Interventional Experience as a Resident

[paz5559]

My program director asked me if I knew of programs that gave their residents interventional experience during the course of their training. I told him I thought the folks at Stanford, Utah, Ohio State, MCV, and Spaulding had the opportunity for such experiences, but thought I better confirm my impression with people with direct experience at each of those programs. He asked if I could ask a broad array of residents from multiple programs about the topic, and I immediately thought SDN would be the right place to check.

If, in fact, you are either a resident or have rotated through programs as a med student where you observed residents (not fellows) performing interventional spine procedures of any kind (ie caudals, interlaminars, transforaminals, etc), if you would either post that information to this board, or, if you prefer, PM me privately, I would be most appreciative.

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[axm397]

UPenn (MSK, not Slipman) - resident performing transforaminals

 

[Stinky Tofu]

Since we have so many electives, you can get as much interventional experience as you want. Within the Harvard system, we get most of our experience through MGH, BWH, NEBH, SRH, and through local private clinics. You can augment this experience by rotating anywhere you want in the country during your senior year. The interventional spine procedures you do the most of in the Harvard system are interlaminars, transforaminals, facets joints, and medial branch blocks. Depending on how many there are, how good you are, and how many the fellow has done, you could also do caudals, morphine/baclofen pump trials, spinal cord stimulator trials, radiofrequency ablations, and epidural blood patches. Other interventional pain procedures you might get to do are IV lidocaine infusions, occipital nerve blocks, SI joint injections, and morphine/baclofen pump refills. You also get to scrub in on the intrathecal pumps and the spinal cord stimulator cases, but you mostly get to open, try positioning the leads, and closing. If you only do one month, you can't expect the attending to let you do much in the OR or in the clinic. The procedures we get to see, but not do are vertebroplasties, kyphoplasties, percutaneous discectomies, IDET, sympathetic blocks, etc.

 

[Disciple]

2+ months at CINN-observation (fellow does the procedures)

2+ months performing procedures split between Physiatry/Anesthesia
-basic stuff mostly (transforaminals, interlaminar, caudals, facets, MBB)
observation for cervicals, discogram, stims, sympathetic blocks, IDET etc.

2 months Cook County MSK outpt clinic performing peripheral nerve blocks/joint injections.

 

[DigableCat]

Residents are easily able to perform lumbar ESIs and MBBs, as well as SI joints, occipital nerve blocks and pump(baclofen, morphine, dilaudid) refills. The more risky cervical procedures are usually left for the pain fellows in most cases except for the most aggressive residents that have already proven themselves. Also the invasive procedures(spinal cord stimulators and pump placements) are done in the OR, so the residents don't usually get to scrub in on those.

I think ultimately it also depends on the volume(and variety) of cases at the clinic. The more volume, the busier the clinic, the more likely the fellows won't squawk when you are trying to get some procedures in. In the beginning of the year, they are all gung ho and want to do each and every procedure that comes by. By the end of the year, they are usually comfortable enough in their skills(and worn out) that they'll easily forgo a procedure to an eager resident.