IR fellowship programs

[IRmonkey]

I think a thread that has information on IR fellowship programs we are familiar with would be helpfull. If you could comment on the fellowships at your institution, or programs you interview at I think that it could be very helpful for everyone. Please include your opinion of the strengths and weaknesses of the program (vascular cases?, IO?, clinical service?, admitting privileges?, stability of staff, etc)

I will post a review of Mayo Clinic's (Rochester) fellowship soon.

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[IRmonkey]

Mayo has 12 interventional radiologists that work at the Mayo inpatient hospital and at the Clinic outpatient center. The IR staff is stable with very few comings and goings. There is a good range of staff age/experience ranging from those getting ready to retire to those that have recently joined staff. The staff have areas of interest (such as PAD, IO, biliary, GU) but aren't exclusive. There are 1-2 fellows per year.

There is a Vascular Medicine Center were several of the staff hold regular clinic hours. Referrals generated from the center go to either vasc surg or IR. Some of the staff specialize in renal arteries and do a good amount of work in this area. There is also a god amount of work in PAD. Aortic EVARs are performed by vascular surgery. One of the IR staff is an expert in venous procedures and there is a significant amount of venous ablation and stenting etc. One IR staff is trained as a cardiologist and has a joint appointment with vascular medicine.

Several staff have interest in interventional oncology and regularly perform TACE and radioembolization. Percutaneous ablation is generally performed by a very active ultrasound/x-sectional group. There are opportunities to spend time doing ablations with US, CT and fusion imaging guidance.

Other procedures such as HIFU of uterine fibroids, fibroid embolization, interventional MR procedures, etc are also performed. Neuroradiology does the kyphoplasties/vertebroplasties, with opportunities to get involved if desired. Spine/pain intervention is done gy a group of non-VIR rads and there is the possibility of spending time with them. Overall the breadth of cases and number is very good. The procedures are performed in an efficient manner allowing one to do a large volume of cases without having to stay all evening.

Call is divided among the fellows (2) and residents (3). Call is taken a week or ½ week at a time.

There are regular didactic sessions/patient management sessions.

Autonomy. Different staff allow varied amounts of autonomy, and some earlier than others. Staff are generally watching or in the room for the procedure (which can be quite different to other places were staff are available, but not present). Some people may not like a staff watching over their shoulder, others may appreciate having someone on hand. It has both +/-.

Research. There is a good amount of research going on for those interested. One staff has a major research grant and does primarily renal arteries and PAD. Others do MR-guided IR or ablation research. Plenty of opportunities for those looking to do clinical or more basic science research.

There is a clinic were staff see their patients. Ir does not have admitting priviledges and admissions are managed by a medicine service. There are opportunities to be more hands on for those that are motivated to do so. There is a new fellowship director and efforts are being made to allow more patient care to be provided by IR. There are also several physician extenders that help manage patients and keep things running.

Elective time possibilities include: ablations with the X-sectional group, clinical rotations on at the vascular medicine center, time with vascular surgery, neuro kyphoplasties/ vertebroplastyies or time doing spine/pain interventions.

Summary:

Pros:

• Number of cases and breadth of cases (including vascular cases)
• Efficiency of the service (# of cases in time spent – I have spoken to prior residents trained at top national programs, they all say none are as efficient as Mayo).
• Many options for elective time.

Cons:

• Autonomy: Staff is generally present for the cases (you aren’t running a room a on your own).
• No admitting privileges –as of yet.