Best residency program to attend if interested in IR

[badasshairday]

I was wondering what people had to say about this. It seems like a resident run program is best in terms of getting hands on procedure training. I heard that places that are very good IR fellowships aren't exactly the best experiences for residents because the fellows do most of the work (ie. big name program, tons of IR fellows). But at the same time, some of the best IR fellowships have relatively few fellows, so the residents get very hands on as well (ie. University of Colorado, only 3 IR fellows and 4 hospitals to cover, 7 angio suites at the university hospital alone, so super busy).

As far as I have heard, U of Colorado is good. Also, as I understand they tend to take at least 1 of their own residents each year. They are highly clinical and do everything IR has to offer. Residents get a very good experience in both VIR and NIR due to a limited number of fellows.

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[Radonkulous]

Have pretty much the same question here.

 

[KublaiKhan]

After talking to residents during interviews it sounds like most programs will allow you to do as much as you want if you are proactive about it and prove your competency. UVA seemed very resident friendly in terms of allowing them to have their own room, particularly as a 3rd/4th year. It seemed to me like the vast majority of residents went there specifically because their IR department is so strong, and as a result I was told that >50% of their residents end up going in to IR.

 

[badasshairday]

UVA seemed very resident friendly in terms of allowing them to have their own room, particularly as a 3rd/4th year. It seemed to me like the vast majority of residents went there specifically because their IR department is so strong, and as a result I was told that >50% of their residents end up going in to IR.

This sounds great

 

[IRneuroIR]

I concur with this sentiment -- if you are proactive and eager, most IR attendings/programs will allow you to do a lot.

I am now in my senior year and do IR whenever I can and have gotten to the point where I have minimal supervision on most cases (essentially as back up) which has really helped to build my independent confidence and troubleshooting abilities. I have also been able to do a lot of NIR cases. I am in a small program with no IR fellows so that helps but plenty of my friends are in programs with IR fellows and are able to get a lot of experience.

In the end, if you are motivated, hard working, and proactive, you can accomplish a lot during residency -- both in IR and otherwise.

 

[VIRads]

I've heard great things about Kaiser Los Angeles. But all second hand word of mouth.

 

[Momentai]

what's the word on kaiser LA?

 

[DrBowtie]

what's the word on kaiser LA?

Dr. Vatakencherry is the program director and very involved in SIR. He is a regular on this IR forum and would be able to give you the best synopsis of their program.

 

[drizzt3117]

After talking to residents during interviews it sounds like most programs will allow you to do as much as you want if you are proactive about it and prove your competency. UVA seemed very resident friendly in terms of allowing them to have their own room, particularly as a 3rd/4th year. It seemed to me like the vast majority of residents went there specifically because their IR department is so strong, and as a result I was told that >50% of their residents end up going in to IR.

Penn and BWH both let the residents do a ton (I got to do lots as a med student at BWH). Brigham is very busy and there's only 3 fellows on VIR.

 

[davidjones]

Is Brigham very busy? This is pure heresay (sp?) but I heard that the Harvard programs (BI/MGH/BWH) were all kind of bare bones because of all the other specialties taking cases.

Since you were a student at BWH can you enligthen us about the nature of the programs there?

Thanks

And again, I'm only posting what I heard and not saying that it's the truth.

 

[drizzt3117]

It was insanely busy. I was there from like ~6 to 9 every day and got to do cases almost the whole time I was there. The Brigham is a very very busy hospital.

Is Brigham very busy? This is pure heresay (sp?) but I heard that the Harvard programs (BI/MGH/BWH) were all kind of bare bones because of all the other specialties taking cases.

Since you were a student at BWH can you enligthen us about the nature of the programs there?

Thanks

And again, I'm only posting what I heard and not saying that it's the truth.

 

[MedManU]

When I interviewed at Mayo Rochester and Arkansas I was impressed with what I perceived as a large breadth of procedures as well as their approach. In both programs, they saw their own patients in the hospital, discharged and admitted them, and had a clinic. PAD may have been a little weak at Arkansas, but they were huge into interventional oncology.

 

[Radonkulous]

It was insanely busy. I was there from like ~6 to 9 every day and got to do cases almost the whole time I was there. The Brigham is a very very busy hospital.

How was PAD work at BWH?

 

[VIRads]

It is great talking about the cool stuff the programs are doing such as PAD, IO etc. But I think the focus of the topic is which program provides the best experience for residents

Some places have residents just do consenting and PICC all day. Nothing else because the fellows have all the other cases (as it should be in places with fellowships).

 

[omarsaleh66]

I have posted about my experiences before but I would like to say that I got to do alot as a resident at Mississippi. I did 6 months of VIR, 2 months of Neuro IR and 1 month of Vascular Surgery. I have done around 600 procedures during my residency.

The first month on VIR, I was doing alot of floor work, and venous access cases, some IVC filters, and all of the CT guided drains and biopsies.

Second month, they let let me loose and got to do way more. Each month after that, I got more and more freedom and by the 4th and 5th and 6th months I was doing cases with alot of independence and most of the times alone with backup available. I have done Fistulograms and declots, PCNS, ureteral stents, gtubes, gastrojejunostomy tubes, PCN ureteral stents, chole tubes, biliary tubes and stents, interventional oncology procedures, Uterine fibroids embolizations, assisting with TIPS, adrenal vein sampling, forein body retrivals, trauma related embolizations, GI bleed embolizations, CT guided biopsies, drains, MSK biopsies, US and flouro guided biopsies and drains. I got to alot of stuff I just cant think of right now.

On my neuro IR months, I got to flouro LPs, got to do diagnostic cerebral angiograms solo, assisted alot on the neuro interventional cases such as coilings, embolizations of AVM, nosebleeds, tumors, etc.. We dont get that much arterial experience so the Neuro months were very good in practicing catheter skills in the arterial system, and working with closure devices like angioseal, Pressor, etc..

As a senior, I did a vascular surgery month to get some exposure to the PAD work. It was a great elective, I worked long hours but learned a ton from doing and watching procedures, clinic, admitting and rounding on patients, consults, vascular lab, noninvasive tests like ABI, PVR, etc etc... I got to do some of the PAD stuff like iliac stents, below the knee interventions for PAD, stents, angioplasty with cutting balloons, iliac vein stenting for May Thurner etc.. The vascular fellow got to do the EVARS, TEVARS but I got to scrub in on atleast 5-6 that month and see how they do it and use Preclose, IVUS, etc.. It was a very good month. It reenforced the importance of clinical skills and it also showed me how much we have to offer other specialities in terms of our diagnostic and interventional experience.

All this experience made me realize how much I love interventional radiology. I may not have liked it so much if I didnt get all this exposure. I definetly feel prepared as a resident do a good job and build on my skills in fellowship. Mississippi is a great residency for people interested in IR, as we have a chairman who is IR and very good, and have the options for vascular elective , etc.. There are no fellows so residents get to do alot. The staff let u do alot and are pretty cool and love to teach. The vascular surgery staff here are awesome as well and treated me like one of their own surgery residents.

Other places where I saw residents getting to do alot when I interviewed for fellowships were Arkansas and San Antonio. I met some really strong residents with alot of experience from U of Florida, Maine, Miami Jackson Memorial.

In a fellowship u have 1 year to accumulate some serious skills. U will get to do about 1000-1800 procedures in fellowship. If u can alot of experience in residency, maybe it will carry over into fellowship. I dont know, some people think it doesnt matter but Im sure it cant hurt.



Also to the OP: Colorado is a very strong program. I work with a sort of young IR guy who did his med school, residency and fellowship at Colorado at the place where I moonlight. He can do it ranging from diagnostic imaging, to PAD, carotids, Aortas, TIPS, and does it really well.

Also to those interested Kaiser LA is awesome as well. I had the pleasure of hearing Dr V talk to the fellows and residents at the SIR LEARN conference and he was awesome. I bet that places is super competitive!! I also met Dr Lockstein from Mt Sinai, Dr Misra from Mayo, and some of the faculty at Penn at some of these conferences and they are very impressive. U would not worry about the future of IR when u see how these guys are successfully competing with the other specialties. If u are good, then u are good. The patients will come!!!

 

[drizzt3117]

How was PAD work at BWH?

We did some, lots of fistulograms/stents, and some more involved stuff, but it being the Brigham (connected to the Farber), it was pretty oncology focused, so we had a ton of embos, with scattered random stuff like IVC filters, etc. It's a good combination of bread/butter, lines (although a lot of those are done by PAs) PCN, choleostomy tubes, etc with more complicated stuff like embos, AVM embos with alcohol, hepatic artery embos, and crazy stuff like TDEs.

 

[VIRads]

Which programs have IR clinics in which residents can take part in?

The specialty is becoming more and more patient/clinically oriented.

You can get great technical training at many of the institutes being named in this thread.

But will you learn indications? Will you learn how to manage complications? Will you learn some of the medical management side of things?

 

[VIRads]

Colorado is a very strong program. I work with a sort of young IR guy who did his med school, residency and fellowship at Colorado at the place where I moonlight. He can do it ranging from diagnostic imaging, to PAD, carotids, Aortas, TIPS, and does it really well.

Sounds like University of Colorado is up there with Medical College of Wisconsin, Yale, Baptist Cardiac and Vascular Institute, Brown, Peoria.

 

[Gvataken]

I have to agree with VIRads, it is very important that you get some component of clinical training (ideally continuity patients and clinic) as a resident. The technical component will be learned, but the clinical component of how to distinguish a paitent;s leg pain as vascular, neurogenic, venous, arterial , arthritic, etc and then what type of management is required can be challenging. Also, knowing the scope of management (medical, exercise regimens, risk factor management, interventional options and surgical options) is not well taught at many programs. RIsk factor management is important for vascular patients to reduce their mortality and morbidity and that includes some basics on statins, anti-hypertensives, smoking cessation, HBA1c etc. It is key to learn this component early on in your training and attempt to maintain those skills.

When I was a resident we had IR fellows that were so hungry that I was not able to do much, and it can vary year to year. Many IR programs that have fellows have not placed an emphasis on resident education and don't rely on the residents. I think this is unfortunate and I have the mentality of "catch what you kill". If the resident works up the patient or sees him in the office, then he should be able to do the case provided he has reasonable technical aptitude for that specific case.

We have one month of IR per year for all trainees. The first IR rotation is within the first 3 months of radiology residency. Our trainees are given quite a bit of autonomy and are usually doing TACE procedures puncture to closure by their 2nd or 3rd year. The residents on IR go to clinic a 1/2 day a week and our service admits 10 to 15 patients to the hospital weekly. So, needless to say our trainees get pretty comfortable clinically.

We have also taken the new board format into consideration and the highly motivated resident who is willing to work hard and does extremely well on his imaging rotations and in-service exams etc is allowed to up to 16 months of IR and clinical rotations interspersed during the 4 years. The first 3 years they do 2 months of IR each year and can do cases afterhours or on the weekends if they are motivated. Their PGY5 year they can do up to 10 months of IR /INR/ clinical rotations. The first few trainees that are going through this particular program have been spectacular and have churned out a great deal of research, have solid technical foundation, and are vastly superior clinically (with continuity clinic patients). The program ends up being similar to what a CLINICAL pathway program offers.

We are hoping that more radiology residency programs incorporate similar patterns of training at their facility for those highly motivated in becoming a clinical IR.

 

[NappingGuppy]

Gonna necro this fine thread - any West Coast programs other than Southern California Kaiser come to mind for IR programs? I imagine this may become more important with the rollout of the dual certificate.