I am creating a new resource for medical students

[DO Work Son]

Hello,

I am a PGY-1 resident who will be completing a residency in Radiology, and hopefully an Interventional Radiology fellowship after that. During my 4th year in medical school, I did a number of interventional radiology away rotations, at both "traditional" training institutions (i.e, post-residency fellowship) and at DIRECT pathway institutions. In the end, this helped me decide that the traditional route was best for me. As enjoyable as this experience was, I was frustrated at the lack of interventional radiology resources available that were appropriate in both cost and content for a medical student. I went into the rotations somewhat "cold," so to speak, regarding preparation and what would be expected of me. There is no "first aid" for the interventional radiology rotation. Luckily, I had wonderful preceptors that were equally great teachers, and I learned a lot. This is a problem, however, that will be much more readily apparent come the switch to IR / DR integrated residencies - more students will be rotating through interventional radiology, and will have a similar experience as I did attempting to obtain resources that are helpful, easy to read, and concise. So, I thought - why don't I spend a little extra time during my (relatively relaxed) Transitional Year and compile my notes into a resource that could potentially help future students?

So, Student Doctor, this is where you come in. I would love to hear from you, medical students, residents, fellows, and attendings.

For students and residents, what questions do you have that would like an an answer to regarding IR? Training pathways? IR suite étiquette? Information regarding common procedures? Something else?

For fellows and attendings, what do you wish students or junior residents rotating on the IR service knew prior to arrival? What skills do you expect them to have? What are your favorite pimp questions? What can they do to maximize their experience?

I appreciate anyone who takes the time to read this, and doubly so if you are able to add to the discussion. I am hopeful that we are able to develop a resource that students find helpful, interesting, and thought-provoking in order to help everyone (students, residents, fellows, and attendings) find the most benefit and enjoyment from their rotation in Interventional Radiology.

Thank you!

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[MadRadLad]

As a med student who is interested in IR, i'd love to know the following:

- Outline of the different training pathways. Not sure what DIRECT is, and I heard that with dedicated IR residencies they will phase out the DR -> IR fellowship pathway.
- Common procedures and things like that. Average time it is, procedures/day
- Outline of a day/week of being an IR doc
- Thoughts on what it would take to be a competitive applicant for IR (how much is research valued, away rotations, step 1, etc.)

 

[WhippleWhileWeWork]

As a first year medical student with an interest in IR I'd like to know
-what steps can be taken early on to improve one's application for either the DIRECT or CLINICAL pathways
-Advantages or disadvantages of, in your case, traditional pathway over Direct
-Lifestyle of general IR
-How and when to focus into certain areas of IR; cancer, vascular, neuro, etc.
-Hear more about the skills and aptitudes that are generally seen in good IR practicioners

Thank you

 

[MadRadLad]

I won't beat around the bush either. What are the different settings of practice for IR physicians and what range of earnings are possible from PP/academics?

 

[DO Work Son]

Than you very much for taking the time to reply! It does seem that there is a lot of confusion regarding the training pathways. It is true that they will be phasing out all of the current training options as they begin to transition to the integrated IR / DR residency. That being said, people who begin training prior to the new IR / DR residency implementation will be "grandfathered in" and allowed to either finish their current training, or switch to an IR/ DR residency without losing any time. You can find more information regarding the new training pathway here:

http://www.sirweb.org/clinical/IR_DR_cert.shtml#Article

And for an overview of the training pathways:
http://www.sirweb.org/fellows-residents-students/pathway-options.shtml

As I continue to work on this project, I will make it a point to discuss these issues in greater detail.

It sounds like you guys are also interested in what program directors find desirable in an applicant. That is something I will ask about, and hopefully be able to get some straight forward answers. Great feedback!

Regarding the "day in the life" and lifestyle, that will be discussed - the take home point, however, is that it really depends. There are a lot of different practice settings, from someone that does 100% IR and is as busy as a general surgeon, to someone who splits their time 50/50 between diagnostic imaging and performing procedures. The advice I have gotten is typically to do what you love. As is true in most specialities, you will be able to choose a practice setting that fits your desired lifestyle.

I appreciate the feedback! If you know others that are interested in IR, please have them drop by and contribute their questions. I'd like for this to develop into an excellent resource for students.

 

[TrueAntagonist]

As someone preparing for IR Sub-I's in the summer, I was hoping you could point out some useful resources/books for med students who want to learn the lingo/pathology/clinical foundation related to IR procedures and consults. Thanks for doing this.

 

[sievert_fever]

I found a list of programs offering the DIRECT and clinical pathways, but have not been able to find a list of the pioneer programs for the upcoming IR/DR pathway. Has anyone else?

 

[WhippleWhileWeWork]

I found a list of programs offering the DIRECT and clinical pathways, but have not been able to find a list of the pioneer programs for the upcoming IR/DR pathway. Has anyone else?

Is that differnent than Direct?

 

[sievert_fever]

Is that differnent than Direct?

Yes. To my understanding...
- DIRECT = 2 IM + 2 DR + 2 IR
- IR/DR = 2 DR + 3 IR (+/- a prelim year?)

 

[TrueAntagonist]

Yes. To my understanding...
- DIRECT = 2 IM + 2 DR + 2 IR
- IR/DR = 2 DR + 3 IR (+/- a prelim year?)

I think IR/DR = 1 prelim + 3 DR + 2 IR

 

[DO Work Son]

Regarding preparation for a clinical rotation in IR: I found the currently available resources to be lacking. I have found Interventional Radiology: A Survival Guide by Kessel and Robertson, and Handbook of Interventional Radiologic Procedures by Kandarpa and Machan to compliment each other well.

Survival Guide is smaller, more portable, and written in a style similar to other review books. It is probably the better book to tuck in your white coat and read quickly before a procedure.

Handbook of Interventional Radiologic Procedures is more complete, and includes discussion of radiation safety, the IR clinic and is far more wordy. It is an excellent book, but is intended to be a reference for fellows and attendings - a good portion of the book is dedicated to research and quality improvement in the field.
Both of them are targeted towards fellows, so the can be a little too technical, as well as skipping entirely some of the most basic aspects of IR (how to handle the equipment, wrap the wire, perform an IR focused H&P, etc.) They are also a little pricey. I am hoping to fill in the gap with my current project - it will be more targeted towards what a student needs to know, more concise, and more affordable. That being said, here are links to the best currently available books on Amazon:

Amazon product

Amazon product

As for the discussion regarding training pathways: DIRECT is essentially two clinical years, followed by two diagnostic radiology years, followed by two interventional radiology years. The clinical years vary in their content, with some institutions having a custom curriculum. Others, however, have you complete an internal medicine intern year followed by a general surgery intern year. The fellows I have spoken with who have gone that route spoke highly of the experience, but the prospect of completing two standard clinical intern years sounds miserable to me.

The new IR / DR combined programs are different in that they will be replacing ALL other training pathways. By 2020, they will be the only way to train in interventional radiology. The exact curriculum is still being developed, but according to the ABR, it will look something like: Intern year, followed by three years of diagnostic radiology which would include a few rotations in IR followed by two years of interventional radiology, which would include training in the surgical ICU and IR clinic. I do not have a list of programs that will transition first, but I think a safe bet would be that anyplace with a radiology residency program and interventional radiology fellowship program will have an IR / DR combined program in the near future.

 

[sievert_fever]

I found a list of programs offering the DIRECT and clinical pathways, but have not been able to find a list of the pioneer programs for the upcoming IR/DR pathway. Has anyone else?

Just heard back from Debbie Katsarelis: "The application process for programs to become ACGME approved has not yet begun. The application process will begin in 2015. The approval process takes several months. As programs become approved, SIR will post them on the website... you should visit regularly for updates." According to this document, there may be few (or zero) programs accredited in time for the upcoming application cycle.

 

[Riverhawk14]

How competitive do you think IR will be in a few years? Also, do you think it would be more difficult for a DO to make it into an IR residency? I recently got accepted into a DO school and very interested in interventional radiology; so, I would like to know what to expect.

 

[DO Work Son]

Hey,

Sorry for the delay in getting back to you - Intern year is keeping me a little busier than I'd like.

It's impossible to say how competitive IR will be in the future. I don't think many people predicted the drop in competition for general radiology residency spots that we have experience in the last few years - it went from one of the most highly sought-after specialities to one that had over 100 spots go unfilled in the most recent match. That being said, IR has remained extremely competitive - it seems that more and more people that do match into radiology want to pursue IR eventually.

Being a DO isn't going to keep you out of an IR residency. I am a DO doing an ACGME (MD) residency, and I know plenty of DOs who have successfully completed ACGME IR fellowships. The most important thing is to study hard, do well on your boards (both USMLE and COMLEX,) and make as many professional connections as you can. If you are able to do research, that is also a huge boost to your application.

I have been working on gathering a lot of information for this resource, and I am in the process of formatting it for a website. Once I have something that I think will be beneficial, I'll come back and post a link. In the mean time, please ask as many questions here as you'd like. If I don't know the answer, I will do my best to find out!

 

[IR rocks!]

Hey DO Work Son,
Great work !.......could you PM me at
[email protected]?

Had something to discuss

IR rocks

 

[je355804]

Regarding preparation for a clinical rotation in IR: I found the currently available resources to be lacking. I have found Interventional Radiology: A Survival Guide by Kessel and Robertson, and Handbook of Interventional Radiologic Procedures by Kandarpa and Machan to compliment each other well.

Survival Guide is smaller, more portable, and written in a style similar to other review books. It is probably the better book to tuck in your white coat and read quickly before a procedure.

Handbook of Interventional Radiologic Procedures is more complete, and includes discussion of radiation safety, the IR clinic and is far more wordy. It is an excellent book, but is intended to be a reference for fellows and attendings - a good portion of the book is dedicated to research and quality improvement in the field.
Both of them are targeted towards fellows, so the can be a little too technical, as well as skipping entirely some of the most basic aspects of IR (how to handle the equipment, wrap the wire, perform an IR focused H&P, etc.) They are also a little pricey. I am hoping to fill in the gap with my current project - it will be more targeted towards what a student needs to know, more concise, and more affordable. That being said, here are links to the best currently available books on Amazon:

Amazon product

Amazon product

As for the discussion regarding training pathways: DIRECT is essentially two clinical years, followed by two diagnostic radiology years, followed by two interventional radiology years. The clinical years vary in their content, with some institutions having a custom curriculum. Others, however, have you complete an internal medicine intern year followed by a general surgery intern year. The fellows I have spoken with who have gone that route spoke highly of the experience, but the prospect of completing two standard clinical intern years sounds miserable to me.

The new IR / DR combined programs are different in that they will be replacing ALL other training pathways. By 2020, they will be the only way to train in interventional radiology. The exact curriculum is still being developed, but according to the ABR, it will look something like: Intern year, followed by three years of diagnostic radiology which would include a few rotations in IR followed by two years of interventional radiology, which would include training in the surgical ICU and IR clinic. I do not have a list of programs that will transition first, but I think a safe bet would be that anyplace with a radiology residency program and interventional radiology fellowship program will have an IR / DR combined program in the near future.

I somehow don't completely agree that in 2020 the IR/DR combined program will be the ONLY way to go into IR as of 2020. Imagine someone who comes out in 2019 and does a first fellowship and then in 2020 decides they'd like to go for IR... Or a resident who begins their DR training in 2016 let us say... I doubt these people wouuld be SOL. There will still be ways for these people to get into the game.

 

[wheewer]

I will be in the middle of my DR residency when the IR fellowships are phased out in 2020. Unfortunately, the number of integrated IR residency spots right now are incredibly limited - it just seems like the only way to end up doing IR is to match into one of the few IR programs out there right now.

How safe is it to end up in a DR residency if my goal is to do IR? I don't want a purely diagnostic career. Is it a big no-no to do a non ACGME approved IR fellowship if there is no other choice by that point in time?

Thanks for your help!

 

[A Nonie Meus]

I will be in the middle of my DR residency when the IR fellowships are phased out in 2020. Unfortunately, the number of integrated IR residency spots right now are incredibly limited - it just seems like the only way to end up doing IR is to match into one of the few IR programs out there right now.

How safe is it to end up in a DR residency if my goal is to do IR? I don't want a purely diagnostic career. Is it a big no-no to do a non ACGME approved IR fellowship if there is no other choice by that point in time?

Thanks for your help!

Bump. Interested to know the answer to this to.


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[TheRealDrDorian]

I am a recently matched R4 who was in a traditional diagnostic residency. IR remains a competitive field with application:fellowship spot ratio of roughly 1 : 1 for the 2016 cycle (previously: 1.2:1 in 2015 and 1.2:1 in 2014; ref: http://www.nrmp.org/match-data/fellowship-match-data/).

For residents early in training, while there is no guarantee and a lot of confusion, I think the majority of current IR fellowships will transition to IR residencies (both integrated and independent) as well as most diagnostic programs having the ESIR (early specialization in IR) distinction by the time you are applying for IR "Residency" (formerly fellowship). Keep in mind, when programs get their IR residencies approved, they will still need senior trainees (e.g. "fellows") to fill their programs. That being said, those if you are at a radiology residency program that currently has an IR fellowship, you be in a safer situation as you may have the option of staying at their home program for an independent IR residency.

For medical students interested in doing IR but either a) don't match into an integrated IR residency or b) are not sure if they want to match into an integrated IR residency, I recommend going to a strong diagnostic residency training program first and foremost (level 1 trauma, major referral center for oncology, high volume), and ideally one that has a current IR fellowship. If the program has an ESIR, that will save you a year in training down the road.

Hope this helps. Please feel free to PM me if further questions.

A lot more helpful info can be found at:
http://www.sirweb.org/clinical/IR_DR_cert.shtml
http://rfs.sirweb.org/wordpressnstall/4787-2/