate your own patients and deal with a wide spectrum of medical conditions represents a huge contribution to patient care and job satisfaction. Chronic disease management is also a significant feature of this specialty with many patients requiring long-term care such as those with Inflammatory Bowel Disease. However, you may also have to deal with acute emergencies at night (especially gastrointestinal bleeding) and should be prepared for this.
For further information and details take a look at the following websites:
> British Society of Gastroenterology
Professor M G Bramble MD FRCP
Consultant Gastroenterologist
Former Vice President British Society of Gastroenterology
Last updated 25/12/06
| |
