IR procedures vs. surgery

[jls34]

Hello all, I'm an MS3 with a quick question about IR for those of you who have more exposure. It seems like thus far in my medical training (and for much of my training in the near future), actually being an operator in the IR suite is out of the question, and the closest I'll get to it is observational. This is a bit different from surgery, where even though my role is minimal, I still can get a sense of what it might be like to do the surgery (i.e. cutting, bovieing, suturing, etc.). Thus I really have no clue what it's like to perform an IR procedure.

How enjoyable are performing catheter based interventions? Is it surgical in the sense that you can get better via practice, and you can feel like an "expert" at certain things? Or is it much simpler from a procedural standpoint than surgery, and thus the attending who's been doing it for 15 years won't be much "better" at it than the fellow or fresh attending?

Please forgive my ignorance regarding the subject. I'm just genuinely curious, since there's no real way for me to experience it myself at this point in my career. Thanks in advance for any insight!

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[davidjones]

Where you are rotating are there procedures that are done by the resident as the primary operator? If so, you may be able to prove yourself enough to them where they allow you to do much of the simpler procedures, tunneled lines, drainage caths, or temp lines. I have had a few excellent med students that I've allowed to do the majority of vascular access procedures with exception of the critical parts: venous stick, measuring the lenght of the tunnel, etc.

If not, you may be able to convince an attending to allow you to sub-select vessels or at least advance the wires/catheters.

The procedures range from mundane (PICC lines/Drains/Biopsies) to irritating (AV fistulas stuff/vascular access) to fun (oncologic interventions, embolizations, portal stuff) to terrifying (TIPS on a variceal bleeder with platelets of 10).

The guy that has been doing it for 15 years will be worse than the guy that's been doing for 20 years and the guy that's been doing for 10 years. The reason the longer you practice the more wierdness you encounter, not only perioperative, but also complications wise, and different kinds of cases. At my place there is a guy who does primarily oncology, one who does primarily women's interventions (UFE/Pelvic congenstion syndrome) and general, one who does primarily Pain interventions as well as embolizations and viscera; one who does PAD, and we have 2 that do CT/US guided stuff as well. While they can all do the same procedures, there is definitelly a noticeable difference working with attendings who are doing cases outside of their expertise.

Likewise in surgery you can a general surgeon will have significantly less trouble with trauma and abdominal surgery, than a breast surgeon who takes general call, but the same general surgeon will not have the same proficiency and breast procedures.

I would really try hard to get more hands on experience, let the attendings know you're interested, usually they will let you do it, unless they are themselves uncomfortable with the procedure or you have somehow shown you can't be trusted.

 

[jls34]

Thanks for the very informative and thorough response. At my school IR exposure in 3rd year is simply 1-2 days of observation in the IR suite, so really not much of a chance to do anything. I'll probably need to schedule an elective in 4th year to get the sort of hands on experience you're talking about. It seems from your response that the IR procedures can be both fun and challenging though, which is what my original question boiled down to.

 

[Gvataken]

I believe that I am continuing to show improvement in my clinical and technical skills each year. There are so many devices that are coming out which add new technical challenges. I just went to the ISET/CIO meeting in Miami. Check out iset.org. They had some amazing new procedures and techniques. In fact this IR from Italy showcased where he was performing endovascular revascularization of the pedal vessels and accessing the toe arteries to retrograde recanalize the lower extremity arterial circulation.

We have a medical student roatation for 3rd and 4th years and it ends up being a mix of outpatient clinic, inpatient consults, and procedural room time. The highly motivated medical student has gotten to do a considerable amount. But, they need to be proactive.

SIR meeting in San Francisco has an exciting day with a dedicated medical student curriculum.

Check out sirweb.org for more information about the meeting and the medical student curriculum should be on there soon.

It is a fun field and is similar to surgery in terms of lifestyle, procedural and clinical components.

PM me if you want to discuss further