Surgery internship. Would it help for IR fellowship?

[AlenS]

---

Members don't see this ad.

I just started my surgery internship.. And will start my DR residency next year.. I'm interested in IR fellowship/ residency in the future:

1- how helpful will the surgery internship be for my fellowship application?

2- What would be the most helpful rotations for me this year?

3- will taking the ABSITE help?

Thanks

 

[shark2000]

The ABSITE score is very important when you apply to IR fellowship, however most IR program directors don't know what ABSITE is, so they don't look at it or don't ask about it.

 

[AlenS]

Thanks Shark.. You mean.. It's good to take the ABSITE only if you score high.. Otherwise its not necessary.. Right?

 

[meister]

After now having done IR I think having some familiarity beyond M3 year with scrubbing and suturing would be helpful. If you actually get to do that as an intern.

 

[Fab5Hill33]

In my experience surgical internships rarely don't add much to your career as an IR. Reason being that most surgery interns are just scut monkeys and don't get much, if any, surgical training. Now if you can find a surgery internship that provides some hands on experience and you can spend a good amount of time in the ICU, that will help. But I think finding those types of surgery internship experiences is rare. I actually got more experience as a medicine intern running codes and placing central lines than my surgery intern colleagues did. Just because the title of the job says "surgery" doesn't necessarily mean it will provide you with surgery-type skills. Do your homework when choosing an internship.

 

[shark2000]

In my experience surgical internships rarely don't add much to your career as an IR. Reason being that most surgery interns are just scut monkeys and don't get much, if any, surgical training. Now if you can find a surgery internship that provides some hands on experience and you can spend a good amount of time in the ICU, that will help. But I think finding those types of surgery internship experiences is rare. I actually got more experience as a medicine intern running codes and placing central lines than my surgery intern colleagues did. Just because the title of the job says "surgery" doesn't necessarily mean it will provide you with surgery-type skills. Do your homework when choosing an internship.

Exactly.

New generation of IR doctors admit their own patients. They see the patients in clinic. They do the pre-procedureal and post-procedural care. IMO, internship either surgery or medicine is useless or at least you learn much much less that what you put into it. But you have to do an internship anyway. So, try to become comfortable with bread and butter medicine. Things like blood pressure, blood sugar, fluid, electrolytes, pressors in the ICU, airway, oxygen, anti-coagulation, .... A medicine internship with some ICU months is good enough. If you are doing surgery, just try to finish it.

Still I stick with my opinion that internship is useless.

 

[shark2000]

Thanks Shark.. You mean.. It's good to take the ABSITE only if you score high.. Otherwise its not necessary.. Right?

No, I meant nobody knows what ABSITE is.

 

[actedcanine]

I'm planning on pursuing a career in IR, and elected to complete an internship in internal medicine. I personally feel that we should think of ourselves as clinicians first and diagnosticians/proceduralists secondly. It is just my opinion that an internal medicine intern year would expose me to the breath of pathology and patient population with comorbidities that I would need to be comfortable managing in the future (i.e., diabetic patient with CKD stage V and PVD and the chronic alcoholic with Hep C and end stage liver disease who also happens to have HCC). This is not to say that a surgery internship would not expose you to these encounters, but I just feel more comfortable with a learning experience where I'm involved in the day to day work-up and management of these types of patients whether it be during inpatient wards, gastroenterology consults, heme/onc inpatient service and CCU. I will echo what more experienced and credible individuals have expressed on these forums such as irwarrior and others...attend tumor boards, interdisciplinary conferences, symposiums and take ownership of patients as to swing the pendulum of patient referral in our direction. Radiology is awesome, we just have to enlighten others including medical students.

 

[je355804]

I just started my surgery internship.. And will start my DR residency next year.. I'm interested in IR fellowship/ residency in the future:

1- how helpful will the surgery internship be for my fellowship application?

2- What would be the most helpful rotations for me this year?

3- will taking the ABSITE help?

Thanks

I did surgery intern year this year and I think it was greatly helpful. I put in about 20 or more port-a-caths this year which the attendings always let us do on our own... not to mention lots of central lines, endo experience in vascular surgeries, suturing experience, etc etc... I will say that I am at a program where interns get tons of OR time. I scrubbed in about 175 cases this year... Although I should add that from what I hear this may not be typical for most surgery programs especially for prelims. My program also let me go down to IR whenever we didn't have cases and weren't on call.

None-the-less, I don't see how having lots of hands on experience could be anything but helpful.

 

[radapplicant920]

In my experience, during intern year you're probably going to only spend (at best) 25% of your time learning something useful to a radiologist and 75% on administrative scut. This is regardless of whether you are in medicine, surgery, or TY. Think long and hard before taking the plunge into a surgical internship. I had a great time in my not-too-busy medicine internship and felt like I learned a ton. Some days were busy and some days weren't, but overall I don't feel like I would have gotten much more out of the year by having extra work on my plate. Meanwhile my surgical intern colleague at the same hospital (also doing radiology) busted his ass all year. He barely got much face-to-face teaching and often got chewed out by miserly attendings for things largely beyond his control. He definitely worked a lot more nights/weekends than I did (not to mention the super early mornings) and routinely violated duty hours. When he tried to report them, the department chair actually harassed him about not getting his work done faster and he pretty much just kept quiet about it the rest of the year. I maintained my sanity this year while I'm pretty sure all he maintained was a heftier waistline...

Finally I'll add that while things like ports, lines, and drains are certainly bread/butter IR and need to be mastered at some point, the technical skills to do these will come with time and practice. On the other hand getting direct training and supervision from the oncologists/hepatologists/nephrologists etc (not to mention hospitalists and PCP's) that are referring cases to radiology and IR (and actually being able to speak their language) is probably more useful and a lot harder to do later on. I spent a lot of time with these specialists during medicine intern year and when I asked them "As a radiologist or an IR some day, what do you think I can do to be more useful to you?" every single one was eager to teach and offer mentorship. Could you do this as a surgery intern? Sure, but its also less likely that you'll have the time or opportunity to.

 

[ScutMonkey8725]

I did surgery intern year this year and I think it was greatly helpful. I put in about 20 or more port-a-caths this year which the attendings always let us do on our own... not to mention lots of central lines, endo experience in vascular surgeries, suturing experience, etc etc... I will say that I am at a program where interns get tons of OR time. I scrubbed in about 175 cases this year... Although I should add that from what I hear this may not be typical for most surgery programs especially for prelims. My program also let me go down to IR whenever we didn't have cases and weren't on call.

None-the-less, I don't see how having lots of hands on experience could be anything but helpful.

Where did you do your surgery internship or where would you now recommend doing a surgical internship that allows such desirable OR time?

 

[Radz123]

EDIT: I just realized my response had nothing to do with the original question. Here are my answers

1- how helpful will the surgery internship be for my fellowship application?

Very, very, very helpful. I know people who matched into top 5 IR fellowships with poor step scores and research. At the time of interview they were explicitly told it was their surgical training that made their application so appealing.

2- What would be the most helpful rotations for me this year?

Vascular Surgery x 1000. Anything where people are extremely sick (ICU). Any rotation that involves frequent ER consults (night float, acute care service). Any rotation that allows interns to do the majority of the surgery (breast surgery). Transplant surgery to understand physiology and how transplants work. Plastics to help you learn how to deal with wound complications and get an understanding of the healing process. Possibly Urology. Trauma.

3- will taking the ABSITE help?

No clue. I've never heard of anyone mentioning an ABSITE score on their application.

 

[tco]

I'm just going to answer this with a general response.

Some people really petition for a surgical internship if they want to do IR. They claim that since IR is surgically relevant, it will be beneficial to them. My counter argument is as follows:

Most surgical interns are treated like scut monkeys. You're asked to medically manage post-op patients by (surgical) attendings who know less medicine than most medicine PGY-2s. You're basically going to learn to look at wounds and write notes, and follow medicine's recommendations on dosing insulin/antibiotics/etc for your post-op patients. Also, be sure to order that KUB on your post-op patient with an ileus. The only real benefit will be in a SICU month, which, if you do a TY instead, you can choose over a MICU month.

It's all irrelevant anyway because, by your PGY5, you're going to have forgotten everything clinically-relevant that you've learned. How much organic chemistry did you remember during your MS3 year?

I guess the question is if you want to jump through the hoops that the powers-who-be want you to jump through or not. If you really want to be their lap dog, you could do a TY, take it easy during most months, and if you REALLY want, do a vascular surgery and SICU month.

 

[irwarrior]

I think a strong surgical internship will prep you best to be an IR. Not all surgical internships are the same and you really need to do your research to see which programs will give you the most autonomy of clinical decision making seeing consults and operating.

IR deals primarily with surgical issues. Cold leg in the ER, DVT, bleeding (internal) . Diverticular abscess, ablations of tumor (more like surgical oncology). Just to name a few. My day to day existence is much more like surgery . I round in the morning on my own patients prior to surgery. I have dedicated operative days and I also have dedicated outpatient clinic days. There are certain things that you need to be aware of as an IR (distal foot exam), looking for compartment syndrome, mass transfusion protocol, the role of basic pressors and what post procedure complications you should be looking for.

But, you do need to continue to maintain these skills throughout residency (having a 3 or 4 year gap is detrimental) and so you should do vascular surgery and ICU rotations throughout residency not just the final year. 2 or 3 months of MICU/SICU during residency would be helpful as would 2 or 3 vascular surgery rotations. The lifestyle of a successful clinical IR is more reflective of a surgeon's day to day existence.

Now, if you are more interested in doing 50% IR and 50% diagnostics where you will likely be relegated to minor procedures such as biopsies ,picc lines, paracentesis, thoracentesis and central venous access as well as procedures that other specialists may send your way due to complexity or time of day , in that case a more conventional IR training approach would suffice or even a general radiology residency should allow you to do minor procedures .

If you want to go out and be able to build an independent IR practice you have to be very strong clinically and be willing to work long hours to establish a robust practice.

 

[CaptainSSO]

S

 

[badasshairday]

I see how vascular surgery can help. But why icu? We won't be making management decisions for patients in the unit. That is what ICU docs are for. We probably will be doing an embo for a bleeding patient who ends up in the unit.

Otherwise good advice. However some of us are at the end of training and don't really have that chance to do a couple months of vascular surgery and ICU. I'm stuck in a more traditional fellowship (which like all IR fellowships these days has at least some clinical presence out of the lab) after a traditional diagnostic radiology residency.

 

[drp87]

I did surgery intern year this year and I think it was greatly helpful. I put in about 20 or more port-a-caths this year which the attendings always let us do on our own... not to mention lots of central lines, endo experience in vascular surgeries, suturing experience, etc etc... I will say that I am at a program where interns get tons of OR time. I scrubbed in about 175 cases this year... Although I should add that from what I hear this may not be typical for most surgery programs especially for prelims. My program also let me go down to IR whenever we didn't have cases and weren't on call.

None-the-less, I don't see how having lots of hands on experience could be anything but helpful.

Would you mind to tell me what program were you in the intern surgery year?

 

[tco]

I see how vascular surgery can help. But why icu? We won't be making management decisions for patients in the unit. That is what ICU docs are for. We probably will be doing an embo for a bleeding patient who ends up in the unit.

Otherwise good advice. However some of us are at the end of training and don't really have that chance to do a couple months of vascular surgery and ICU. I'm stuck in a more traditional fellowship (which like all IR fellowships these days has at least some clinical presence out of the lab) after a traditional diagnostic radiology residency.

It's about procedures and having the autonomy to do them. Most SICU months allow the residents to do everything necessary - lines, tubes, drains, whatever. Not necessarily management decisions.

 

[Radz123]

ICU helps you feel comfortable with very sick patients.

Will you be able to give detailed explanations regarding the underlying physiologic disturbances of your patients 10 years post residency? No.

Will ICU exposure help you maintain a cool mind when **** hits the fan? Definitely yes.

 

[irwarrior]

The procedural aspect to be learned is perhaps airway management and intubation. With a glidescope things may be easier.

We do not utilize anesthesia for the bulk of our procedures and the patients who come down to IR are pretty sick. It behooves us to get more comfortable with the vents and pressors and drips. Sometimes our patients are on telemetry but with low blood pressure and septic and it is imperative that you feel comfortable managing their BP with fluid boluses and pressors etc. Many of our patients are on the verge of coding , especially our ESRD patients and a strong foundation in management of these sicker patients may improve our outcomes. Often these patients are hyperkalemic and may even have ECG changes and we will be the ones placing access or revascularizing their fistula.

As you are sedating patients, it is imperative that you feel comfortable with airway management which would include increasing the oxygen amount to non-rebreathers or even oral airway, jaw thrust/chin tilt and ambubag use. You should feel comfortable with the reversal agents and be prepared to give them Some of these patients may ultimately convert to PEA arrest due to hypoxemia (goal is to be pro-active in preventing this) and you should initiate ACLS algorithm as the code team is simultaneously initiated.

If you have an aortic dissection patient it is imperative that you understand the role of dp/dt and appropriately place them on esmolol followed by a CCB such as clevidipine. After thoracic aortic stent graft repair, you should have some comfort with ICP drain management to prevent paralysis.

If you have a bleeding patient (which IR are managing more and more of) , it is critical that you understand the role of mass transfusion protocols as well as clotting agents such as kcentra etc and how to manage the blood pressure with fluids and pressors etc.

Patients can also code from the procedures that we perform and can also become septic from our interventions (biliary drains etc) and for those patients we should have some comfort in the treatment and management of sepsis.

If you have a basic foundation in intensive care medicine, you will not be afraid of sick patients and will be able to potentially prevent codes in the IR suites. I have seen time and time again where the basic working knowledge of ICU principles has prevented some of my patients from bad outcomes. This is why I encourage others to get some ICU exposure during training and the more the better.

With the advent of the IR mini-fellowships , I would strongly encourage budding "clinical" IR to go and seek ICU and vascular surgery experience as this will in my opinion make you a stronger clinical interventionalist and protect and enhance the care of your patients.

If, you are planning on dabbling in IR and doing venous access, paracentesis, thoracentesis, biopsies etc, it is not as critical to get critical care training.

 

[tco]

The procedural aspect to be learned is perhaps airway management and intubation. With a glidescope things may be easier.

We do not utilize anesthesia for the bulk of our procedures and the patients who come down to IR are pretty sick. It behooves us to get more comfortable with the vents and pressors and drips. Sometimes our patients are on telemetry but with low blood pressure and septic and it is imperative that you feel comfortable managing their BP with fluid boluses and pressors etc. Many of our patients are on the verge of coding , especially our ESRD patients and a strong foundation in management of these sicker patients may improve our outcomes. Often these patients are hyperkalemic and may even have ECG changes and we will be the ones placing access or revascularizing their fistula.

As you are sedating patients, it is imperative that you feel comfortable with airway management which would include increasing the oxygen amount to non-rebreathers or even oral airway, jaw thrust/chin tilt and ambubag use. You should feel comfortable with the reversal agents and be prepared to give them Some of these patients may ultimately convert to PEA arrest due to hypoxemia (goal is to be pro-active in preventing this) and you should initiate ACLS algorithm as the code team is simultaneously initiated.

If you have an aortic dissection patient it is imperative that you understand the role of dp/dt and appropriately place them on esmolol followed by a CCB such as clevidipine. After thoracic aortic stent graft repair, you should have some comfort with ICP drain management to prevent paralysis.

If you have a bleeding patient (which IR are managing more and more of) , it is critical that you understand the role of mass transfusion protocols as well as clotting agents such as kcentra etc and how to manage the blood pressure with fluids and pressors etc.

Patients can also code from the procedures that we perform and can also become septic from our interventions (biliary drains etc) and for those patients we should have some comfort in the treatment and management of sepsis.

If you have a basic foundation in intensive care medicine, you will not be afraid of sick patients and will be able to potentially prevent codes in the IR suites. I have seen time and time again where the basic working knowledge of ICU principles has prevented some of my patients from bad outcomes. This is why I encourage others to get some ICU exposure during training and the more the better.

With the advent of the IR mini-fellowships , I would strongly encourage budding "clinical" IR to go and seek ICU and vascular surgery experience as this will in my opinion make you a stronger clinical interventionalist and protect and enhance the care of your patients.

If, you are planning on dabbling in IR and doing venous access, paracentesis, thoracentesis, biopsies etc, it is not as critical to get critical care training.

Your SICU months must have been VERY different than at my hospital.

The residents on SICU do all of the procedures that don't need to go to the OR, and sometimes do go to the OR with the attendings for very sick patients. There was virtually no medical management because "SICU" was actually a consult service.

 

[irwarrior]

Your SICU months must have been VERY different than at my hospital.

The residents on SICU do all of the procedures that don't need to go to the OR, and sometimes do go to the OR with the attendings for very sick patients. There was virtually no medical management because "SICU" was actually a consult service.

Hmm. That sounds more like a procedural service as opposed to a conventional SICU.

Intensive care management typically includes higher level of monitoring including up to 1:1 nursing ratios, arterial lines, swans, CVP, ventrics/ICP, post operative patients (i.e. post whipples, hepatic resections, transplants, trauma, ruptured AAA, intracranial hemorrhages, thoracic and thoraco-abdominal repairs etc).

 

[spinesign]

My PD suggested a surgical year if you're interested in IR

 

[irwarrior]

https://www.youtube.com/user/IRResidents?app=desktop

Interesting discussion from current IR residents (UVA/U of Michigan/U Penn) as well as IR PD (MCW, UVA, U of Michigan, U of Colorado)

Global recommendation for IR driven trainees is surgical internship. IR PD panel was also advocating for surgical internships and training. Makes sense as the successful IR day to day existence is more reflective of a surgeon as opposed to an internist. Rounds before operating, operative days, admissions, post operative complications, outpatient clinics, wound management etc.

 

[badasshairday]

Yes. Do it. Try to do as much vascular surgery as possible. Learn vascular diseases management, diagnosis, and treatment. Do IR fellowship. Profit.

 

[irwarrior]

I agree a large vascular component in your internship would be beneficial as that is a common entity that you should feel comfortable managing. The more you do of it early on the better you will be at it. You should also to try to get ICU rotations in your surgical internship.

 

[tco]

https://www.youtube.com/user/IRResidents?app=desktop

Interesting discussion from current IR residents (UVA/U of Michigan/U Penn) as well as IR PD (MCW, UVA, U of Michigan, U of Colorado)

Global recommendation for IR driven trainees is surgical internship. IR PD panel was also advocating for surgical internships and training. Makes sense as the successful IR day to day existence is more reflective of a surgeon as opposed to an internist. Rounds before operating, operative days, admissions, post operative complications, outpatient clinics, wound management etc.

UVA's PD is all gung-ho about everyone doing a surgical month and "integrated" months with other services during residency. However, I've heard (telephone discussions with) from past VIR residents that those months (including the surgical internship) do not contribute significantly to their residency education. One resident in particular told me that he spent the majority of his Cardiology rotation writing thank you notes to the referrring clinicians. UVA also has a huge influence on SIR, given their positions within the organization. So, it's not exactly surprising that SIR is pushing a "global recommendation" for surgical internship so hard. IMO, it's just another example of trying to appease to the Surgeons by giving them motivated scut monkeys. "Please keep giving us good VIR cases when your old vascular surgeons (who don't do endovascular procedures) retire."

I obviously have a very jaded opinion of that group. I did a lot of research and ultimately ranked them near the bottom of my match list, despite their reputation and approximation to where home is for me. They seem very self-serving.

I'll end the rant there.

 

[irwarrior]

As a practicing IR, who had to overcome poor radiology training, I have a bias that the new integrated training will be a step in the right direction. I had inadequate clinical exposure during residency and that was detrimental to me establishing a practice. It took a great deal of effort to overcome that.

I have already started to see some of these new "IR " residents who have done pathways or mini-fellowships come out and they are in my opinion at the level of many of the conventionally trained IR that ar 3 or 4 years out. The only place that I have seen the trainees come out after one year with reasonable clinical acumen and ability to build a practice is miami vascular. I hope this changes as more and more programs establish a true clinical practice.

I must disagree with your views of UVA. Fritz Angle is one of the nicest and most approachable IR physicians you will meet and is extremely humble. Dr. Matsumoto and Dr. Sabri have also been very accommodating and always are willing to answer my questions at the annual meetings. They truly know their stuff. They know the trials and are involved as PI in many of the major vascular trials as well.

I have heard quite the opposite from several UVA IR pathway residents that I have come into contact with. It is a rigorous program and not every one is able to cut it. They have pretty comprehensive training and many of their graduates are highly capable and doing quite well. Certainly not for a resident who is on the fence about IR or not gung ho about IR as they will be unhappy. It is a very "busy" place. UVA has one of the longest histories training IR residents. Most of the current programs have never experienced training an IR resident and so there will be certain growing pains that UVA has sorted out.

In some ways, I see the surgical internship as a litmus test to see if you can handle an IR lifestyle. I personally would favor someone who did a surgical internship over someone who did a transitional internship (all other things being equal) as this shows a certain degree of commitment and I believe that type of individual would be a better fit in our specific practice. Again, if you are going to dabble in IR (piccs, paras, thoras, biopsies, abscess drains) there is no need to do a surgical internship or IR residency and conventional training is sufficient.

 

[Scilencer]

I've been following this thread with some interest as a current TY intern that's heading to radiology next year. I currently have an moderate-to-strong interest in IR (whether I will ultimately pursue it will be decided once in residency) and I think a surgery intern year may be overkill for IR. Perhaps I feel this way since my TY program requires 3 months of surgery and ICU (I'm doing SICU), and after a few months of q3 call now, with the plethora of wound vacs/wounds/debridements, NGTs and chole/appy/resections my opinion is that there is a diminishing return for doing 5-7 more months of floor work with occasional OR time which would be included in a prelim year.

I'm aware that certain other TY programs are medicine based so maybe that's what you guys are referring to? I ask all this because of irwarrior's statement that hiring IR practices would look at what type of intern year you did in their evaluation of your candidacy. Thoughts?

 

[irwarrior]

Internship is an important year. Not all surgical internships are the same just like all internal medicine or TY years are the same. I have seen exceptional IR come from TY years and I have seen poor IR come from surgical years. But, on average if you take the average student and put them through a surgical internship they develop a way of thinking and approach that is not seen with the average student that goes through a TY year. Some TY years are more like a glorified 4th year, where the trainee gets little autonomy. Now if you go to a surgical preliminary year, where you are the 4th trainee on the service you are not going to get as much out of it as if you are the one working hand in hand with the attendings or just under the chief resident.

Regardless of where you go, make sure you make the most of it and take it seriously as that year of clinical medicine is the foundation on which you will build the remainder of your clinical skills on.

 

[tco]

As a practicing IR, who had to overcome poor radiology training, I have a bias that the new integrated training will be a step in the right direction. I had inadequate clinical exposure during residency and that was detrimental to me establishing a practice. It took a great deal of effort to overcome that.

I have already started to see some of these new "IR " residents who have done pathways or mini-fellowships come out and they are in my opinion at the level of many of the conventionally trained IR that ar 3 or 4 years out. The only place that I have seen the trainees come out after one year with reasonable clinical acumen and ability to build a practice is miami vascular. I hope this changes as more and more programs establish a true clinical practice.

I must disagree with your views of UVA. Fritz Angle is one of the nicest and most approachable IR physicians you will meet and is extremely humble. Dr. Matsumoto and Dr. Sabri have also been very accommodating and always are willing to answer my questions at the annual meetings. They truly know their stuff. They know the trials and are involved as PI in many of the major vascular trials as well.

I have heard quite the opposite from several UVA IR pathway residents that I have come into contact with. It is a rigorous program and not every one is able to cut it. They have pretty comprehensive training and many of their graduates are highly capable and doing quite well. Certainly not for a resident who is on the fence about IR or not gung ho about IR as they will be unhappy. It is a very "busy" place. UVA has one of the longest histories training IR residents. Most of the current programs have never experienced training an IR resident and so there will be certain growing pains that UVA has sorted out.

In some ways, I see the surgical internship as a litmus test to see if you can handle an IR lifestyle. I personally would favor someone who did a surgical internship over someone who did a transitional internship (all other things being equal) as this shows a certain degree of commitment and I believe that type of individual would be a better fit in our specific practice. Again, if you are going to dabble in IR (piccs, paras, thoras, biopsies, abscess drains) there is no need to do a surgical internship or IR residency and conventional training is sufficient.

You're basing your opinion on residents that you've seen who are happy with the program, and have gone to national meetings combined with the outward appearance of the directors at their organization's annual meetings.

I interviewed with both Dr. Angle and Sabri, and spoke at length with Dr. Matsumoto. I agree that they all are very nice, answered all questions I had, and were extremely excited about their program. They are willing to work hard and get good results with their trainees. However, I feel there is a huge selection bias. If you put those trainees who go to the UVA VIR program at nearly any other program in the country, they're still going to end up being great IR residents (and also love their program) because they're highly motivated and enjoy what they do.

For the most part, I agree that it's good training. I just think they're going very overboard with this whole "clinical representation" thing. If they want IR clinics and IR specific rotations, awesome, but scutting Rads residents out to Cardiology and Vascular Surgery is nonsense. Yes, those reports are few, but they do happen.

I could see myself doing fellowship there, but the residency was pretty off-putting to me, for the reasons I've mentioned already. I know I probably sound like I'm badmouthing them, but I'm really not. I would never actively try to convince someone to not go there, just stating my opinion.

 

[badasshairday]

Everyone has their own opinions on things but mine are a little more in line with IRwarrior. I am nearing the end of training as a PGY5 going into IR fellowship. I am scrambling to hone my clinical acumen and would rather have 2 or 3 off radiology service rotations in things like vascular surgery, ICU, stroke neurology.

You're basing your opinion on residents that you've seen who are happy with the program, and have gone to national meetings combined with the outward appearance of the directors at their organization's annual meetings.

I interviewed with both Dr. Angle and Sabri, and spoke at length with Dr. Matsumoto. I agree that they all are very nice, answered all questions I had, and were extremely excited about their program. They are willing to work hard and get good results with their trainees. However, I feel there is a huge selection bias. If you put those trainees who go to the UVA VIR program at nearly any other program in the country, they're still going to end up being great IR residents (and also love their program) because they're highly motivated and enjoy what they do.

For the most part, I agree that it's good training. I just think they're going very overboard with this whole "clinical representation" thing. If they want IR clinics and IR specific rotations, awesome, but scutting Rads residents out to Cardiology and Vascular Surgery is nonsense. Yes, those reports are few, but they do happen.

I could see myself doing fellowship there, but the residency was pretty off-putting to me, for the reasons I've mentioned already. I know I probably sound like I'm badmouthing them, but I'm really not. I would never actively try to convince someone to not go there, just stating my opinion.

 

[irwarrior]

I was lucky enough to be able to do a vascular surgery and cardiology rotation during my residency. I spent all of my time in the VS clinic and still use many of those tenets to this day. I was a guest on their rotation and was more than happy to help out wherever they needed me. As far as helping out the team or attending when you are being educated by another group of physicians where you are a guest is more than reasonable. If another resident on a service wanted to rotate with me, I would expect them to round on the patients, admit them and take care of the peri-procedural care. If they came in and wanted to do the case with no effort doing the remainder of the work needed, I would not be very happy.

There is some truth to the average UVA pathway trainee is likely to succeed regardless of where they go. But, most people need rigorous training to excel and be able to develop a practice after residency. Looking at what graduates do of the various programs is somewhat indicative of their training.

I personally think that the current IR/DR training program does not have enough clinical rotations from PGY2 through PGY5 and I would encourage trainees to get additional IR or clinical rotations during that time. The clinical integration is paramount to being a strong clinical interventionalist.

Either way it is exciting times and I am looking forward to the changes that are being implemented.

 

[tco]

I was lucky enough to be able to do a vascular surgery and cardiology rotation during my residency. I spent all of my time in the VS clinic and still use many of those tenets to this day. I was a guest on their rotation and was more than happy to help out wherever they needed me. As far as helping out the team or attending when you are being educated by another group of physicians where you are a guest is more than reasonable. If another resident on a service wanted to rotate with me, I would expect them to round on the patients, admit them and take care of the peri-procedural care. If they came in and wanted to do the case with no effort doing the remainder of the work needed, I would not be very happy.

There is some truth to the average UVA pathway trainee is likely to succeed regardless of where they go. But, most people need rigorous training to excel and be able to develop a practice after residency. Looking at what graduates do of the various programs is somewhat indicative of their training.

I personally think that the current IR/DR training program does not have enough clinical rotations from PGY2 through PGY5 and I would encourage trainees to get additional IR or clinical rotations during that time. The clinical integration is paramount to being a strong clinical interventionalist.

Either way it is exciting times and I am looking forward to the changes that are being implemented.

I totally agree with this, but you have to think about the timing of the clinical training, and what the training will encompass. A surgical internship is going to be mostly forgotten by the time fellowship rolls around. I loved organic chemistry, but didn't remember any of it by my third year of medical school. It's a similar idea.

I have NO problem with doing work. What you described (admitting patients, post procedural care, etc) is medical work. Being someone's secretary is a different issue. What I described (writing thank you notes to clinicians) is scut secretary work.

 

[irwarrior]

Surgical internship should give you an approach to patient care. i.e. rounding before going to the IR suites. Post operative complications. Outpatient clinic etc. It makes you a bit more aggressive and a little less timid and ready to face the hurdles in IR. Of course, you need to continue to have rotations in clinical medicine during your PGY2,3 as well as 4 years. A 3 year gap is detrimental to you being a solid clinician.

IR physicians and radiologists are poor at practice development and calling referring physicians back and writing "thank you" letters are a standard practice and in my opinion is a part of the case. I think it is good for trainees to see successful practices be it IR, cardiology, or vascular surgery and implement some of these tools in their own practice.

I have seen trainees feel that anything outside of being primary operator as "scut" and in my opinion that is not the case. It is important to be involved in all aspects of patient care.

I equate scut to a trainee getting coffee for their attending or being asked to pick up dry-cleaning etc. Well that in my opinion is abuse.

 

[tco]

I equate scut to a trainee getting coffee for their attending or being asked to pick up dry-cleaning etc. Well that in my opinion is abuse.

Or writing thank you letters...

 

[meister]

Acquiring coffee is the most important part of my day, any med stud who complains about getting coffee for staff is clearly not qualified for radiology.