Notes from the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) Junior Summer School, Italy 2015
In 2015 the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) organised the first Junior Summer School, a one week programme of focused teaching on 20-24th July for GI radiology trainees. It was held at a ranch in the Italian countryside approximately 35 minutes from Rome, and all the teaching was delivered in English. This was the first time ESGAR organised this sort of event so I thought I would share my experience.
I'll start by giving a little background on myself. I'm Chris, a clinical radiology trainee from Nottingham (UK). I was coming to the end of my 4th year of radiology training and had decided to sub-specialise in gastrointestinal (bowel) and hepatobiliary (liver & gallbladder) imaging. I first learnt about the summer school when I attended an excellent ESGAR CT colonography course early in May 2015. The summer school is the first initiative by ESGAR to promote abdominal imaging among new generations of radiologists. The application process was simple and consisted of a cover letter, CV and letter of proof of training. I found out I was accepted in June 2015 so booked my flights and started packing! It was a bargain at €200 (£160) for the whole week including teaching, accommodation and all meals/drinks. I just had to fork out for the flights to Rome.
At 4:45am the airport shuttle bus took me from my hotel to the terminal at Gatwick Airport (London). It was overcast and grey - standard British weather! In two hours I was in Rome and when I stepped off the plane it was like entering a furnace - it was 38°C! I met up with seven other trainees from Spain, Sicily and Belgium and we all jumped into a minibus and drove into the Italian countryside.
The ranch (my room was in the building just behind the group of people)
On arrival we were rushed into the teaching venue to join the others who had arrived earlier that day. Fortunately, we only missed the introduction lecture and not any formal teaching! We grabbed some lunch (selection of ham, bread and grapes) and sat down to learn about the imaging of focal MRI liver lesions and modern approaches to liver imaging.
The teaching room
The room consisted of several workstations, which were shared between small groups of trainees, and a projector for case discussions and lectures. The lessons involved a presentation by an expert in the field followed by group work and interactive case based discussions. The morning sessions generally ran from 9am - 12:30pm and the afternoon sessions from 2:30pm - 6pm. Every hour or so there would be a break with snacks such as fresh watermelon and mini-pizzas to keep us going!
Watermelon refreshments between teaching
I was tired after all the traveling and the heat was wearing me down, but I managed to get through the first afternoon! The last session was an excellent presentation on the role of multidiciplinary team meetings (MDTs) given by Dr Marti-Bonmati (Valencia, Spain). There were a few key messages and bits of advice for us to take away such as developing a zero tolerance for last minute case additions (I liked that one...).
Once the teaching had finished we were shown to our rooms. I shared a twin room with Carlos, a trainee from Portugal, and we were one of the lucky few to have air conditioning. The venue was absolutely stunning. There was a central villa, with a few surrounding smaller buildings and even a swimming pool with horse fountain.
Relaxing in the pool after a long day of teaching
I went for a swim in the late afternoon sun and met many of the other trainees. There were 23 of us in total coming from all over Europe and at different stages of training ranging from 1st year trainees up to newly appointed consultants. The mix was great and it was interesting hearing how other training schemes in Europe were run.
A specific programme of events had been arranged for each evening throughout the week. This first evening was dinner and wine tasting. A local wine grower brought six different wines and gave a short speech on each of them. The dinner lasted well into the night and we tasted the different varieties of wine throughout the evening. The tables were beneath large canopies with candles making it very atmospheric. It was a good end to a long day!
One of the courses during dinner on the first evening
Wine tasting and toasting!
A buffet breakfast was served in the morning. I woke up earlier than many of the others so I started typing this blog on my Surface Pro. I discovered there was limited phone signal and no Wifi so I couldn't get internet access on my computer. It transpired that this was actually a deliberate choice by the course organisers in order to make the event more social - it certainly worked and I hardly used my Surface the rest of the week!
In the morning we were treated to an excellent talk on vascular abnormalities within the liver covering many of the different kinds of perfusion defects and what they indicate. This was followed by case based discussions centred around MRI liver cases. We presented cases in groups - ours was a patient with an absent spleen and what looked like a lymph node at the porta hepatis. I presented our findings and it turned out we were completely wrong as the patient actually had polysplenia.
After more watermelon, grapes and coffee there was a session on steatosis and liver cirrhosis. I personally found many of the cases very challenging, and it was at times a steep learning curve, however the atmosphere when presenting was very supportive and encouraging (even when we had no clue!), and working with 2-3 other trainees and sharing knowledge was a great way of learning new ideas.
Morning teaching on liver pathology
Listening to the morning teaching
Lunch was delicious and consisted of 3-4 courses served on tables just a few meters from the pool. To cool off we dipped in and out with many of the faculty joining us. The afternoon teaching was a little delayed, but in the summer heat the pool definitely took priority! The afternoon teaching was on pancreatic neoplasms with many examples of different solid and cystic lesions. The last session of the day was the most interesting and concentrated on 'Patient care in Radiology', an important area that is so often overlooked by radiologists during their day to day work.
Lunch by the pool
We were given kebabs of fruit and melon while we swam!
Presentation on Patient care in Radiology by Dr Laghi (Latina, Italy)
In the evening a 'Rome by night - Tour on a private bus including dinner' had been arranged. When the bus finally arrived (with the traditional late Italian efficiency :P ) it turned out to be a 'party bus' complete with disco, DJ and Prosecco! It was an fun trip to Rome, however realising the tinted windows would make siteseeing difficult, we were dropped off near the Castel Sant'Angelo, walked to a piazza and had beer and pizza. Some of us took the opportunity to buy some vodka and on returning to the Villa we had a midnight swim with cocktails!
Prosecco on the party bus tour of Rome!
Thankfully when I woke up I didn't feel hungover from the night before! Breakfast was again delicious and the morning session started with teaching on bariatric surgery imaging, an area that I'm particularly interested in. There was a lecture covering the different procedures and rates of complications followed by group work looking at five different cases including an oesophageal perforation, herniated sleeve gastrectomy and gastric bypass with perforation and fistula. Myself and the three Belgan guys managed to get the correct diagnosis in each case, which felt great and made a big change from the difficult MRI cases we studied the previous day!
Group learning at workstations
The second morning session was on different biliary system pathologies. I found there was too much to take in, however copies of the slides were helpfully uploaded to the ESGAR website so I could download and learn in my own time. During the teaching we could hear the horses neighing outside, which was a pleasant distraction. The villa was also teaming with cats, dogs and other wildlife, with a few of the pets often wandering around the room saying "hello" during the teaching!
One of the many pets saying hi!
Stables (left), teaching room (right)
After another lunchtime of good food (mozzarella, tomato, salad and meatballs), swimming and turning up late to the afternoon sessions again, we learnt about abdominal emergencies. Having worked in a busy major trauma centre (Queens Medical Centre, Nottingham), I had seen many of the conditions before, however I still picked up a few gems such as double checking for evidence of rectal perforation when presented with pelvic fractures.
Abdominal trauma teaching on splenic injuries
The teaching finished at 17:30 and after a chat and swim a fleet of cars arrived to transport us to Rambla Beach for dinner. The driver of my car had no sense of direction and got completely lost! - and even when he eventually gave in to pride and turned on his sat nav, we ended up turning around at least four times before we finally arrived!!
We were greeted with pizzas and an open bar. The sun was setting over the sea and the evening meal consisted of seafood, pasta, mussles and watermellon. A few of us went on a late walk down the beach under the stars.
Dinner at Rambla Beach, Maccarese
After breakfast and walking the beautiful 250m trek to the teaching venue (which sometimes felt much further in the heat!) we learnt about the classification and diagnosis of pelvic floor disorders. The presentation was one of the best on the course so far as it immediately improved my knowledge of defaecation proctography and inspired me to start reporting MRI proctograms. I made a few notes as we went along.
A horse on the walk between the teaching and accommodation
Learning about the indications, technical aspects and spectrum of pathological findings in MR defecography
Another lunch, another swim and more great Italian cooking. I was determined to get a tan so slapped suncream on and sat by pool. My back felt like it was in an oven - many of the Spaniards and Italians warned me against this, but I was determined to have something to show for when I got home! Unfortunately I did not tan well and failed in my mission...
In the afternoon there was an excellent lecture on rectal cancer staging by Prof Gourtsoyianni (London, UK) followed by interactive case discussions covering topics such as fibrosis post chemoradiotherapy, TNM cancer staging and how to identify involved lymph nodes. The final talk of the day was about publishing scientific papers, particularly focusing on what to write in a cover letter to journal editors. Especially useful were links to resources to assist with research planning such as Sealed Envelope, a website with online calculators to help determine how many subjects a clinical trial needs to recruit.
Beer tasting on the final evening
On the final evening we were treated to a BBQ and beer tasting with live music. It was a nice send off from the organisers who had done a fantastic job, particularly Simone Semler-Fierro who did much of the work to make the course enjoyable.
Guidance on fistula MRI
I packed my bags and went to an hour of teaching on peri-anal fistulas before leaving slightly early to catch my plane. After a long day of traveling back to Nottingham I was straight into a weekend of night shifts!
Ah the life of a trainee :)
On the train home, exhausted but happy!
The ESGAR Summer School was delivered by experts at the top of their field with a non-threatening mix of lectures, interactive cases and group presentations. I was able to pick up some invaluable pieces of knowledge and the material was kindly made available online afterwards. The venue was stunning, I made friends with trainees from all over Europe and there was a brilliant social programme. I think the first ESGAR Junior Summer School was a great success and if it is held again next year I would thoroughly recommend it to any radiology trainee interested in abdominal radiology. As I was the only trainee from the UK it would be great to see more of us represented there next year!
I look forward to seeing everyone again at ESGAR 2016 in Prague!
For more details please visit the ESGAR website at www.esgar.org/workshops/summer-school-for-residents
The ESGAR Junior Summer School 2015
If you would like to know more about my experience of the ESGAR Junior Summer School or have any questions, please feel free to contact me via the contact us page.