Advice about SIS

[interjectionreflection]

Hello everyone, im sorry if this has been asked before but I could not find anything to my specific situation. I am doing a 2 year fellowship in Canada for Interventional Pain and have not been able to attend SIS due to COVID making it difficult to travel. I am now nearing completion of my training and debating weather I need to attend SIS bio-skills. I already have done most of the interventions and have a good number of cases in my procedure log and feel relatively comfortable doing the bread and butter cases (the ones listed in the cervical and lumbar advanced courses). It would have been nice to attend these courses earlier in my training. I have also watched the videos which they sold this year and bought the guidelines. From those that went to lumbar advanced or cervical in retrospect do you think it would be worthwhile if you had gone in your last month of fellowship/after fellowship? Im finding it difficult justifying a $3000 (CDN) cost and travel and stay as well on a fellow salary.

Thanks again for any input.

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[willabeast]

The problem for me was not my skills, it was almost always the x ray technician skills. As i sometimes had to work with x ray techs whose primary job was MRI or CT or ultrasound and knew almost nothing about fluoro it made me realize i needed to learn how to operate a fluoro machine and position patients for fluoro. SIS has a course for technicians, it was by far the most useful course i ever took anywhere. IF you have competent fluoro techs where you wind up, it is totally not necessary. You take the good techs for granted at teaching institutions.

 

[hyperalgesia]

Hello everyone, im sorry if this has been asked before but I could not find anything to my specific situation. I am doing a 2 year fellowship in Canada for Interventional Pain and have not been able to attend SIS due to COVID making it difficult to travel. I am now nearing completion of my training and debating weather I need to attend SIS bio-skills. I already have done most of the interventions and have a good number of cases in my procedure log and feel relatively comfortable doing the bread and butter cases (the ones listed in the cervical and lumbar advanced courses). It would have been nice to attend these courses earlier in my training. I have also watched the videos which they sold this year and bought the guidelines. From those that went to lumbar advanced or cervical in retrospect do you think it would be worthwhile if you had gone in your last month of fellowship/after fellowship? Im finding it difficult justifying a $3000 (CDN) cost and travel and stay as well on a fellow salary.

Thanks again for any input.

I think you get more out of it after a year or so in practice.

 

[Ducttape]

have you "run" the C-arm for others, to get a feel of the machine and how to take the best images?

when one of your colleagues or attendings are doing procedures, ask to run the machine with your tech supervising you, if you haven't done so already.


in some of the jobs out there, you will not only be the proceduralist, you will be telling a tech who doesn't know what they are doing how to move the machine or take appropriate images or collimate or oblique etc.

 

[pastafan]

Wait until you have a tech bang the table a few times shifting to a lateral. It will make you appreciate a competent tech.

 

[lobelsteve]

Wait until you have a tech bang the table a few times shifting to a lateral. It will make you appreciate a competent tech.

Or lower the C-arm onto the arm of an asleep patient.
Or crash into the base of the table when getting back AP from lateral and not raising the C-arm.
Or smashing an elbow when going CLO in C-spine.

 

[NJPAIN]

The problem for me was not my skills, it was almost always the x ray technician skills. As i sometimes had to work with x ray techs whose primary job was MRI or CT or ultrasound and knew almost nothing about fluoro it made me realize i needed to learn how to operate a fluoro machine and position patients for fluoro. SIS has a course for technicians, it was by far the most useful course i ever took anywhere. IF you have competent fluoro techs where you wind up, it is totally not necessary. You take the good techs for granted at teaching institutions.

I think that they stopped running the tech course a while ago.
Unless you somehow know you will always have a rockstar tech you MUST know how to operate the Carm. I have worked with clueless per diem techs and hospital technicians who never operate fluoro. I put a cap on the II and use the foot pedal. I direct the tech to lock and unlock after I position the Carm. I don’t depend on the skill of the tech; wish I could.

 

[interjectionreflection]

Thanks for the suggestions everyone. Thankfully im at a place with a really good tech who showed me the ropes when i first started so thankfully that is not a concern. I may be understanding this wrong but it sounds like from the replies the majority of the benefit to attend SIS would be to learn to use the C-arm better? Does anyone have any specific thoughts on attending the SIS cervical or lumbar courses if in the last few months of training?

 

[RoloTomassi]

I'm curious, what does your 2 year fellowship consist of? What procedures do you learn any how many? What are you not exposed to?

 

[interjectionreflection]

I'm curious, what does your 2 year fellowship consist of? What procedures do you learn any how many? What are you not exposed to?

Its pretty varied -- we do a lot of MDC, MSK, Addictions, Peds, Sleep/cancer and electives.

Procedures again are luck of the draw (what you see while your on rotation) typically:
Lumbar: ILESI, TFESI, MBB, RFA, pDRG, lumbar sympathetic/Splanchnic, IA facet
Cervical: ILESI, TFESI, MBB, RFA
Misc: SIJ, LBB, LB RFA, Impar

OK exposure: US

Minimal to no exposure: stellate ganglion, neuromod, regenerative medicine, peripheral issues outside of large joints (i.e. next to none hand/wrist, elbow, ankle or foot) and craniofacial

 

[deleted875186]

Haven’t done the SIS course, but my understanding is is is focused on the bread and butter procedures mentioned above and how to do them perfectly.