Quality IR Programs

[IRGuru]

For all the prospective rads applicants, can we review those programs which are perceived as strong in IR? I think this would be enormously helpful in terms of deciding where to apply. I suggest the following template but feel free to amend as needed.

Program:
Strengths: (e.g. PAD, IO, amazing faculty etc...)
Weaknesses:
Level of resident vs. fellow participation and autonomy: (e.g. will a resident get to run a room by him/herself?)
Clinical prowess: e.g. is the program more clinically focused or technically focused?
Research prowess:
Independent service: yes/no
Independent clinic:
Support from the diagnostic radiology department/faculty:
Ancillary staff: (comment if these programs have nurses, vascular techs etc...)
Additional comments:

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[phatfarm]

Program: Stanford

Strengths: Awesome young enthusiastic faculty, lots of research (open up any copy of JVIR and you'll see at least one manuscript from Stanford), busy service, very clincally oriented, tertiary medical center which brings in lots of interesting cases, excellent learning environment, great equipment with DYNA-CT.

Weaknesses: Maybe not as many bread and butter cases

Level of resident vs. fellow participation and autonomy: Yes! A resident can run a room by him or herself, but that is dependent on the attending.

Clinical prowess: I think there is more of an emphasis on treating the disease process appropriately, as opposed to do a procedure, just because it can be done.

Research prowess: Superb!

Independent service: Yes

Independent clinic: I know there is clinic, just didn't get to see it

Support from the diagnostic radiology department/faculty: Yep

Ancillary staff: The PAs and techs are really nice and are happy to be there. I learned a great deal from them too.

Additional comments: Completely awesome program. 5 total fellows, up from 3/year. Lots of TACE, Y90, some biliiary interventions. Definitely lots of high end cases.

 

[drdenim]

Any exposure to vascular procedures at Stanford (PAD, EVAR?) Enough to be comfortable actually performing them? Also, if there is experience for the fellows is this through the IR department or in conjunction with vascular surgery?

 

[drdenim]

Can you comment on the vascular experience at Stanford (PAD, aortic stents, etc.)?

 

[7summits]

Program: Maine Medical Center

Strengths: Supportive, progressive and clinically-minded faculty, good variety of cases (fair amount of peripheral vascular work, TACEs, RFAs, recently did an aortic endograft with more likely in the future, and of course lots of the bread and butter stuff) no fellows, great hands-on experience, have sent residents to great IR fellowships recently (Miami Vascular, Stanford, MUSC, U Colorado).

Weaknesses: See “Research prowess” below. Not an academic program if you’re looking for that, though they are affiliated with Tufts.

Level of resident vs. fellow participation and autonomy: No fellows to contend with. This may be attending-dependent, but apparently if you show that you are motivated and competent, they will let you take on a lot of responsibility.

Clinical prowess: Definitely clinically focused! Other services order IR consults, not IR procedures.

Research prowess: Not known to be a strong point of the MMC program in general, but a good amount of case studies and clinical series are available. The IR research at MMC is definitely the most robust vs. research in the other areas of Radiology.

Independent service: Yes

Independent clinic: Yes, including the first resident IR clinic in the country. They get referrals from other services and residents will hold clinic about twice a month. Still small, but growing.

Support from the diagnostic radiology department/faculty: Very good. Everyone recognizes that IR is a shining star at MMC and is proud of that.

Ancillary staff: I didn’t ask about this, but the techs/nurses that I met were very friendly and I didn’t hear anything that would make me think otherwise.

Additional comments: A true gem of a program. Residents who express an interest in IR have even done their first IR rotation during their intern year (which is a medicine year also done at MMC, with 3 months of Radiology built in). You can also do vascular surgery elective later on if you want. There is a good procedural caseload in the other Radiology rotations as well, so that also helps you build confidence. The residents seem very happy to be there, especially those set on going into IR.


**Note: I am a medical student who interviewed at MMC this interview season.

 

[7summits]

Program: Kaiser Permanente Southern California

Strengths: You see the full spectrum of IR here: IO, peripheral vascular stuff, thoracic and abdominal aortic endografts (starting to be done percutaneously now), biliary interventions, some TIPS, plus all of the bread and butter stuff. The residency PD is an IR who is very progressive and clinically-oriented. For residents who prove they are motivated and can excel in the diagnostic Rads aspects of training, he’ll let you add additional IR rotations during your R2 and R3 years in addition to doing an IR mini fellowship during your R4 year. The chairman is also an IR, and in general all of the IR faculty are talented and bring diverse experience (Hopkins, Mallinckrodt, UCLA, Stanford) to the table.

Weaknesses: Fellows from USC rotate through, but there seems to be more than enough cases to go around. Not an academic institution, if that's important to you.

Level of resident vs. fellow participation and autonomy: Might be somewhat attending-dependent (as with most places), but in general it seems residents get good autonomy once they’ve shown they can handle it. The residents I talked to seem to be happy with the level of autonomy they have.

Clinical prowess: Definitely clinically-focused. IR has a good relationship with vascular surgery as well as the other departments in the hospital and gets referrals from them. Inter-disciplinary conferences are held frequently with surg onc, medicine subspecialists and vascular surgery to present challenging cases and come up with treatment plans.

Research prowess: Lots of IR research available if you want it. In addition, the Kaiser system has a searchable database of all of their So. Cal patients (over 3 million) so you can find patients who have a condition or have had a procedure of interest that way and design a study around that if you want.

Independent service: Yes.

Independent clinic: Several of the attendings hold clinic weekly and the resident on service typically attends clinic ½ day per week.

Support from the diagnostic radiology department/faculty: They seem very supportive.

Ancillary staff: Very friendly and knowledgeable techs and nurses.

Additional comments: Residents pursing IR seem to land in solid fellowships and it’s definitely possible to go into academics after completing a residency here (former residents have). The Kaiser system is something everyone has their own opinions about, but in general has a good reputation in the west and I found I liked it. The Kaiser Sunset location is a tertiary care center for Kaiser members from all over southern California, so you see both interesting pathology and awesome procedures. Residents are friendly, happy and like their program in general. Awesome place to get a solid IR foundation that will put you ahead of the game when you start fellowship.

 

[IRmonkey]

Program: Mayo Clinic, Rochester
Strengths: Quality and number of cases. Everything from PAD, to chemoembolization to opportunities for interventional spine work to MR-guided prostate ablation.
Weaknesses: No admitting service (yet). Variable autonomy.
Level of resident vs. fellow participation and autonomy: Fellow and senior residents will have the opportunity to due procedures by themselves but, will always have a staff watching (they won't be in their office down the hall). This obviously also depends on the degreeof diffilculty of the the case and the confidance the staff has in any given trainee.
Clinical prowess: Incredible technical skills. Vascular clinic.
Research prowess: Strong research opportunities particualrly in PAD and ablation techniques.
Independent service: No. Although there are opporunities to be invovled in patient care to the degree one desires (I've been told by staff).
Independent clinic: Yes. Primarily a shared vascular clinic where they work side-by-side with vascular medicine docotrs. Stafaf also see non-vascular patients, but not as part of a "___ center."
Support from the diagnostic radiology department/faculty: Excelelnt relationship with the DR staff.
Ancillary staff: Have not seen any probelms or heard of any...
Additional comments:

• National leaders in PAD research, business of radiology, vein interventions.
• High volume of cases (PAD, IO, etc). Dedicated resdients can finish residency with more cases than many get in fellowship. This allows resdidnts to get a huge head start for fellowship if they stay at Mayo for fellowship or get "two" fellowship experiences if they go elsewhere for fellowship.
• Quality cases: IO, PAD, EVARs, vein interventions, interventional urology, biliary cases, etc (Full gammit)
• Efficiency: Most days cases are done by 5 pm.
• Staff skill: Very technically skilled staff.
• Mayo networking: Mayo radiologists are at all of the top radiology groups nationally. Residents/fellows that are worth their salt have access to the network for finding "unposted" jobs etc.
• Options: Elective time can be used to get experience body intervention (Us or CT-guided ablation, biopsy etc), spine pain intervention, neuroradiology procedures, clinical time with vascular surgery or vascular medicine.
  • The vascular and spine intervention electives are particularly important/in demand for those going into private practice.
• It should be noted that Mayo often fills its positions internally -limiting availability for outside candidates.

​

 

[Radonkulous]

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[davidjones]

Don't have first hand info but I'm pretty sure IR is split up between angio and body I.e. ablation and the like and neither section is particularly clinical at the Harvard programs. If someone wishes to correct me please do. Of the others you mentioned Penn and ucsf have high volume and strong faculty but not sure how clinical they are. Some amazing program are not affiliated with top rads residencies. Peoria, Miami vascular Arkansas. Also Northwestern,Yale, wake forest, musc and UNC aregreat as well.

 

[Radonkulous]

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[davidjones]

When I say "clinical" I mean admit patients, have a clinic, and where IR is a consult service and the referring doc isn't just putting in an order. There are still places with heavy procedure volumes and light clinical practice. But like I said I don't know how the above 2 work.

 

[davidjones]

Also forgot to mention Brown and UVA (frequently mentioned as "top" residencies) also have amazing IR programs.

you may want to check out auntminnie for reviews regarding IR programs as well. Though if this list was to get going I think it would be better.

 

[Radonkulous]

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[RisingSun]

Also forgot to mention Brown and UVA (frequently mentioned as "top" residencies) also have amazing IR programs.

you may want to check out auntminnie for reviews regarding IR programs as well. Though if this list was to get going I think it would be better.

Wanted to second this.

At Brown the residents do the full gamut of interventional procedures, including carotid and intracranial work. I think that this is a big draw to their residency and many of the residents were planning on going into IR because of their great experience during residency. Just be careful you don't ruin your shirt and tie when doing procedures on non-IR months.

UVA has a phenomenal IR training program. There is a busy dedicated IR clinic. I think they had 7 angio suites, usually going nonstop with procedures. Many of the IR faculty at my home program felt like this was one of the strongest IR programs in the US. Seemed like there was a great working relationship with the vascular folks. There is a direct IR tract where you do your internship in surgery at UVA, then rads residency and are fast-tracked into the IR program. During your rads years there are rotations in cardiology, ICU, and vascular surgery. I really liked this program and the faculty that I met, ranked them highly.

Other places that stuck out were William Beaumont, OHSU, Loma Linda, UC Davis, and Sacred Heart in Spokane (which is a tiny residency program but have a ridiculous number of procedures and the residents do it all and are extremely well trained from what I hear).

I think that for residency people also need to consider how hands-on the non-IR rotations are. If you are placing drains every day when on chest and body, doing LPs/interventional pain procedures and diagnostic caths when on neuro, all biopsies when on breast, and become facile with U/S when on ultrasound rotations, then you will be just that more comfortable with the equipment and techniques needed for IR procedures and will be able to do more when on IR rotations.

 

[davidjones]

I think Sacred Heart in Spokane is related to a place called Inland Imaging which is a private group with a huge IR group, that is very, very clinical that consists of 6 or 7 interventionalists and close to as many surgeons. Look it up online if you ever need a shot in the arm during residency.

 

[badasshairday]

Program: Medical College of Wisconsin
Strengths: (e.g. PAD, IO, amazing faculty etc...) Lots of PAD and a very good relationship with vascular surgery. Vascular surgery often will do open parts of a procedure in the IR suite, then the IR guys go in and do the endovascular things. Lots of IO, especially chemoembolizations for liver cancers. Amazing faculty, we definitely have a big wig in IR here. Faculty also have come from many strong IR programs (ie. Trained at Northwestern in the era before vascular surg took over the PAD endovascular inteventions at northwestern, Miami Vascular, Dotter Institute at Oregon Health Sciences).
Weaknesses: Not in New York City, Chicago, or California.
Level of resident vs. fellow participation and autonomy: (e.g. will a resident get to run a room by him/herself?) I've seen the fellow do a high end procedure himself, with the Attending standing back as backup. I saw the Fellow do a diagnostic angio for lower extremity athersclerosis with the attending not even scrubbed in. Also the residents get to do a lot. The R3 put in perc nephrostomy tubes herself at the end of her IR month, with attendings standing back. Obviously residents do PICC lines alone.
Clinical prowess: e.g. is the program more clinically focused or technically focused? BOTH. IR has their own clinic, admitting service, and consult service. The IR attendings, fellows, and residents make rounds on their patients in the hospital. Plenty of young attendings of the new, clinical, generation.
Research prowess: Yes.
Independent service: yes, see above.
Independent clinic: Yes.
Support from the diagnostic radiology department/faculty: Definitely.
Ancillary staff: (comment if these programs have nurses, vascular techs etc...) Seems like a good group.
Additional comments: They do the full gamut of IR procedures here.