IR Away Rotations

[2018IRDOC]

I'm about to be a 4th year in an average state school in Texas and I will be applying for DR/IR residency in 2018. I'm planning on doing 2 aways and I was wondering if you guys had any experience in any programs? Any recommendations? Places should I avoid?

Looking at UCSF, Stanford, UCSD, WashU, NW, MGH, BWH, BID.

Thanks

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[DJNYY]

I'm about to be a 4th year in an average state school in Texas and I will be applying for DR/IR residency in 2018. I'm planning on doing 2 aways and I was wondering if you guys had any experience in any programs? Any recommendations? Places should I avoid?

Looking at UCSF, Stanford, UCSD, WashU, NW, MGH, BWH, BID.

Thanks

Don't conflate institutional prestige with IR quality. Of those that you mentioned, Stanford and ucsd are the ones most worth your time. That said, I know someone who did an away at Stanford and didn't even get an interview there. As well as someone who did an IR away at ucsd who didn't match IR at all. With respect to the other programs you listed, I distinctly recall a resident staring at me blankly while telling me he fell down to Brigham on his match list for IR fellowship and how even fellows there consistently struggle to get opportunities to be primary operator on the complex cases and don't finish training feeling totally competent. Likewise, if you go to mgh, your competency in vascular disease management will be non-existent. Northwestern vascular surgery has superstars like Melina Kibbe and IR has lost out on that territory completely. You should really be looking at places like UWashington (Seattle), MCW (Milwaukee), Rush, UVA, UMichigan, Yale, etc. Those that are clinically oriented and have particular expertise in vascular disease management. Go somewhere where IR takes care of patients before and after procedures, has heavy influence at multidisciplinary conferences, and is aggressive in obtaining referrals (especially from primary providers). Basically, places that most closely resemble Bapstist cardiac and vascular institute. Remember, the general consensus is a place like BCVI sets the bar on how an IR practice should operate. Some of the places you mentioned don't even touch any of the patients that bcvi are experts in treating. When you look up some of the practices I recommended, you will see IR groups that practice the way IR was meant to be practiced, like a surgical subspecialty

 

[Naijaba]

Don't conflate institutional prestige with IR quality. Of those that you mentioned, Stanford and ucsd are the ones most worth your time. That said, I know someone who did an away at Stanford and didn't even get an interview there. As well as someone who did an IR away at ucsd who didn't match IR at all. With respect to the other programs you listed, I distinctly recall a resident staring at me blankly while telling me he fell down to Brigham on his match list for IR fellowship and how even fellows there consistently struggle to get opportunities to be primary operator on the complex cases and don't finish training feeling totally competent. Likewise, if you go to mgh, your competency in vascular disease management will be non-existent. Northwestern vascular surgery has superstars like Melina Kibbe and IR has lost out on that territory completely. You should really be looking at places like UWashington (Seattle), MCW (Milwaukee), Rush, UVA, UMichigan, Yale, etc. Those that are clinically oriented and have particular expertise in vascular disease management. Go somewhere where IR takes care of patients before and after procedures, has heavy influence at multidisciplinary conferences, and is aggressive in obtaining referrals (especially from primary providers). Basically, places that most closely resemble Bapstist cardiac and vascular institute. Remember, the general consensus is a place like BCVI sets the bar on how an IR practice should operate. Some of the places you mentioned don't even touch any of the patients that bcvi are experts in treating. When you look up some of the practices I recommended, you will see IR groups that practice the way IR was meant to be practiced, like a surgical subspecialty

A bit of insight about the application process: Surgical residencies highly value away rotators; most surgery places will take half their class from hard-working rotators over someone with a higher board score. Applicants to surgical residencies, particularly neurosurgery, perform 2-3 aways with the reasonable expectation that they'll match at one of those programs. This is not the case in IR. As DJNYY pointed out, an away rotation isn't enough to secure an IR interview, let alone match. Don't go into an away rotation expecting to match (or interview) at that program. Instead, look for aways with broad exposure to IR practice with well-known IR faculty. Get to know one of the faculty members while you're there and ask for their recommendation.

Plug for UW: I'm biased now since I'm going there for DR, but theirs is the only program that strongly encourages IR applicants to do an away rotation with them. I thought this might be a generalization on their website, but if you compare it to their DR page, it seems they only care about rotators for IR, and not for DR.

I also have some program-specific experiences:

UCSF: IR attending at UCSF recommended against rotating here.
Stanford: IR rotation doesn't guarantee you an interview.
UW: They matched three IR integrated: One was a UW student, one did an away rotation, I don't know about the third.
Yale: Will rank-to-match IR rotators for DR (usually). Not exactly what you want, but it's something.
UCLA: One person did an IR rotation there and ultimately matched DR there.

 

[2018IRDOC]

Thanks for the response! I appreciate the advice. I'm looking into UWash, MCW, UMich and Yale as well.

What were y'all's experiences at different programs on the interview trail? Feel free to PM.

Thanks

Don't conflate institutional prestige with IR quality. Of those that you mentioned, Stanford and ucsd are the ones most worth your time. That said, I know someone who did an away at Stanford and didn't even get an interview there. As well as someone who did an IR away at ucsd who didn't match IR at all. With respect to the other programs you listed, I distinctly recall a resident staring at me blankly while telling me he fell down to Brigham on his match list for IR fellowship and how even fellows there consistently struggle to get opportunities to be primary operator on the complex cases and don't finish training feeling totally competent. Likewise, if you go to mgh, your competency in vascular disease management will be non-existent. Northwestern vascular surgery has superstars like Melina Kibbe and IR has lost out on that territory completely. You should really be looking at places like UWashington (Seattle), MCW (Milwaukee), Rush, UVA, UMichigan, Yale, etc. Those that are clinically oriented and have particular expertise in vascular disease management. Go somewhere where IR takes care of patients before and after procedures, has heavy influence at multidisciplinary conferences, and is aggressive in obtaining referrals (especially from primary providers). Basically, places that most closely resemble Bapstist cardiac and vascular institute. Remember, the general consensus is a place like BCVI sets the bar on how an IR practice should operate. Some of the places you mentioned don't even touch any of the patients that bcvi are experts in treating. When you look up some of the practices I recommended, you will see IR groups that practice the way IR was meant to be practiced, like a surgical subspecialty

 

[qxrt]

Don't conflate institutional prestige with IR quality. Of those that you mentioned, Stanford and ucsd are the ones most worth your time. That said, I know someone who did an away at Stanford and didn't even get an interview there. As well as someone who did an IR away at ucsd who didn't match IR at all. With respect to the other programs you listed, I distinctly recall a resident staring at me blankly while telling me he fell down to Brigham on his match list for IR fellowship and how even fellows there consistently struggle to get opportunities to be primary operator on the complex cases and don't finish training feeling totally competent. Likewise, if you go to mgh, your competency in vascular disease management will be non-existent. Northwestern vascular surgery has superstars like Melina Kibbe and IR has lost out on that territory completely. You should really be looking at places like UWashington (Seattle), MCW (Milwaukee), Rush, UVA, UMichigan, Yale, etc. Those that are clinically oriented and have particular expertise in vascular disease management. Go somewhere where IR takes care of patients before and after procedures, has heavy influence at multidisciplinary conferences, and is aggressive in obtaining referrals (especially from primary providers). Basically, places that most closely resemble Bapstist cardiac and vascular institute. Remember, the general consensus is a place like BCVI sets the bar on how an IR practice should operate. Some of the places you mentioned don't even touch any of the patients that bcvi are experts in treating. When you look up some of the practices I recommended, you will see IR groups that practice the way IR was meant to be practiced, like a surgical subspecialty

On what merits are you saying Stanford and UCSD offer better training than other "average" IR institutions like MGH? IR PAD management is virtually non-existent at those institutions too, and none of them are particularly clinical or non-clinical at the level of MCVI to differentiate amongst them. I've heard that BWH has been reduced to a line service, but that's something specific to them.

There are some programs that do it all, many of which you've mentioned, but outside of that, a lot of this ranking business sounds like hogwash to me...after all, none of us have seen all the programs to provide an apt comparison. Some other programs stand out through their research, but that isn't going to help a fellow become a better clinician.

 

[DJNYY]

UCSD lists peripheral angioplasty/ stents and aortic stent-grafts within their services included. So does Stanford. The main point I'm trying to make to OP is that, while some institutions may be fantastic as a whole or have fantastic DR, this doesn't always correlate to the IR department. I know of an approved IR residency affiliated with a top 30/40 medical center that doesn't even have admitting privileges. One at a top 20 where attendings rarely, if ever, round on patients. Also, at many places, vascular and IR have very poor working relationships and at others, they are more cordial. But while the literature does state that IR only does ~20% of peripheral vascular work nationwide (40% vascular, 40% cards), I think a person should still make an effort to go somewhere where they can develop competency in this area through their training. Just because a lot of IR departments don't do it doesn't mean an IR bound student shouldn't desire it from their training. If you don't develop competency treating this patient population through your training it will be difficult to acquire it later on. The places I listed certainly don't represent an all inclusive or rank order list consisting of the best IR fellowships, but they have two of the major attributes I think a med student should look for when targeting for training. The main point I was making to OP, is don't look at USNW hospital rankings to guide your selection when trying to find the best IR training. Because that seemed to the be common thread connecting the institutions he/she had listed for looking at an away rotation

 

[irwarrior]

These are all great points. I think it is paramount that you get true clinical integration and a comprehensive clinical and technical skill set in the IR residency. The DR training can be leveled out somewhat by reading on your own and garnering knowledge, but subspecialty education also can facilitate this.

IR is relatively new to the "clinical" practice and there is tremendous variability in what that means. I would advocate you go to a place that has a busy outpatient clinic seeing as broad a scope of IR as possible with referrals from primary care and urgent care and ER that are undifferentiated as well as where the IR provide you as much scope of practice as feasible (vertebroplasty/kyphoplasty/fibroid therapy/varicose veins/IVC filter placement and retrieval/TIPS/BRTO/PAD with sfa /tibial interventions/thrombolysis/cerebral angiography/stroke therapy/aortic interventions (abdominal/thoracic)/visceral interventions (SMA and renal PTA/stenting)/thrombolysis/thrombectomy (DVT/PE/arterial).

Look at the fellow and resident case logs and look at the board of cases. Also, make it a point to check out their clinic. Also, see is the fellow or resident primary operator (are they in the complex cases alone). Some attendings are very hands on and others are much more hands off and the trainee gets their skill set quicker. Unfortunately much of this is not advertised and most programs and IR attendings are not willing to state that their programs have inherent weaknesses or deficiencies in training. This is why the students applying for these programs need to do their homework and make sure that the program they are interviewing is as advertised. I would encourage away rotations as it does give you some type of framework to compare programs to and gives you some experience. If you have 2 or 3 IR rotations as a medical student, that is equivalent to what is the minimum requirement in the PGY2,3,4 years of IR residency (i.e. 1 month per year). So, you can truly enhance your IR experience if you take the MS4 IR rotations seriously.

 

[qxrt]

UCSD lists peripheral angioplasty/ stents and aortic stent-grafts within their services included. So does Stanford. The main point I'm trying to make to OP is that, while some institutions may be fantastic as a whole or have fantastic DR, this doesn't always correlate to the IR department. I know of an approved IR residency affiliated with a top 30/40 medical center that doesn't even have admitting privileges. One at a top 20 where attendings rarely, if ever, round on patients. Also, at many places, vascular and IR have very poor working relationships and at others, they are more cordial. But while the literature does state that IR only does ~20% of peripheral vascular work nationwide (40% vascular, 40% cards), I think a person should still make an effort to go somewhere where they can develop competency in this area through their training. Just because a lot of IR departments don't do it doesn't mean an IR bound student shouldn't desire it from their training. If you don't develop competency treating this patient population through your training it will be difficult to acquire it later on. The places I listed certainly don't represent an all inclusive or rank order list consisting of the best IR fellowships, but they have two of the major attributes I think a med student should look for when targeting for training. The main point I was making to OP, is don't look at USNW hospital rankings to guide your selection when trying to find the best IR training. Because that seemed to the be common thread connecting the institutions he/she had listed for looking at an away rotation

I strongly agree with you that an IR fellow needs to get at least some PAD experience during a fellowship; many private practice IR groups are practicing PAD work at a higher level than any academic IR group currently. My point, though, is that dishearteningly, there are only a few places that give IR fellows the hands-on experience in PAD to act as a foundation. Most programs list peripheral angioplasty or similar things on their scope of practice on their websites, but this typically means that someone (whether vascular surgery or someone else that IR fellows do not get immersive experience working with) is doing them. I would caution everyone to take things on the websites at full value; I say this as someone who has interviewed at many of these programs, spoken with current fellows, and seen the discrepancies between projection and reality.

 

[Smoking Jay Cutler]

Thought I'd resurrect an old post that didn't get much attention to see what the thoughts are.

"drwildcat5+ Year Member
We're talking so much about ranking IR programs. Maybe it would be easier to do two lists for this IR ranking system:
1. IR clinical training. &
2. IR prestige/fancy name + Research

There are other sources for DR rankings so we can ignore that for now.

Clinical:
Tier 1 (Programs that do almost everything including PAD at main campus (Not VA)): Michigan, Sinai, UVA, MCW, MUSC, Yale, Rush, Brown, Maine, UFlorida Jax, USF, Christiana, Kaiser. There are probably more and adding them would be useful.

Tier 2 (Programs that do some things): other programs

IR national swag:
Tier 1: Stanford, Michigan, Sinai, Penn, Vandy, UVA, U Wash, Dotter, MCW, Northwestern, U Colorado, Yale, MGH, WashU, UCLA. Add more please

This is just a starting point. Feel free to debate."

 

[rufaterd]

If I'm being honest... I spent a month at MUSC and did not see a single PAD case. There was one EVAR that one fellow was going to scrub with the vascular surgeon.

 

[DrfluffyMD]

by the way that tier list is not accurate. I will post a personalized rank list in the future.

 

[IRorBustguy]

^^ Interviewed at most of the of the Tier 1's and agree w/ Michigan, Sinai, UVA, MCW, MUSC, Brown, Rush, Maine. Tier 2 - Yale, UF Jax, USF, Christiana, Kaiser. My least favorite is probably Yale. Got the feeling they were really academic and by far the least personable and least clinical. If you want to master low level IR cases like ports lines drains biopsies go to Yale

also - tier 1: ucla, UW

 

[Smoking Jay Cutler]

I also spent a month at MUSC. I scrubbed a few PAD leg cases, one with radial approach, but not many altogether. I also saw some carotid stenting, aortic endoleak repairs, mesenteric stenting and then the usual IO, biliary, neph, CT cases, etc. I think there was only one TIPS.

 

[IRorBustguy]

I also spent a month at MUSC. I scrubbed a few PAD leg cases, one with radial approach, but not many altogether. I also saw some carotid stenting, aortic endoleak repairs, mesenteric stenting and then the usual IO, biliary, neph, CT cases, etc. I think there was only one TIPS.

i think Even the high volume places do like 10-15 TIPs a year

 

[Naijaba]

i think Even the high volume places do like 10-15 TIPs a year

I saw five TIPS at Stanford during the two-weeks I was there. No PAD though.

 

[DJNYY]

If I'm being honest... I spent a month at MUSC and did not see a single PAD case. There was one EVAR that one fellow was going to scrub with the vascular surgeon.

This insider knowledge is the only way to really get to the truth. Wish there was a way that some programs were more transparent. One place, University of Illinois @ Peoria actually lists the procedures and cased numbers that they do: Interventional Radiology - University of Illinois College o...

 

[DJNYY]

May be also helpful for others to know of programs with DR only this past year who have strong IR groups.
The ones that come to mind for me are: U Illinois Peoria, VCU, Indiana University, Hopkins, Kaiser permanente

 

[DJNYY]

Thanks! as someone who is about to start M3 some/many of those programs will have IR residencies by the time I match in 2019.

So it seems like most of the strong clinical IR programs are not in the west. Is that safe to say? I mean I've heard Kaiser and UW mentioned here, and UCSD, Loma Linda and UCI elsewhere, but for the rest of the programs what do people think? (or on the programs I mentioned as well.)




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There is just a more dense geographic cluster of IR programs in the east. If staying in the west is a priority for you, also do some research on Oregon, University of Colorado, U arizona and Utah. All had IR this past year but I can't speak to how clinical they are since I don't know too much about any one of them. Maybe someone else who knows those programs better could comment

 

[Fab5Hill33]

10-15 in a year for an entire institution/training program is low. I know of places with only 1 or 2 fellows that do 60-70 TIPS (but that is the exception).

I would guess that the average IR fellow graduates having performed about 10-15.

i think Even the high volume places do like 10-15 TIPs a year

 

[MadRadLad]

Anyone know about the IR departments at Henry Ford, Beaumont, Cincinnati or Ohio State?

 

[harambe4ever]

Are away rotations required? My school has a strong IR program and I will have 1-2 IR letters.

 

[DJNYY]

Anyone know about the IR departments at Henry Ford, Beaumont, Cincinnati or Ohio State?

Henry Ford does more prostate embolizations than any place I interviewed at. They are clinically oriented also. No PAD though. It's categorical and you'd have to do your prelim surgery there. Wasn't a hug

Beaumont, I know nothing about.

Cincinnati had DR only this year, but I think they have one of the more underrated IR departments out there. They are very clinical and recently expanded their IR space. They have some young faculty there that I really like, especially Dr. Chadalavada. They also have Dr. Vu who is pretty innovative and even invented his own device that they call the Vu tube. They have no immediate plans for IR residency and are sticking with just ESIR right now. 2 fellows per year and the Cincy DR residents usually choose to stay their for IR training which is a positive indication. Also cincinnati childrens is world renowned so pediatric IR opportunities are strong if that's your thing

Ohio State IR is surprisingly lacking. Perhaps the worst IR section I came across. OSU has a big health system so they have volume and some complexity but nothing else. They can't admit their own patients, don't round on them, they JUST got approved to use shared clinic space for 1 day a week only because it was an IR residency requirement (indicates they don't have any interest in a clinical IR service and are more concerned with checking off boxes to satisfy acgme IR residency requirements; MASSIVE red flag). Attendings put in all the ports. No PAD. No noteworthy research. Both PDs gave off a strange vibe which dropped them to the very bottom of my ROL

 

[DJNYY]

Are away rotations required? My school has a strong IR program and I will have 1-2 IR letters.

Not required, but if you do them at certain places it can certainly help. Uwashington (seattle) states on their website, they encourage away rotators. Other than that, look for places with PDs who have a demonstrated interest in medical student education. Like Michigan (Dr. Khaja), MCW (Dr. Patel), UVA (Dr. Sabri), Emory (Dr. Peters), UChicago (Dr. Navuluri). Another place to consider is Cleveland Clinic. They will have IR next year (3 spots) and through the grapevine the IR PD there was very aggressive about setting that up ASAP even though the DR team was a little more hesitant

 

[IR4thewin]

I also spent a month at MUSC. I scrubbed a few PAD leg cases, one with radial approach, but not many altogether. I also saw some carotid stenting, aortic endoleak repairs, mesenteric stenting and then the usual IO, biliary, neph, CT cases, etc. I think there was only one TIPS.

Just curious, who was the attending on the PAD? That department no longer has Dr. Adams who was dual trained in vascular surgery as well and had a lot of great cases. Also, from what I could gather, Dr. Schonholz is the main one doing AAA. Not sure when he will retire but some insider knowledge says probably less than five years from now. That was a factor in my evaluation of that program.




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[quirkygator]

What do you guys think about Penn IR? I don't get it seen mentioned that much on threads.

 

[DJNYY]

.

 

[DJNYY]

Any insight on the quality of training at Cleveland clinic? Would it be a 'tier 1' or 'tier 2' program.



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Good question, and I don't have a great answer. They do a TON of hepatobiliary work and let residents get their hands on very early into training which is a big plus. Even with 3 fellows, they have 6 angiosuites moving all the time so there are 3 rooms for the rotating DR residents to get their hands on stuff. They don't do vascular stuff (as you can see, a select few programs still do) but they are clinical. For that reason I give the IR a tier 2. But among the better tier 2s. The DR residency seems to be more DO friendly than most and I'm not sure what caliber of students they've matched in prior years, but they had 2/8 residents fail the CORE last spring which concerned me. Insider reports tell me that had to do with the residents not putting in the necessary effort, not necessarily the programs fault

 

[DJNYY]

What do you guys think about Penn IR? I don't get it seen mentioned that much on threads.

I can't say much about the department, other than a recent graduate from that fellowship told me that he thought it was "malignant" (whatever that means). I know someone who did an away rotation there and said he got pimped quite a bit, but he said it was an impressive department with impressive faculty. He also indicated that they do give interview preference for away rotators and people in pennsylvania & big name med schools. He said they only interviewed around 20 or so for their 2 spots. 1 was filled with a Penn student, not sure about the other

 

[Smoking Jay Cutler]

Just curious, who was the attending on the PAD? That department no longer has Dr. Adams who was dual trained in vascular surgery as well and had a lot of great cases. Also, from what I could gather, Dr. Schonholz is the main one doing AAA. Not sure when he will retire but some insider knowledge says probably less than five years from now. That was a factor in my evaluation of that program.
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Drs. Schonholz, Guimaraes, Adams, and Dr. Veeraswamy, a vascular surgeon, who comes over to the IR rooms and does a fair amount of cases with IR.

 

[angiohopeful]

Can anyone offer info on the IR departments at Dartmouth and at Temple?

 

[IRdoggy]

Anyone know the approximate PAD numbers at Dotter or UW-Seattle?

 

[BlackBox]

About when should we expect to hear back from some of these aways, in relation to our selected rotation start date? I know it varies, but are we talking about 3 months before or more like 1?

 

[qxrt]

.

 

[tco]

When I was a medical student, I did an away at Arkansas and had a great experience. However, the attending who took me under his wing is now in private practice, so I don't know if the experience will be the same.

They have a super specialized tech or something who is certified to do low end procedures. If you made friends with him, he would probably teach you all of those.

 

[spruntable]

Anyone know about the IR departments at Henry Ford, Beaumont, Cincinnati or Ohio State?

Beaumont felt like good prep for private practice, the IRs do all their PICCs and dialysis fistulae (rather than APPs as at a lot of academic centers), emphasis on speed and volume over case complexity, but great stroke work if you're into neuroIR. Not much PAD though. At a teir 1 IR institution for med school and one of our IR attendings did residency there. PD is aggressive and believes in the program.

 

[m3db01]

Beaumont felt like good prep for private practice, the IRs do all their PICCs and dialysis fistulae (rather than APPs as at a lot of academic centers), emphasis on speed and volume over case complexity, but great stroke work if you're into neuroIR. Not much PAD though. At a teir 1 IR institution for med school and one of our IR attendings did residency there. PD is aggressive and believes in the program.

Interesting, thanks for the insight. I’m quite interested in neuro IR as well, so im looking for IR/DR programs that have at least some neuro IR training. Apparently Brown is a strong IR/DR program that also gives you good stroke training. I’ve even heard claims that it is the one of the only peripheral IR programs that gives you any significant neuro Ir training. Anyone else know of any IR programs where neuro IR is a significant part of your training?

 

[qxrt]

Interesting, thanks for the insight. I’m quite interested in neuro IR as well, so im looking for IR/DR programs that have at least some neuro IR training. Apparently Brown is a strong IR/DR program that also gives you good stroke training. I’ve even heard claims that it is the one of the only peripheral IR programs that gives you any significant neuro Ir training. Anyone else know of any IR programs where neuro IR is a significant part of your training?

There are none, really. That's a unique part of Brown's IR fellowship. There are many other IR fellowships that will let you take 2-4 weeks of neuroIR rotation, but it's not built into the fellowship as a regular part of daily practice.

That said, don't mistake Brown IR's neuroIR exposure for an actual complete neuroIR experience. They will teach you to take stroke call, but an actual neuroIR fellowship involves a lot more complicated stuff, like AVM management. Stroke call work only scratches the surface of what neuroIR actually is. Personally, I think stroke call should be managed by dedicated neuroIR-trained physicians due to how complex neuro can be and how risky the ramifications, but I guess in a rural area with smaller hospitals, sometimes IR is the only one who can deal with that.

 

[m3db01]

There are none, really. That's a unique part of Brown's IR fellowship. There are many other IR fellowships that will let you take 2-4 weeks of neuroIR rotation, but it's not built into the fellowship as a regular part of daily practice.

That said, don't mistake Brown IR's neuroIR exposure for an actual complete neuroIR experience. They will teach you to take stroke call, but an actual neuroIR fellowship involves a lot more complicated stuff, like AVM management. Stroke call work only scratches the surface of what neuroIR actually is. Personally, I think stroke call should be managed by dedicated neuroIR-trained physicians due to how complex neuro can be and how risky the ramifications, but I guess in a rural area with smaller hospitals, sometimes IR is the only one who can deal with that.

I figured. Still, it would be cool to integrate some neuro IR into an IR practice if possible. I do understand that they are pretty separate fields though, and that I should pick one or the other. Maryland has a Neuro IR rotation for 4th year medical students that I’m considering doing. Anyone have any info on this program/rotation by chance? Are there any other programs that offer rotations to medical students in NIR? Maybe@Naijaba? I know he was/is interested in NIR.

 

[m3db01]

I figured. Still, it would be cool to integrate some neuro IR into an IR practice if possible. I do understand that they are pretty separate fields though, and that I should pick one or the other. Maryland has a Neuro IR rotation for 4th year medical students that I’m considering doing. Anyone have any info on this program/rotation by chance? Are there any other programs that offer rotations to medical students in NIR? Maybe @Naijaba? I know he was/is interested in NIR.

 

[DrfluffyMD]

Your best bet for neuroIR is to go through neurosurgery. In a lot of hospitals neurosurgery owns neuroangio.

 

[Tiger100]

There are none, really. That's a unique part of Brown's IR fellowship. There are many other IR fellowships that will let you take 2-4 weeks of neuroIR rotation, but it's not built into the fellowship as a regular part of daily practice.

That said, don't mistake Brown IR's neuroIR exposure for an actual complete neuroIR experience. They will teach you to take stroke call, but an actual neuroIR fellowship involves a lot more complicated stuff, like AVM management. Stroke call work only scratches the surface of what neuroIR actually is. Personally, I think stroke call should be managed by dedicated neuroIR-trained physicians due to how complex neuro can be and how risky the ramifications, but I guess in a rural area with smaller hospitals, sometimes IR is the only one who can deal with that.

Being able to cover the stroke call as IR is very valuable.

There is not enough work for a dedicated NeuroIR in an average community hospital even in big cities outside multi-specialty hospitals and academic centers. Neurosurgery in some places do some NeuroIR but outside big academic centers it does not seem an attractive business for them and anyway there are not enough Neurosurgeons in most places.

As a result, most places have relative shortage of people who can capable of doing intervention and on the other hand they don't have the volume to support a dedicated NeuroIR person. For elective cases like coiling aneurysm, they can send the patient to academic centers and probably this is a good idea because these procedures are uncommon and is better to be done by high volume operators. But for stroke there is the emergency-urgency factor.

I think it is a very good time for IR to jump into the stroke intervention and start to own it. Otherwise, I am concerned that neurologists may start to do it and even in some places if there is shortage vascular surgeons may jump on it.

IR is in a very good position to take ownership of it in community practice and I know a few IRs who do it. Obviously, they can not do complex NeuroIR procedures but for IA thrombolysis and mechanic thrombectomy they are doing a nice job. Once IR gets good at it, they can start to broaden their scope of practice or at least there is a potential to do so.

SIR is behaving very passive in this regard, IMO.

 

[Smoking Jay Cutler]

Tiger is on the money here.

 

[spruntable]

While this thread is being resurrected, any interest in using it as an expectation vs interview impression tool? Like what you thought or knew about the program going in, what they said at the interview, how much seems legit, overall assessment? Sort of as a complement to what's on the spreadsheet.

 

[tco]

Not required, but if you do them at certain places it can certainly help. Uwashington (seattle) states on their website, they encourage away rotators. Other than that, look for places with PDs who have a demonstrated interest in medical student education. Like Michigan (Dr. Khaja), MCW (Dr. Patel), UVA (Dr. Sabri), Emory (Dr. Peters), UChicago (Dr. Navuluri). Another place to consider is Cleveland Clinic. They will have IR next year (3 spots) and through the grapevine the IR PD there was very aggressive about setting that up ASAP even though the DR team was a little more hesitant

Your list is outdated.

Sabri is no longer at UVA, for what it's worth.

There's a great thread on Aunt Minnie about program impressions.

 

[tco]

@tco which thread? I was looking for that for IR and had a hard time finding it. I found one for DR though.

As this interview season is coming to a close I'm starting to look more at where I'll be applying for aways this next year. Do programs change their away schedules much year to year? Or can I start looking at this year's dates and making plans for when they'll open apps, when their (2 or) 4 week rotations start & end?

Thanks everyone. Good luck to those deep in the cycle this year.

It's under the Interventional Radiology section. Be sure to go to the bottom and select to show all posts from the beginning. I think it's called impressions or program rankings or something.

 

[m3db01]

Sorry if this was already discussed, but how many away rotations should I apply to? How easy is it to get your away rotations in the months from July-October? If I over-apply for aways and have to turn down away rotations will that make me look bad come application/interview season?

Thanks for all your help.