kimbosliced

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Jan 12, 2010
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Does anyone have any idea on the time frame for the rumored primary IR certificate--when it will come to fruition?

I know someone mentioned it in an early post, but I couldn't find anymore information on this.

What would this program entail?
 
Oct 3, 2010
97
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It could be a while before the primary certificate in IR is available. But, until then I would highly recommend those who want to become high end interventionalists to consider a Clinical pathway such as the one at UVA. It is pretty competitive, but I have talked to a couple of their trainees and they seem to get great training. I personally think that is a great way fort those surgical types who want to focus their education on IR.
 
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kimbosliced

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Would this be a better way to go rather than the new DIRECT pathway?
 
Oct 3, 2010
97
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If you know that you want to do high end IR, then I would say a pathway to IR is a good way to go. The difference in the DIRECT is that you get less imaging and more clinical. While the Clinical Pathway you get more interventonal and less clinical.

Clinical Pathway you do a year of internship (surgery or IM). Then during the next 4 years you do up to 16 months of IR/clinical rotations and 32 months of diagnostic training. The fellowship year is all IR. So in essence you get nearly 40 monhts of clinical rotations/IR and 32 months of imaging.

With the new board format and ACGME status you can also ask your residency program director to set up something similar for you.

What I am allowing at my program for the highly motivated and interested student/resident is

a surgical or medicine internship followed by 2 months of IR every year for the 1rst 3 years of radiology and then up to 10 months of IR their senior year and then onto an IR fellowship. This format is very similar to the CLINICAL pathway and remains in the ACGME guidelines. This is something that anyone who is applying to radiology can potentially do if they are interested. But, the rotations may have to be switched around to allow this.
 
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kimbosliced

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Wow, that does sound very intriguing. Does one apply for these Clinical and/or DIRECT pathways through the standard match?

If so, how does it compare for matching vs. Diagnostic Rads alone?
 
Oct 15, 2010
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For those of you following the progress of the primary certificate, here is an update from the SIR's IRnews newsletter, written by John Kaufman who's been one of the biggest proponents of the primary certificate (I transcribed this from the newletter so there could be a couple spelling/formatting issues):

.The underlying core concepts are that 1) the use of imaging to guide interventions is as fundamental to medicine as the use of imaging for making diagnoses and therefore merits recognition as a primary specialty; 2) IR is the specialty within medicine that encompasses the broadest and deepest range of image-guided interventions; 3) IR is best situated within ABR; 4) the training for IR is unique and combines imaging, intervention and focused periprocedural patient management skills; and 5) patients will benefit from the advancement of IR as a discrete discipline. The primary certificate in IR will add to current training and certification, so that traditional fellowships and the DIRECT pathway would continue. The IR residencies, by definition, will reside within radiology departments as part of the portfolio of the radiology chairs. ABR would continue to support maintenance of certification (MOC) for all current certifications in IR and endorse equivalence of subspecialty and primary specialty certificates in terms of procedural competencies. The ability to acquire a primary certificate in IR through a "grandfather" mechanism will be available for an estimated period of five years..
. .
.As previously discussed in IR News and elsewhere, there have been several variations proposed for the primary certificate. The most recent proposal included two options: a free-standing IR certificate without general diagnostic competencies and a dual-certification pathway that would result in both an IR and DR primary certificate. In order to assess the degree of membership support for these proposals, a survey of active full members of SIR was conducted in fall 2010. With more than 20 percent of members responding, 63.5 percent were in favor, 25.1 percent were against and 11.5 percent were indifferent. Although this provided a statistically valid strong expression of support, the comments provided by one out of five people were even more revealing. Members indicated a strong preference for the dual certification in IR and DR rather than an IR-only certificate. This was particularly true among many of those who voted against or were indifferent to the two proposals, suggesting that the results would have been even more strongly in favor had only the dual certification pathway been considered. Coincident with this survey, a poll of SIR medical student members was undertaken. The interest in dual certification in IR and DR was striking, with 90 percent of medical students expressing preference for this option over an IR-only certificate. .
.
.
.In response to these survey results, discussions with members and interaction with the leadership of several key radiology organizations, the primary certificate proposal has been modified to offer only dual certification in both IR and DR. The overall length of training will now be five years after internship. Residents will begin training in a DR residency, with emphasis on IR rotations. After the third year of DR, the residents will then branch into a two year IR residency that will be a highly structured and integrated experience including graduated levels of responsibility for procedural and nonprocedural care. Although the overall formal DR training is less than that of a standard DR residency, the additional DR experience gained while evaluating imaging before and during the two years of IR residency will be sufficient for full competency in DR as well as IR..
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.Dual certification in two overlapping primary specialties following integrated training in a combined program is an accepted concept. A well-known example is the four-year Internal Medicine and Pediatrics Residency. Though substantially shorter than an outright combination of Internal Medicine and Pediatrics (three years each, for a total of six years), residents who complete ..these programs qualify for two different primary certificates from two different boards. With the dual certification proposal in the IR primary certificate, the two specialty certificates will be issued by the same board—ABR..
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.There are several advantages to the dual certification pathway. First and foremost, this will ensure that imaging competency remains a defining feature of imaged-guided interventional procedures, as patients benefit from the combination of expert imaging and interventional skills. Second, integration into existing DR departments will be much easier, as the IR primary certificate now meshes well with the new DR residency format of three core years plus one year of largely elective rotations. Third, concerns about creation of a division between IR and DR are resolved. Lastly, the three years of overlap during the DR years will allow residents flexibility to move in or out of the IR primary certificate program if they change their minds during training..
. .
.Through a continuous process of discussion, debate, reflection and consultation, the IR primary certificate proposal has changed substantially over the past four years. The ABR/SIR Primary Certificate Task Force is confident that the end result (a single pathway with sufficient DR training for dual certification in IR and DR) is a robust, attractive and viable proposal. This will be an additional training option, not a replacement for current programs. A primary certificate in IR will help ensure that patients will continue to benefit from the advancement of image-guided interventions across a wide spectrum of diseases, conditions and organ systems....
 

Radonkulous

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...
 
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Oct 3, 2010
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The Primary Certificate just took a big step forward...SIR just sent out an e-mail...here it is:

"MESSAGE FROM SIR PRESIDENT: ACR COUNCIL APPROVES LANDMARK RESOLUTION ON IR PATHWAY

The American College of Radiology (ACR) Council voted to approve Resolution #44, “Interventional Radiology Pathway,” on Tuesday, May 17, during ACR’s 88th Annual Meeting and Chapter Leadership Conference in Washington, D.C. This resolution is in support of the proposed ABR Dual Certificate in Interventional and Diagnostic Radiology, which results in competency in both IR and DR and raises IR to specialty standing. This would be an additional, focused training option; traditional VIR Fellowships and the DIRECT pathway will continue, and certification in only IR will not be possible.
This comes 10 years after the ACR Council approved the resolution “Recognition and Retention of Interventional Radiology Within Radiology,” which recognized IR as a distinct component within the house of radiology during the September 2001 ACR meeting. The training pathway still requires approval of the American Board of Medical Specialties (ABMS), but this resolution is an important endorsement that increases the chances for that proposal.
“The unique nature of IR within medicine has been affirmed by the plurality of radiology, a crucial step toward final approval of the Dual Certificate in Interventional Radiology and Diagnostic Radiology by ABMS,” said John A. Kaufman, MD, FSIR, SIR past president, who is guiding this effort. “Furthermore, this proposal strengthens the bond between diagnostic competency and image-guided interventional competency.” The proposal also has the support of the following key organizations: the Association of Program Directors in Radiology (APDR); the Society of Chairs of Academic Radiology Departments (SCARD); the Radiology RRC of ACGME; the American Osteopathic College of Radiology (AOCR); and the American Association for Women Radiologists (AAWR). The proposal will be submitted to ABMS in late December and a final decision is expected in early 2012.
“We are one step closer to approval of this important specialty pathway due to the efforts of many members,” said Timothy P. Murphy, MD, FSIR, FACR, SIR president. “Their support is greatly appreciated. I especially would like to thank John A. Kaufman, MD, FSIR; Anne C. Roberts, MD, FSIR, FACR; Philip S. Cook, MD, FSIR, FACR; Kenneth W. Chin, MD, FSIR, FACR; Curtis A. Lewis, MD, MBA, JD, FSIR, FACR; Steven L. Ferrara, MD; Alan H. Matsumoto, MD, FSIR, FACR; and Richard Duszak Jr., MD, FSIR, FACR, for their tireless efforts. Special thanks also go to Charles E. Ray Jr., MD, PhD, FSIR, FACR; John D. Fulco, MD, FSIR, FACR; Richard Strax, MD, FACR; James B. Spies, MD, MPH, FSIR, FACR; Daniel A. Siragusa, MD; Timothy L. Swan, MD; Michael A. Braun, MD; Jeanne M. LaBerge, MD, FSIR; and Gary J. Becker, MD, FSIR, FACR.
The support of ACR state chapters, regional caucuses and other organizations was also instrumental to this achievement and they will be recognized in further communications. The following is the final approved resolution language:
BE IT RESOLVED, the American College of Radiology supports the proposed training program leading to dual primary certification in both interventional radiology and diagnostic radiology as an additional training option in interventional radiology. Refer to Appendix A."

(Schedule based on four-week blocks)
PGY Year
IR/DR Dual Certificate
1
Internship
2
DR 12 / IR 1
3
DR 12 / IR 1
4
DR 12 / IR 1
5
IR 10 / ICU / DR 2
6
IR 13
Total IR (min)
27 (includes ICU)
Total DR (max)
38