Episode 006: Career Chat with Dr. Samir Grover-Leadership in Medical Education
Guest: Dr. Samir Grover
SHOW NOTES
Jack Yang
Thanks so much for tuning in again to Scope Notes, your Gastroenterology focused medical education podcast created by learners for learners! I’m Jack Yang, a current third-year medical student at Western University joined by my co-host Huaqi Li, a first year Internal Medicine resident here at the University of Toronto (U of T). Our incredible faculty advisor is Dr. Parul Tandon, a Staff Gastroenterologist and Clinician Scientist in Inflammatory Bowel Diseases at the University Health Network and Sinai Health in Toronto.
Scope Notes brings you monthly episodes covering clinical pearls, guidelines reviews, and the career journeys of outstanding GI physicians, especially those shaping the future of the field here in Canada. As always, we would like to thank the Division of Gastroenterology and Hepatology at the University of Toronto for their generous support of this podcast.
Today we have a special episode for everyone, we are thrilled to be joined by Dr. Samir Grover, a staff Gastroenterologist and Executive Vice-President of Academics at Scarborough Health Network (SHN). Dr. Grover holds the inaugural Research Chair and Education at SHN’s Research Institute, and he is the founder of the Grover Lab which focuses on simulation-based education and technology enhanced learning in GI. He has over 200 peer-reviewed publications. Dr. Grover, welcome to Scope Notes!
Huaqi Li
Hi, Dr Grover, thank you so much for joining us on the podcast today. Could you start off by telling the listeners a little bit more about your training and research background?
Dr. Samir Grover
Absolutely and thanks very much for inviting me. So, I'm a Gastroenterologist. I work at Scarborough Health Network. I did my medical school at the University of Toronto, and then I did Internal Medicine at the University of Toronto. I got very interested in Nephrology when I was a medical student, and I worked with this wonderful Nephrologist named Dr. Kamel Kamel at St Michael's Hospital, who knew more about potassium than I think anybody on the planet at the time. It was no coincidence that his initials were KK. He introduced me to research methods, in mentorlike type conversations and things along those lines.
And then I did my Internal Medicine, and I got a little bit less interested in Nephrology and a little bit more interested in procedural medicine and decided to apply to Gastroenterology. I did Gastroenterology at the University of Toronto, and then did an Advanced Endoscopy fellowship under Dr. Norman Marcon who was previously at the Wellesley Hospital and had moved across to St Michael's Hospital at the time.
At the time, the thing that drove me the most was the fact that I was starting into procedural training, and really it was almost as if it was a new paradigm. For your listeners, to understand the divide between Internal Medicine and Surgery, realize that internists have a particular way of thinking more so than doing. And a lot of Internal Medicine training really is focused on obtaining a database information and synthesis and trying to create plans and taking that database and using your brain to figure out what needs to be done next. Whereas when you start as a PGY4 in Gastroenterology, you get this brand-new thing, a procedural based focus around endoscopy, where you use a completely different skill set, and I felt completely untrained for that. I felt like I didn't learn anything. I was harkening back to CC3 and Surgery and learning procedures for the first time, and how that was something that I think was more translatable than anything I was learning in my Internal Medicine training. And I thought there must be a better way of doing things, and that's what I focused my Master of Education on- trying to find ways to use theory to guide us with technology and about how to incorporate procedural education into adult learning that took place sort of later on in people's careers. And that's what I did for my training.
Huaqi Li
Awesome. Thank you so much, and so interesting, you mentioned Dr. Kamel I actually just came off nephrology, and he's still there and still teaching about potassium!
Dr. Samir Grover
I think one of the coolest things about the social aspects of clinical medical training is the super cool people that you end up meeting and how, I don't do anything with Nephrology now, but I think one of my earliest mentors was somebody who was as hard core of a physiologist as you could get. Just from the fact that he was cool and translatable in terms of how to ask research questions and how to answer them.
Huaqi Li
For sure. And you mentioned a bit about your Master of Education. You've also had many leadership roles at U of T, as well as now at Scarborough. Could you talk about how your experience with those were and how that has influenced your career thus far?
Dr. Samir Grover
I'd love to. So, I never thought I would be involved in leadership, or even sort of like hospital leadership in any way. I sort of delved into things, because when I was doing my Master of Education, I really just wanted to find a better way to use technology to teach procedures. And at the time, less so now, but at the time, I was in my late 20s, and I was really into video games, as most sort of you know guys and girls too! I thought that video game skills were transferable across teaching procedures. The controllers were different, but like the early-stage simulators for endoscopy, essentially were video games for gastroscopy and colonoscopy. So, I was trying to explore that as part of my Masters. And then I really wanted to determine whether just because you got better at video games, at the time it was Grand Theft Auto 4 had just come out, and I was thinking in my head: “if you got really good at the driving element of Grand Theft Auto 4 does that actually make you a better driver?”. I won’t get into whether it makes you better at crime! But certainly, I'm not sure if it made you a better driver. I was thinking, if we did the same in the video game of simulated procedures in medicine, there had to be a way to robustly determine whether it actually made a difference in the procedure itself. That's sort of what I wanted to start off, is create a program where we could use technology to teach procedures in Gastroenterology, target adults who were in their PGY3 or 4 years in Adult or Pediatric Gastroenterology, train them with respect to doing things, and demonstrate the fact that they've had a tangible difference initially, with respect to clinical outcomes.
So, I really wanted to become a researcher on that, and not a leader in any way. But I really found that when you stretch yourself in medicine, the ability to scale what you do comes best if you're able to lead inside those areas. So, I took on sort of minor leadership roles as I got a little bit further on in my career. At St Michael's Hospital, I became the Site Lead for Education for Gastroenterology, which was sort of aligned with what my interests were in terms of education and research. I took on a leadership role with respect to endoscopy education for the University of Toronto. At the time, there was a committee that was trying to figure out better ways to teach endoscopy at the post graduate level. I led that and my ideas were able to come to the forefront, with respect to that. I was really inspired by a colleague of mine by the name of Catherine Walsh. She's a Pediatric Gastroenterologist and an Education Scientist who really encouraged me to go to the major post graduate institutions if I wanted to have my work disseminated. So, the specialty societies in Gastroenterology, for example, have a lot of roles with respect to post graduate education. I joined the Education Committee for the Canadian Association of Gastroenterology. I got involved the American Society of Gastrointestinal Endoscopy, which is a major specialty society that involves endoscopy education as part of its roles in the United States. Then the Royal College here in Canada, and sort of delved in my interest, and realized that in order to actually make changes into the way that rubrics take place, you have to be able to lead, either formally or influence people that those changes will take place.
I try to do that through our training program in Gastroenterology at the University of Toronto for my site lead role, where I started off a course for teaching endoscopy through simulation to start. Then I tried to bring all of the innovations that we were working on from a research standpoint, directly to the forefront, where residents could actually trial things and work with simulators that we were building and provide some feedback what works and what didn't work and participate in the research that we were doing in terms of developing things along those lines.
And then eventually I decided to strengthen my leadership chops in the post graduate environment by probably taking on my favorite job that I've had so far, which is Post Graduate Program Director for Adult Gastroenterology at the University of Toronto, which is so leadership light like you know, being a program director for residency there's limited stakeholders. You know, the budget is still decided upon by universities, but it is so fun, guys! It is probably the best job I have ever had, the ability to take things that we were developing and then go to probably the most engaged people there are, learners that are directly learning those skills for the first time and working with them to evolve them and creating systems that work for them. I found nothing more fun ever, and that was, I think, probably the one job that made me realize that leadership, if it's authentic to what you really, truly enjoy doing ends up being one of the most rewarding experiences there is.
2023-ish, I learned about an opportunity, so I was working at St Michael's Hospital for a long period of time. I really enjoyed my clinical work over there, but in 2023 I learned about an opportunity that I thought was a rare one. The University of Toronto has four undergraduate medical training sites that are operationalized in academies. The academies are basically a clustering of teaching hospitals that provide clinical delivery for undergraduate and postgraduate education. And there was a big expansion that was planned for U of T in conjunction with the Ministry of Health, and in conjunction with the Ministry of Colleges and Universities. It's got a new name now, but that's what it was at the time, to deal with a Human Resources crisis in the east part of the city in Scarborough. And this would involve the creation of a fifth Academy for the University of Toronto, something that hadn't happened in a really long time. A lot of my interests with respect to technology enhanced learning really were limited to procedural education in Gastroenterology. I thought this would be a unique opportunity to start with a white blank slate and see whether we could incorporate some of these novel thoughts to medicine as a whole, starting with undergrads. And if you ask some of the greatest educators in science and medicine, the highest value comes from the younger you're able to access learners and the earlier they're on their trajectory. So I jumped into the opportunity, applied, and surprisingly, got the job of Vice President of Academics at Scarborough Health Network, which I started in the end of December 2023 and made the decision to move across all of my stuff from St Michael’s, a hospital that I really loved working at and which is an integral part of my identity, to a new hospital, Scarborough Health Network, where I'm sort of building new things across our educational programming, starting with undergrad and proceeding into professional education, and post graduate education as well.
Huaqi Li
Amazing! Thanks so much, you have had a very adventurous career so far!
Jack Yang
We kind of touched on this a little bit earlier. Dr. Grover, you founded the Grover Lab, working on advanced simulations and technology driven learning in GI and endoscopy, which is clearly something you're very passionate about. Can you walk us through the origin story of the lab and what you and your team are most excited about working on right now?
Dr. Samir Grover
As I sort of mentioned before, the realization that in Internal Medicine you learn procedures, you're not aligned towards learning procedures necessarily, and you must work towards it was sort of the genesis of my lab. And I think it's more out of lack of thought than about self-involvement, that it ended up with the name the Grover Lab, because I don't think we had a name to sort of encompass things at the beginning, when it first started. But the goal was to use technology to meet those gaps that existed with respect to teaching and assessment at the time, endoscopy, but now broadly across medical education and health professionals’ education, was sort of how it started.
I was learning colonoscopy when I was a PGY4, and I was starting on patients for the first time. And I was, as mentioned, playing video games and trying to improve my hand eye coordination so that I would get better at it. And I realized there must be a better way to do things. I had found an old colonoscope, one that was a fiber scope that didn't require a light source, that had one of those things where you can look in through the eyepiece. And I created a pattern using cardboard into a tube that you could pass across. And I was trying to do that at home with this, it was actually Dr. Marcon, who's one of my mentors and who had given me the loaner of the old colonoscope to see if I could pass it through and whether that made a difference. I found that just practicing that at home made so much of a difference with respect to my hand eye coordination. I figured there must be a way to test this. So, we had created a course for simulated colonoscopy that we used mechanical models for and virtual reality models for, as they were sort of evolving. The old virtual reality models were very simplistic. They were basically computer simulators using two generations ago, XBOX type graphics. But we wanted to show that that made a difference with respect to things, and I think based on that initial study where we demonstrated the fact that a structured training program in colonoscopy improved outcomes in first clinical colonoscopies that were done by novice endoscopists- that was the genesis of me, sort of thinking about the variety of different things that one could do and test in that space.
And once you delve yourself into something, guys, that you're passionate about, the gaps become apparent, and the questions become very apparent. I tell my trainees this all the time, you guys are really smart, and if there is something that you haven't figured out, odds are the world doesn't know the answer to that. And this is an opportunity for you to delve into, to create a piece of knowledge that can meet that gap. We took that sort of further on beyond whether simulation could teach colonoscopy to whether simulation could teach things like ergonomic stance when you're doing procedures, knowing that there's a lot of injuries that take place in endoscopy. Whether computers, and this is coming true more so with large language models now, but even 10 years ago we were thinking about using computers to teach things like communication skills and sort of softer non-technical skills along the way. We thought that we could structure that, and once these questions came up to us, we consolidated them into research studies that we could use the same framework.
A lot of the enablers were that it was easy to achieve this in teaching hospitals- our subjects were residents who were very keen to learn, right? So, I think that was a massive enabler, with respect to research, and we had excellent collaborations with industry that were able to provide us with models and allow us to co-develop models with them. The Allan Waters Family Simulation Center at St Michael’s Hospital is a brilliant place where we had artists that were able to help construct colonic models and stomach models for us. So, it was a really fun time to be able to build things, and that was sort of how the lab had its genesis, Jack.
Jack Yang
Thank you so much for that one! Who would’ve known playing with cardboard can be of use there. Very insightful! Just a quick follow up here, where do you see the Grover Lab and all your research in general in the next 5 to 10 years?
Dr. Samir Grover
The big thing that's happened in the past year has been generative AI, and the way that generative AI will fit into medical education is going to revolutionize the way that we do training and assessment, in my mind. My lab has evolved quite substantially since those early days in terms of the things that we test. We've done a lot of clinical research also and we tried to find that fantastic spot of showing that education improves clinical outcomes down the line. We've sort of done that in sort of very modest ways, but I think our focus now must be around how AI is going to be involved in education, because it's the one technological enhancement that has taken place so dramatically over the course of the past year, and it's going to change everything.
For example, if you have access to LLMs, like if you have ChatGPT or Gemini, you can access anything under the sun with high accuracy with respect to medicine. Your role as a medical practitioner, as a learner changes dramatically. You are no longer the person that needs to memorize vast quantities of material. The material will be available at you, your patients, and your trainees down the line, fingertips’. You now change into someone who's responsible for judgment, delivery of information and contextualization of information, teaching those skills specifically, and figuring out how to teach those skills in an AI world. This is something that we're interested in evaluating in our lab, and I think that is going to become a cogent issue, even sort of like this year as we develop new systems. As mentioned, we're building a new Academy of Medicine in Scarborough, so it's well aligned with starting things from scratch and new ways to be able to deliver curriculum.
I'll give you another example, guys, which is assessment. Assessment is huge, in my opinion, and has lots of chances for improvement in health professions and education, and you guys have probably seen that even in your training. So far in medical school and residency, how many times do you actually get assessed when you're on the ward with direct visualization? There's just no time, right? My wife did Surgery before she did Family Medicine, and I asked her once, you know, how many appendectomies have you actually had observed and assessed? And she said, zero. If you tell the general public that the skills of highly established medical practitioners really haven't been vetted by experts along the way in a detailed manner, they’d find that very surprising. But that's the reality of medicine. We think technology is an answer to that, and I think AI provides potential solutions to this multimodal data sources that are able to come across and provide synthesis through CNNs or through LLMs and are able to determine performance. I think this is something that we're able to do now with the way technology exists. This is another thing that we're evaluating in our lab, particularly starting with Gastroenterology as a model system and then going across to other areas.
Huaqi Li
Thank you so much! We kind of reflected on what your lab is looking forward to in the future, just looking back into your past achievements of the lab and the outputs you've had. Jack did a thorough PubMed search on you, and you have the 2015 and 2017 randomized trials that you've done through the lab for simulation curriculum. We're just wondering if you could touch base on kind of the key takeaways of those studies and what you were most excited about.
Dr. Samir Grover
That's kind of cool that you guys did a deep dive! The 2015 paper was a study on a standardized training and assessment curriculum versus equivalent number of hours without standardized training curricula on simulators to teach colonoscopy. The primary outcome was determining what performance was in first colonoscopies done in a population of novice endoscopists.
It's really hard to do randomized studies in an education for so many different reasons. First of all, at the time, we really didn't even have good quality performance metrics for colonoscopy, so this work was timed around the development of tools that, for the first time, were able to give you performance standards in colonoscopy, starting with things like the direct observation of procedural skills. There's a rubric that has since been taken as the primary rubric by the major Surgical Society in America, called the A.C.E, it was created by a colleague of mine named Dr. Robert Sedlak at the Mayo Clinic. Then Dr. Catherine Walsh, who I mentioned before, had just developed and robustly validated the GI ECAT, which is the Gastrointestinal Endoscopy Colonoscopy Assessment Tool, which determined the competency in colonoscopy, since then there has been an upper GI version as well. So, these tools were just validated for the first time and for the first time you actually had ways to determine in your experiments whether you actually made a difference. Secondly there aren't that many trainees in postgraduate medicine in particular discipline, so doing single center studies becomes very, very challenging. And thirdly, is recruitment- it's very hard to tell people that we're trying to determine on the first colonoscopy that this person is doing, whether one is better than another in terms of a curricular method. Recruitment also becomes difficult in terms of patients with studies like that. So, it was sort of a three-year effort to get that first study done and to build the infrastructure to be able to do that. And, it was kind of cool to show that if you made a difference with respect to the way that you integrated teaching with appropriate curriculum, appropriate feedback, and appropriate changes that were made inside a computer environment of simulators, you actually made a difference with respect to an outcome that could be measured in the clinical setting. And I thought that was sort of neat to see that we were actually making a difference.
We published only an abstract form, sort of what trainees’ reactions were. We also had learner reflections afterwards on what it was like, and there was a lot of empowerment that took place, that they felt they were more prepared by the fact that they had practice, practice, practice, practice deliberately inside of safe setting, and received appropriate feedback and coaching. They felt much more comfortable and much more empowered to do their first ever clinical procedures. Those sorts of outcomes, we thought, were tangible and relevant to learning environments, and I'm very proud that we were able to demonstrate that in such a robust fashion.
The 2017 paper was influenced by a former colleague of mine named Dr. Ryan Bridges. He's at the Li Ka Shing knowledge Institute, and he developed a model of education called self-regulated learning. This is a paradigm where learners are able to contextualize and internalize what the processes are by themselves with respect to their learning inside a particular environment, setting goals themselves, mentally practicing inside their head and determining what the next steps are by themselves, without necessarily needing a teacher present. We wanted to have that reflection aligned around something we call the challenge point framework, which in the literature is described as where learners would be able to determine by themselves, or on the basis of feedback that was provided, what their own level of performance was and what their challenges were. For the purposes of making sure that what they were learning procedurally aligned with where challenge was best. I'll give you an example: if you know how to ride a bicycle, if we put you on a bicycle with training wheels, it's going to be too easy for you, and you're not going to learn anything along the ways. But if we put you on a high-performance mountain bike and put you on the first stage of the Tour de France, that may be too hard for you to learn. You may need something that's intermediate in between those things in order to actually learn something. We wanted to use self-regulated learning for trainees to be able to determine what that optimal challenge was when learning colonoscopy. Then we put half of our learners into a curriculum based around that and have which we called a progressive learning curriculum and half based on a structured training and assessment curriculum. We demonstrated the fact that simply contextualizing your own learning and determining where the challenges were as you progressed across that curriculum made a difference with respect to performance in multiple domains of colonoscopy on first colonoscopy procedures done compared to an equivalent amount of time done with a standardized curriculum. It’s sort of the power of the learner with respect to guiding their own performance down the line. I thought that was sort of a neat finding. What was cool in that study, is we showed for the first time that non-technical skill performance improved with self-regulated learning. So, if you were actually thinking about how you were performing procedures and contextualizing this with respect to how you were working in a simulated environment, you were thinking about things that were outside of the technical realm and demonstrating the fact that you were better at them. Things like communication and leadership, which was a cool finding that came out of that study that we explored a little bit more in future studies we did.
Huaqi Li
Thank you so much. Dr. Grover, that's so interesting and the kind of logistical aspect of doing an RCT in the educational setting, like you said, and the takeaways that you mentioned!
Jack Yang
Our next question for you is that you've also led the development of practical tools like the Toronto Upper GI Cleaning Score, and focused some of your work on ergonomics, feedback and non-technical skills, which you mentioned a little bit already as well. What are a couple of ways these tools have translated into real changes today in how endoscopy is taught or practiced?
Dr. Samir Grover
So, Jack, I hurt my back in 2012! I was out of commission for probably six weeks. I think the first time I met Dr. Michelle Sholzberg, who's a Hematologist at St Michael’s Hospital and a good friend of mine, I was hunched entirely down and bent at 90 degrees because that's the only way that I could walk around the hospital! I went to go see a physician to provide advice on what to do about my back pain. The advice I got was you need to take better care of yourself when you're scoping because you're bending down way too much, and this is probably contributory and has been going on for years. As we were doing our simulation training courses, I saw that a very simple intervention of telling trainees to change the height of the bed in simulated endoscopy actually seemed to make a difference in terms of the first procedures I was seeing down the line, where the ones that we mentioned that to tend to change the height of the bed. Which made me think that maybe ergonomics could actually be taught through education early on, where behaviors will stick. When you're first learning something, you'll probably hearken back to that over along the ways.
So, we had our training course that we typically do for our trainees. We videotape the procedures as part and parcel of that, mainly for sort of reflection and feedback afterwards. So, we had that dataset, and then we created an ergonomic curriculum where we specifically taught ergonomic forward behaviors. This was done after the consensus review of the endoscopy literature in the simulated environment, and then took a look at ergonomic behaviors in that group compared to the previous cohort that had gone through a course without ergonomic specific training. We used some validated tools on upper extremity assessment and full body assessment in terms of determining risk for occupational related injuries. We showed that in the course that had ergonomic specific training, there was a significant difference with respect to behaviors that could potentially lead to injury down the line. I think sort of a soft finding, but the first finding that education could actually make a difference in terms of the behaviors in endoscopy that may potentially lead to injury. So that's sort of how that sort of evolved. We published this in 2020 and 2019 is when we finished the study. But since that time, so much work has been done on ergonomics, in endoscopy, realizing that it's a real hazard, right? Like, if you put yourself in repetitive procedural situations over and over again, you're going to end up at risk for injury.
One of my colleagues at the University of California San Francisco, Dr. Amandeep Shergill, has taken the lead with respect to this and developing strategies for learners, as well as practicing endoscopists to globally to improve ergonomics. A lot of the stuff that's been done on education has evolved from people that have built upon some of our early studies on simulation inside this space that has been incorporated into the ASGE Practice Guidelines on Ergonomics. One of the recommendations is that education, early on in training, may be something that's useful in terms of preventing injuries down the line in practicing endoscopists. I think we saw this first of everybody, and I was sort of happy that this got integrated into guidelines.
But I think I mentioned to you guys before that if you don't know something, odds are the world doesn't know what it is. In gastroscopy, just as sort of high-definition endoscopy, white light endoscopy sort of came into play, we realized that there were a lot of barriers that ended up taking place because we really didn't have a good way of determining quality of endoscopy in the late 2010s. We had a Fellow, Jose Vargas, one of our Therapeutic Endoscopy Fellows from South America, who said that they’d addressed this, where he came from, by administering simethicone. I'm like, yeah, we give simethicone all the time, that's Ovol, so this is a de-foaming solution that we put in syringes, and we can flush down the endoscopic channel to get rid of bubbles so you can see things inside the gastrointestinal tract through the stomach better. He's like, no, no, we don't do that! We get them to swallow simethicone 30 minutes before the procedure, and it just cleans everything out. And then we give them a score of one, two or three in terms of how clean their stomach is, and then if it's not clean enough, then we do the simethicone flushes and everything else, sort of clean things along the ways. I said, well, tell me more about this “123” system. And he's like, we developed it, but it has never really been validated. And I'm like, well you know, isn’t this an important part of quality? And he's like, it probably is. That's why we decided to actually formalize a scale to determine what gastric cleanliness is. I think we thought that it would be very useful, as early gastric cancer was what was in our heads at the time. If you were obscuring the mucosa, you couldn't pick up lesions that were potentially endoscopically resectable. And if they were left in there, they may not become endoscopically resectable over time. That was the motivation behind it. We were also influenced heavily by both the Boston Bowel Prep scale, which is a similar scale done for colonoscopy that everybody used in practice, and colleagues in Ottawa, Emilie Jolicoeur and Alaa Rostom, who developed the Ottawa Bowel Prep scale, which is the Canadian version of a bowel prep scale that had gone through a rigorous validation system as well, and that we were used to using at St Michael’s Hospital also as an alternative scale.
We were already reporting a whole heap of procedures for a variety of different reasons for education at St Michael’s, and we had all the equipment. So, we thought, well why don't we figure out whether we can obtain video recordings of poor-quality gastroscopic preps, and ones that were done sort of with excellent fasting and good washing and see if we can determine whether a scale that we created that was simple and easy to use could be validated by experts who use the scale in terms of performance, and we showed that we could do this. We took a whole bunch of videos and sent them across to experts and told them to grade them on scales, and then showed them the same videos over again and told them to grade them on scales again and showed that the inter-rater reliability and intra-rater reliability was very good for the scale. We wanted to name it after our favorite city in the world, Toronto- the Toronto Upper Gastrointestinal Cleaning scale. It was actually a multi-institution effort with experts from around the world providing feedback with respect to their areas.
And then GLPs really took off, sort of post pandemic. So, the gastroparesis associated with GLPs became a very, very real issue in terms of quality in gastroscopy. So, the timeliness of having scales like this became very cogent. The scale has subsequently been validated in the pediatric setting and has been incorporated into a variety of different guidelines with respect to detection of, for example, gastric intestinal metaplasia. In the European Guidelines, they used our scale as part of their references, along the ways.
It was an easy idea. It was born through from the fact that, we realized this was deficit, and we realized that if this is a deficit for us, it's probably deficit for everybody, and doing the testing to figure out whether something like that could be validated and useful for everybody was something that we thought was a worthwhile effort and that we were empowered to be able to do, and that's sort of what that came through.
Jack Yang
Thank you! There's actually a funny meme that endoscopists look like they're doing karaoke! So not only do you need good posture for singing, but you also need good posture for scoping!
Dr. Samir Grover
Absolutely! Although I think in my new job, guys, I don't do as much endoscopy. I used to scope every single day, or pretty much every single day, and now my job involves a lot less endoscopy. But just like I talked to my wife about all the time, I have less back pain and less wrist pain now. My thumb doesn't hurt the way that it did before. So, I'm sure that repetitive strain injuries coming from endoscopy are a very, very real thing.
Huaqi Li
Thank you so much. Dr Grover! I really like it when, you know, things happen so organically from the questions that you have or things that you learn in your practice and then translate into research!
Jack Yang
For a final question, we always like to ask our guests: for medical students and residents interested in pursuing Gastroenterology or integrating clinical GI with education and research, what advice would you offer?
Dr. Samir Grover
The brilliant thing about Gastroenterology is it's such a broad discipline. There was one of my mentors, his name is Joe Connon, and he was Physician in Chief at St Michael's Hospital for a decade. I had the pleasure of sharing an office with him for a bit, and one of the first things he told me was that Gastroenterology is the best career in Internal Medicine because every organ talks to the gut. There is no more Internal Medicine specialty than Gastroenterology, and it's hard because pragmatically, you think of Gastroenterologists, especially endoscopists, as a proceduralists, right? Like you think of it as sort of being the most different compared to the other Internal Medicine specialties. Hepatology is so tremendously sub-specialized now that you'd think that it was a very highly sub-specialized domain that's very different. But that's sort of put into my head, that the whole body relies on the digestive system and the liver and being able to treat diseases of the digestive system allows you to have an insight over what human bodies can do as a whole and improve what human bodies can do as a whole. So, I would go at it with that lens.
GI is broad. There's so much that's there, and the impact that you can make clinically in Gastroenterology is vast and can be served in multiple different ways. If you take that paradigm and you sort of broaden it, you can do, randomized controlled trials in inflammatory bowel disease and find new medications to improve people's bowels. You can do population studies in hepatology and determine sort of where the gaps are in social determinants of health that will stop nonalcoholic fatty liver disease from being an entity that will lead cirrhosis. You can take a look at education interventions with respect to nutrition, and trying to find a way for us to improve nutritional environments, through education as a route to improve global health in ways that, RFK Jr. in his sort of mindset is a little bit different than the ways that we would approach things, but would allow us to approach health in a way that was not necessarily pharmacologically mediated, and may improve public health outcomes as a whole. All of these can be things that anybody can do in Gastroenterology as a specialist inside that area that have vast impacts. And I think if you're interested in Gastroenterology as a career, I would try to find something that you really are passionate about in any of those spheres and delve headfirst into that one thing and try to do it as deeply as you possibly can. For me, that was education and technology, and I delved headfirst into it and tried to learn as much about it as possible. And as long as you're passionate about it, you will find your space, and that will inform you about all aspects of what you want to do in your career in Gastroenterology. So that would be my recommendation.
I'll add one more thing, and that is, I've name dropped so many names in this podcast, it's by design, because mentors are so important, right? Like having somebody that's able to guide you along the ways in your career is something that is of utmost importance as you sort of try to figure out where your space is in your medical and academic career. So, you guys are both lucky, you have my former resident, Dr. Parul Tandon, as your mentor along the ways. Trying to find people like that, who are sparky, who love exactly what they're doing, who are thoughtful, and who put energy into you will think about ways that your career can be shaped that you may not have even thought about. I think that's critical for the learner that's coming across. So, find those gems of mentors and hold on to them and use them to your benefit. They'll love to be asked to do so.
Jack Yang
Wow, that was an incredible discussion! Dr. Grover, thank you so much for joining us and sharing your experiences, insights, and vision for the future of GI education and research. We hope to have you back in the near future to discuss some exciting GI topics.
For our listeners you can also find Dr. Grover’s recent publications within the Grover Lab website linked in the show notes (https://www.groverlab.ca). If you liked this episode, be sure to subscribe to Scope Notes wherever you listen and give us a rating and review- it really does help new listeners find the show. We’d also love to hear from you- tweet us @scopenotesGI or send us a message through our website to suggest topics or guests. Until next time, thanks for listening!
