I hope that residents/medical students can use these ideas to enhance their educational experience. Hopefully if more and more of us are participating in these activities, it will help show DR leadership that we are thirsty for clinical IR training that is really not fostered by the current DR residency training platform, and in this way, motivate change in resistant programs.
*-Start a year-round IR rounding service at your DR program:
If not already in place. This can be staffed by Residents interested in IR. At my program, 3 residents share responsibility, alternating week-long shifts. We arrive early and pre-round on a mostly vascular-based inpatient service: monitoring for post-procedural complications, vascular exam (palpation and doppler), foot exam, comorbidity analysis/mgmt, etc. We then proceed to our regular DR rotations (neuro CT, body CT, US, etc.) After work, we go see and work up consults (every IR procedure is a consult unless admitted by our service).
-*Moonlighting:
Although not allowed by some programs due to malpractice coverage, moonlighting on a medicine service or in the ED is a great option for maintaining clinical skills in a broad range of areas, in addition to getting some extra $. Check with your program to see if this can work for you. Really an awesome way to keep all of the knowledge you learned during your intern year up to date and fresh in your mind (keep in mind if you did a medicine intern year, you completed 1/3 of that residency). You will likely need a state medical license (pass through Step 3 and apply to your state).
-*Rounds with other services:
When on a certain rotations, rounding with the appropriate clinical service can really enhance your educational experience. For example, at my institution, the residents on NeuroMR/CT have the option of rounding with neurosurgery/NeuroIR prior to proceeding to the regular work day. I have found this extremely useful with both the clinical correlation of the studies I am reading, but it also makes my NeuroCT/MR reads a great deal more useful to those who order them.
Other examples include:
-ICU rounds on Chest rotation
-Surgery rounds on Body CT/MR
Please experiment and let us know what you have found that works/is useful!
*-Strong Internship:
Arguably the most important way to build a strong foundation/enhance your clinical skills. It is one year to learn a ton of information, don't waste it with an easy program!
Although I am biased as I did a medicine intern year, I feel that, as noted above by completing a year of medicine internship I learned a great deal (1/3 of a medicine residency program). I chose a very rigorous program where I was able to interact with and learn from leaders in the field of medicine, and really feel that it helped prepare me for my future career goals. It also helps with IRs image: if the best interns are the ones being lost to IR, that says a great deal about the field, and the medicine colleagues you gain through intern year will remember this.
With a surgical intern year, you also learn a great deal of useful information (procedural skills, mgmt of comorbidities - DM mgmt, cardiac risk factors). While I did not do a surgical intern year for concern of becoming a scut monkey, from what I have since learned from my colleagues who completed a surgical intern year, community programs let you operate more as they do not have Categorical Surgical interns who take preference over you. If someone can elaborate on surgical intern year experience, it would be greatly appreciated.
*-Multidisciplinary Conferences:
Very important way to not only learn a great deal about disease processes and multidisciplinary mgmt, if you are interactive, ask questions, and voice your input, these conferences are a stage set for changing referring clinicians attitudes toward IRs as disease experts, rather than "skilled catheter jockies."
*-Other conferences:
Although not directly related to clinical skills/judgement, Participate in AMA conferences. You can learn a ton about medicine and government. Run for leadership positions. Our DR colleagues say it all the time, "If you are not at the dinner table, you are what's for dinner."
Some of these are ideas I've been able to implement, some are ideas that I hope to implement in the near future.
Please keep this forum going and add your own ideas. Tell us what works/does not work for you and why.
