How to get the most out of your training?

[7summits]

I'm an MS4 in the process of appying to residencies now, and I've been looking into each of the training pathways for IR. Although the DIRECT path is appealing, I've decided that a clinical pathway would be ideal for me. Based on the sheer volume of applicants and the limited amount of programs that offer a clinical path (or a program similar to it) I know that it's possible that I won't match at one of these programs.

My question is: how do I make sure I get the most IR exposure out of whatever DR residency I match into? I know there are ways to increase the # of IR rotations you do throughout residency, but I'd like to hear other suggestions- Reaching out to local IRs? Finding creative ways to keep brushed up on your clinical skills? Taking extra IR call (if available-I've seen advertised at some programs)?

Thanks!

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[Lacuna]

Due to the restructuring of the boards, there will be about 9 months in 4th year (pgy 5) to do mini fellowships. You can choose do one subspecialty during this time, like IR.

 

[Gvataken]

This is a great question. Something that the RFS resident fellow section of the SIR is working on.

We have proposed a number of methods to maintain clinical aptitude during ones diagnostic training.

I think that a strong clinical internship is key. I did internal medicine prelim. A strong clinical surgical prelim would also be good. I personally don't think a transitional program is as useful ( I feel that it is more like a glorified extension of 4th year). In fact at our program, I got rid of the transitional year because of that and have noted that my residents come into radiology with a stronger clinical background.

Next, many of the RFS members are doing clincal moonlighting during residency. Urgent care, emergency room, free clinics etc.

Next with the new restructuring of the boards, I have allowed my own residents inerested in IR , to do up to 16 months of IR scattered with clinical rotations such as cardiology, ICU, vascular surgery , surgical oncology etc. The residents will be allowed to do 2 months of IR each year for 3 years and then 10 months their final year. Then they can go on to a dedicated IR fellowship. This

During the IR rotation the residents at my facility go to a 1/2 day of clinic every week on IR. They are asked to 80 cases in a 4 week IR rotation. The other thing that I have done is to have them take IR call their first year of radiology.

The RFS has developed a clinical lecture series webinar.

We also are developing resident IR continuity clinics. Residents are asked to pick up 5 continuity patients each rotation that they follow for the duration of residency. They are asked to order the imaging and labs etc and act as that patient's IR physician.

Hope that helps.

 

[Lacuna]

How do the other specialties take radiology residents on their service? Are they scrubbing into and assisting in cases (ie. endovascular AAA repair) or are they doing more intern level work?

 

[Gvataken]

When, I did my residency I used a couple of electives to rotate with the other specialists.

I did a vascular surgery clinic/vascular lab rotation. Very useful for me to see patients with the vascular surgeons in a clinic environment and I still apply some of those principles to this day. As a resident I just did clinic work.

I also did a pediatric interventional cardiology rotation and watched a bunch of ASD and PFO closures as well as some aortic coarctation repairs etc. It was nice to see the structural aspect of interventional therapies.

It can't hurt to ask. The worst they can say is no.

Many of my friends have gone to Europe to do mini-fellowships (3 months ) doing about 8 cases a day as primary with a mix of carotids, peripherals, aortic work.

 

[IRGuru]

Many of my friends have gone to Europe to do mini-fellowships (3 months ) doing about 8 cases a day as primary with a mix of carotids, peripherals, aortic work.

Is this possible to do as a resident? If so, it would be fantastic experience since 8 cases of "high-end" PAD work is more than I saw on my vascular surgery rotation.

 

[Gvataken]

I think it is best for someone who has done at least 12 months of IR. In order to take full advantage of one of these mini-fellowships you should have some basic catheter skills and know some of the basic IR techniques.

 

[IRmonkey]

For those of us that will still be going to L'ville for orals, creative use of elective time can also get you a good amount of interventional time during your residency. At my residency we do 3 consecutive months of IR. Add to that a few months of procedural US, interventional CT rotations, spending time with the neuro-interventional guys during neuroradiology rotations and IR rotations during elective months and one can get 12 months of procedural/interventional training during a diagnostic residency. I'm sure residencies can vary in the degree this can be done, but if one shows interest and seeks it out one can do a mini-fellowship even with oral boards 4th year. I plan to try and get some elective time with the vascular surgeons as well.

 

[IRpadawan]

Great point about elective time. The other thing as well is that if you are truly interested in IR you can't be afraid to take extra call. Even if you don't want to do that, have your coresidents call you when there are interesting procedures on their calls. In this way, I have been able to get extra procedures under my belt such as TIPS and SVC stenting for SVC syndrome as well as traumatic embos.

Unfortunately for me, the vascular surgeons don't have a good relationship with the IRs at my institution. That is reality though so there is not much I can do about rotating with them.

Another thing to look into though would be away rotations in residency. I am not sure how prevalent they are but I have that capability at my institution.

 

[phatfarm]

Wow, really good responses. I agree with all of the above. Being proactive while on service demonstrates that you are serious about IR and hopefully will encourage your IR attending to help you along by getting you involved in other cases.

Use other non IR rotations to perfect your skills. I like my US rotation because of the huge numbers of thyroids, paras and thoras we do. Instead of just marking the largest pocket of fluid, I make sure that I can see my needle tip precisely as much as I can. Developing scanning skills and localizing your needle position is very helpful for when you are getting access. Likewise for thyroids and mammo too. US guided core biopsies definitely got easier and easier with practice and spending time doing each procedure.

Try to get elective time to go to a field outside of radiology like vascular surgery, PMR to pick up tricks that others use to get the job done. Perfect your suturing skills, learn how others work up patients. There is lots of learning to be done both in IR and outside of IR.