Why isn't IR part of intern year?

[Naijaba]

This is something that I've been wrestling with since matching DR-only, and I was hoping some individuals responsible for crafting the new residency can provide some insight. I could've ranked all IR-programs above DR programs, but even then my chance of matching IR would've been ~25%, given the sheer number of applicants. I matched at UW, an institution with phenomenal DR and IR, but they don't yet have ESIR. I'm not keen on doing a two-year independent residency. After thinking about it for a while, here's my conclusion:

If intern year included 6 months of IR + 1 ICU rotation, there would be no need for ESIR and the IR/DR residency would be 5 years.

My logic is pretty sound as I've heard the "requirements" over and over along the interview trail. Consider the following questions:

1. Why is IR/DR-integrated six years?
Vascular surgery is 5; ENT is 5; Gen surg is 5; Ortho is 5. DRs now take their boards during R3/PGY-4. IR/DR-integrated residents spend their last two years doing almost all IR rotations, so there is minimal DR training that these residents would miss. It really comes down to my second question...

2. What is gained by having that extra year dedicated to IR?
According to this document: The minimum ESIR requirements are: at least 8 IR rotations, 1 ICU rotation, and up to 3 IR-related rotations during PGY2-5.
"IR-related" means IR procedures not done in the IR suite (i.e. vascular surgery, MSK, neuro-IR, maybe even breast). I'm doing a surgical prelim which includes an ICU rotation and a vascular surgery rotation. Shouldn't half a year of surgery satisfy the "IR-related" requirement? It seems that the PGY2-5 requirement is the only thing preventing it from counting. Be that as it may, most DR-residents will do three IR-related rotations throughout their first three years, anyhow.

If you follow my reasoning, this means that the only unsatisfied requirement is 8 months of IR to satisfy the ESIR requirement. Almost all DR residencies require their residents to do 1-month of IR during PGY2-4. So when you remove the ICU requirement, remove the "IR-related" requirement, and account for 3-IR rotations built-into DR residency, there are really only five additional months of IR required by ESIR. So then my last question...

3. Why isn't IR part of intern year?
If residents did 50% gen surg and 50% IR during their intern year (this is how neurosurgery, vascular surgery, etc. do it), then they would complete the 6-months of IR rotations right from the get-go, alongside the ICU-requirement.

Seems like this is the best direction for IR to head in the long-term. My biggest beef is that prelim surgery should be required; if it were required the ICU and the "IR-related" requirements could be completely eliminated.

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[qxrt]

Makes no sense to do 6 months of IR as an intern prior to any DR training, considering that the entire basis of IR is using an understanding of DR to perform procedures.

 

[Naijaba]

Makes no sense to do 6 months of IR as an intern prior to any DR training, considering that the entire basis of IR is using an understanding of DR to perform procedures.

Vascular surgery interns do more than operations during their 6 months on vascular: they see patients in clinic, handle consults, and manage floor patients. I imagine the goal is to have IR do the same for IR patients. In terms of procedures, much of IR can be done without a deep knowledge of imaging (tunneled catheters, ports, g-tubes, nephrostomy tube, etc.), especially if under the supervision of an attending / chief (or current IR-fellow).

 

[DrfluffyMD]

Vascular surgery interns do more than operations during their 6 months on vascular: they see patients in clinic, handle consults, and manage floor patients. I imagine the goal is to have IR do the same for IR patients. In terms of procedures, much of IR can be done without a deep knowledge of imaging (tunneled catheters, ports, g-tubes, nephrostomy tube, etc.), especially if under the supervision of an attending / chief (or current IR-fellow).

Yes, much of IR CAN be done without deep knowledge of imaging, but SHOULD it be done without deep clinical or imaging knowledge?

This is the same argument for midlevels. You can train a high school kid to throw a line in, but what if you see collaterals? Can you read an x ray well enough to tell that your line is in the aorta versus a left sided IVC?

Intern year is to learn how to manage patients and build a clinical foundation. It isn't a time to specialize.

When you get two certifcates, training gets longer.

 

[DrfluffyMD]

Wasn't that part of the keynote speaker's presentation at SIR this year? He taught his grandson how to deploy a stent?

And I can teach a monkey to cut an aorta and an elementry school student to sew it back together.

Knowing whether to cut, when to cut, where to cut, and what to do after you cut is more important than how to cut.

If you didn't match IR, then seek internal transfer or ESIR. Good luck.

 

[TheRealDrDorian]

Yes, much of IR CAN be done without deep knowledge of imaging, but SHOULD it be done without deep clinical or imaging knowledge?

This is the same argument for midlevels. You can train a high school kid to throw a line in, but what if you see collaterals? Can you read an x ray well enough to tell that your line is in the aorta versus a left sided IVC?

Intern year is to learn how to manage patients and build a clinical foundation. It isn't a time to specialize.

When you get two certifcates, training gets longer.

Couldn't have said it better.

The extra year of IR added to the training pathways was to improve technical AND CLINICAL expertise needed in the field.