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MUSC Advanced Endoscopy Fellowship 2011: Dr Adam Haycock

I am very grateful to the BSG for allowing me this chance to visit the Digestive Disease Centre at the Medical University of South Carolina (MUSC). I was one of four gastroenterologists who spent 8 days in this unit as a guest of Dr Peter Cotton and his team.

I am very grateful to the BSG for allowing me this chance to visit the Digestive Disease Centre at the Medical University of South Carolina (MUSC). I was one of four gastroenterologists who spent 8 days in this unit as a guest of Dr Peter Cotton and his team.

The ethos of the Digestive Disease Centre is to provide a multidisciplinary approach to patient care, and the recently built hospital was designed specifically to facilitate this. All the digestive diseases staff (including surgeons, pathologists, physicians, nurses) have offices next to each other to encourage cross-speciality communication. The managerial and administrative aspects are very well run by four specialist nurse coordinators, one for each of upper GI, lower GI, pancreatic and hepatobiliary work. They organised everything in the patient pathway from the point of original referral to ultimate discharge and, as they are clinically trained, were able to deal with numerous issues that would challenge a non-clinical administrator. I think we could learn a lot about how to improve our patient care from studying such a service delivery model. As I expected, the endoscopy unit itself was state-of-the-art – we counted 18 different screens and monitors in the EUS room alone, as the photo demonstrates!

The programme was tailored to our specific interests, but enabled us to see a wide range of services and procedures. My particular interest is in endoscopy training, and I had the opportunity to talk with many of the residents undergoing ERCP, EUS and colonoscopy training. The unit provides training to 3rd and 4th year residents wishing to specialise in advanced endoscopy. They achieve an impressive average of 300 procedures each a year, and the training is clearly of very high calibre. However, we had a very interesting discussion about credentialling, which Peter Cotton has been advocating for years, and which still remains a real quality assurance issue in both the USA and the UK.

Charleston itself was a lovely town and small enough to walk round easily. The people were enormously friendly (one of the hospital security guards bought me lunch one day) and clearly proud of their city. The weather in June was warm (100 degrees F) but with air-conditioning everywhere, you were never hot for long! Peter was kind enough to invite us out to his weekend house on Dewees Island, a unique environmentally-friendly community 20 minutes boat ride from Charleston. We were fortunate to be guests at a combined art exhibition/opera concert in the main clubhouse, which was a delight. The rest of his team at the DDC were also very convivial, and hosted us for several excellent dinners at some of Charleston’s finest restaurants!

My experience was beneficial in allowing me to be able to see not only the pro’s and con’s of the American medical system, but I also learnt a great deal from discussions with the other UK gastroenterologists and I will certainly take back several ideas and innovations to implement in my own hospital to improve the care of my patients and our service provision.

Thanks again to the BSG and to the sponsors for facilitating this enormously enjoyable and educational opportunity.