IR Away Rotation Advice

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BroDoc22

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Hey everyone,

I've been accepted to do an away this summer and wanted some feedback from people that've done aways! I want to be mentally prepared for what an away rotation looks like in IR and want to be as prepared as possible.

If people can provide their experience doing an IR away I'd really appreciate it ! (time you usually got in/left, your responsibility on the team, expectations/hands on experience for procedures, clinic duties, call, how many days you worked per week, helpful text, how to excel etc.)

Any information at all would be fantastic, thanks everyone!

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I’m sure this will vary based on location but this is what my days were like at my two away rotations. You may or may not have the opportunity to function as a tech or first assist depending on the location of your rotation and their prior experience with students. You will also likely work with a few different residents and fellows who will each have a different comfort level in getting you involved hands-on.

Usually I would arrive at 6:30am, run through the list of cases on the board, and look up two to three I knew the least about. After that I would do a morning scrub, and try and split up cases with other students. Cases would start around 0700 to 0730, and anything you could do as far as helping to transfer patients or turn over rooms to reduce turnaround time is very helpful. The day would usually wrap up by about 1800, but occasionally we would stay until 1900 to wrap up cases so the on call team didn’t have to come in. I volunteered to do a week and weekend of call to get an idea of what that’s like. I’d suggest doing so to get a feel for taking call and the variety of emergent cases that your institution will help provide treatment for. Usually faculty will maintain one half to one full clinic day per week, and you should expect to go to clinic once per week.

Before you go in I’d watch the YouTube video Introduction to IR Tools by IR Education 2-3 times over to gain a basic understanding of equipment. In general know a wire from a catheter from a sheath, flush everything with heparanized saline, wipe down wires before and after use, and keep wires separate in the flush bowl after use. Radiology techs or assistants are a great source of information for how to set up a table, how to handle and use equipment, and can teach you a lot that will make you more helpful as a first assist when you get the opportunity. Volunteer day one to learn how to setup a table and prep equipment.

On day one make sure you know how to scrub, throw your own gown and gloves, and wear lead and PPE. Practice positioning the C-arm and table at the end of the day, and hopefully a tech will be available to show you how to run the controls. Make an effort to use proper shielding, keep your hands out of the x-ray field, and step back on digital subtraction runs.

Practice using an ultrasound and needle together on chicken breasts or jello or whatever simulation your institution has available. When you’re comfortable volunteer to get venous or arterial access, injecting local under ultrasound is a great way to build hand-eye coordination even if you don’t get to pop through a vessel yourself. After that stay engaged in the case, ask questions, and try to anticipate the next few things your attending or resident will need and have them prepped and ready to go. When the case is wrapped up you will usually have an opportunity to suture if applicable, and clean and dress wounds. Ask your tech or assistant or resident to show you how to suture or hold pressure a few times until you feel comfortable volunteering to do it yourself. At the end of a rotation you should hopefully be comfortable doing paracentesis, thoracentesis, placing tunneled and non-tunneled PICC lines and HD catheters. But more importantly you want to get to know your residents, fellows and staff, and honestly evaluate if you would be happy training in your current setting and practicing IR as a career.

My rotations required a case presentation in which I summarized the relevant clinical history, procedural steps and equipment, and reviewed literature to answer key learning points as they came up. I used a combination of radiopedia articles and sources, Seminars in IR, JVIR, Techniques in JVIR, and Radiographics articles for my presentations. In addition the Society of IR maintains a current reference list for various topics on their website. Sorry I can’t place links in the article, but everything should be a quick google search from the info provided.

Helpful References
I would say Kandarpa’s IR Procedures text is a must have if you are at all serious about IR. The latest version also has some good pre and post-procedure management info. Additionally Seminars in IR, especially the “How I Do It” articles, and relevant JVIR or Techniques in VIR journals were helpful for certain higher level procedures.

If you have any specific questions I’d be happy to answer them. Good luck and welcome to the most exciting field of medicine! Don’t be afraid to get your gloves wet, and remember “be one with the needle”.
 
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Wow thanks so much for the detailed review that is super helpful!

My school doesn’t have an academic department so my major concern was seeming “proficient” in procedures but I suppose the desire to learn and improve every day is really the only thing that is needed, as technical skill is something that will be honed over time. Thanks again and if you can think of any other tips that would be great!
 
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Does anyone know when we should be hearing back from VSLO aways? or has anyone heard back?
 
Does anyone know when we should be hearing back from VSLO aways? or has anyone heard back?
Every program is different... The program you applied to has a date listed on VSAS that tells you when they start notifying people of acceptances.
 
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