Tips for medical student IR rotation

[badasshairday]

Any tips for VIR rotation for a 4th year medical student?

Will be doing my rotation at a very clinically strong VIR program. We have a great relationship with vascular surgery. VIR does a lot of peripheral arterial interventions such as cold feet, EVAR, renal stents, carotids. Also interventional onc. Basically VIR at my program does the full gamut of procedures that are under the umbrella of interventional radiology. VIR admits patients, has a consult service, has a general Interventional radiology clinic in the specialty building, has a vein clinic, and an interventional onc clinic as well. They are part of a tumor board with rad onc, surg onc, med onc; as well as a vascular board with vascular surgery.

What should I read up on besides the handbook of interventional radiologic procedures? Any medical therapies I should be up to speed on, ie PVD medical therapies, treatment goals for lipids. What should I know about liver cancers? I will read up on procedures like TIPS, including indications, contraindications... should I know post procedure medical therapy to look like a star? Any other advice?

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[Gvataken]

It seems you have the gist of what you need to know.

A couple of things to review include:

Interventional Oncology:
1. AASLD guidelines on HCC diagnosis and management
2. Hepatic vascular anatomy (some great articles in JVIR, including David Liu's article on vascular variants for mesenteric angio)

PAD
Medical treatments:

Rutherford classification
acute and chronic limb ischemia
wound evaluation and management
vascular anatomy
role of stents, atherectomy etc

But, Kandarpa is quite comprehensive and a great start. Good luck.

 

[IRneuroIR]

I think you already have a pretty good knowledge about IR as compared to many medical students but Dr. V's advice is solid. In our program, we typically ask more about clinical medicine and anatomy from the students rotating through the service although we don't often get a student rotating through IR for a full month -- that's great!

I think IR has made significant improvements in it's outreach to medical students. I can remember not too long ago as a 3rd/4th year medical student barely knowing about IR. In fact, I used an elective month during my internship to really "check it out" -- almost an extension of my medical school rotations. It's great to hear and see that there are so many interested and motivated students pursuing careers to become IRs -- our field is in excellent shape!

 

[badasshairday]

Is it unreasonable or unrealistic to have goals at becoming somewhat proficient at PICC's and/or ports and/or pigtail chest tubes by the end of this month, of course under highly supervised conditions? I haven't really had much of a chance to do any. I tried one PICC on my own so far. I've been going in on big cases such as y90's, TACES, DEB TACES, PAD stenting cases, thrombolysis ect, and scrubbing in to be close to the action so I get to handle some of the wires coming out or slide cathetors over guide wires, and suture catheters in place at the end of cases, which is cool. I was just hoping to have some basic proficiency at "simple" procedures like PICC's and pigtails. It is somewhat frusturating especially since this is what I want to do for my career. Maybe my expectations are too high?

 

[davidjones]

I think for a med student just getting a handle on what's going on and being able to know the steps of each procedure, and more importantly pre- and post- management and indications for each procedure would put you much ahead of the game.

Getting your hands on stuff like PICCs and central lines is more like gravy at this point. There are residents out there who can't do these supervised/unsupervised (granted these are likely not ones going into IR), however, even these "simple" procedures can be technically difficult and may even require direct attending involvement, i.e. a chronic HD patient with 4 failed AVFs who needs a tunneled central line and has SVC occlusion.

That being said, I think it is totally reasonable to try to get hands on experience, especially if it's just you and a resident. There have been a couple of very good med students who proved to me that they knew the stuff I listed above and came with me when I rounded on patients etc, that I let do everything but the venous stick (mostly because I am also still new and weary of letting others stick the carotid :-D).

But to give you an idea, I have worked with about 10 med students closesly so far, and have let only 2 actually do stuff while I watch, everyone else pretty much just assisted.

 

[badasshairday]

Thanks for the advice. Everything has gotten a lot better.