training in interventional radiology: update residency... · training in interventional radiology:...
TRANSCRIPT
![Page 1: Training in Interventional Radiology: Update Residency... · Training in Interventional Radiology: Update ... intervention, patient care ... specialists •Diagnostic Radiology analogy](https://reader031.vdocuments.mx/reader031/viewer/2022022513/5af01a0b7f8b9ac62b8e4144/html5/thumbnails/1.jpg)
Training in
Interventional Radiology:
Update April 2014
John Kaufman MD
Jeanne M. LaBerge, MD
1
![Page 2: Training in Interventional Radiology: Update Residency... · Training in Interventional Radiology: Update ... intervention, patient care ... specialists •Diagnostic Radiology analogy](https://reader031.vdocuments.mx/reader031/viewer/2022022513/5af01a0b7f8b9ac62b8e4144/html5/thumbnails/2.jpg)
January 16, 1964
2
![Page 3: Training in Interventional Radiology: Update Residency... · Training in Interventional Radiology: Update ... intervention, patient care ... specialists •Diagnostic Radiology analogy](https://reader031.vdocuments.mx/reader031/viewer/2022022513/5af01a0b7f8b9ac62b8e4144/html5/thumbnails/3.jpg)
Charles Dotter, MD
“The angiographer…..must accept the
responsibility for the direct care of patients
before and after the procedure; now see
them as patients, not just as blocked
arteries.”
1968
3
![Page 4: Training in Interventional Radiology: Update Residency... · Training in Interventional Radiology: Update ... intervention, patient care ... specialists •Diagnostic Radiology analogy](https://reader031.vdocuments.mx/reader031/viewer/2022022513/5af01a0b7f8b9ac62b8e4144/html5/thumbnails/4.jpg)
VIR Subspecialty Certificate
• First exam 1995
• ABR Diagnostic Radiology diplomates
only
• Completion ACGME-accredited
fellowship
• 500 cases from fellowship
• 200 cases from 12 months practice
• 10 year renewable certificate
4
![Page 5: Training in Interventional Radiology: Update Residency... · Training in Interventional Radiology: Update ... intervention, patient care ... specialists •Diagnostic Radiology analogy](https://reader031.vdocuments.mx/reader031/viewer/2022022513/5af01a0b7f8b9ac62b8e4144/html5/thumbnails/5.jpg)
IR Competencies
Imaging Procedures
Patient care
IR
5
![Page 6: Training in Interventional Radiology: Update Residency... · Training in Interventional Radiology: Update ... intervention, patient care ... specialists •Diagnostic Radiology analogy](https://reader031.vdocuments.mx/reader031/viewer/2022022513/5af01a0b7f8b9ac62b8e4144/html5/thumbnails/6.jpg)
IR Is Complex
6
![Page 7: Training in Interventional Radiology: Update Residency... · Training in Interventional Radiology: Update ... intervention, patient care ... specialists •Diagnostic Radiology analogy](https://reader031.vdocuments.mx/reader031/viewer/2022022513/5af01a0b7f8b9ac62b8e4144/html5/thumbnails/7.jpg)
Why Change Training
• IR practice has evolved
– Complexity
– Non-procedural care
• Multiple ways to deliver image-guided care
• Patients benefit from well-trained IR
specialists
• Training, certification best situated in
Radiology
7
![Page 8: Training in Interventional Radiology: Update Residency... · Training in Interventional Radiology: Update ... intervention, patient care ... specialists •Diagnostic Radiology analogy](https://reader031.vdocuments.mx/reader031/viewer/2022022513/5af01a0b7f8b9ac62b8e4144/html5/thumbnails/8.jpg)
Why A Specialty?
• IR skill set is unique and complex – Imaging, intervention, patient care
• Image-guided intervention widely applied – Patients benefit from well-trained IR
specialists
• Diagnostic Radiology analogy – Everyone uses some imaging, but someone
has to be the expert
8
![Page 9: Training in Interventional Radiology: Update Residency... · Training in Interventional Radiology: Update ... intervention, patient care ... specialists •Diagnostic Radiology analogy](https://reader031.vdocuments.mx/reader031/viewer/2022022513/5af01a0b7f8b9ac62b8e4144/html5/thumbnails/9.jpg)
Evolution of IR Training
• 1992 – Accreditation fellowships
• 1994 – VIR Subspecialty recognized
• 1995 – VIR Subspecialty exam
• 2000 – VIR Clinical Pathway
• 2005 – VIR DIRECT Pathway
• 2009 – IR Primary Certificate rejected
• 2012 – IR Specialty, IR/DR Certificate approved
9
![Page 10: Training in Interventional Radiology: Update Residency... · Training in Interventional Radiology: Update ... intervention, patient care ... specialists •Diagnostic Radiology analogy](https://reader031.vdocuments.mx/reader031/viewer/2022022513/5af01a0b7f8b9ac62b8e4144/html5/thumbnails/10.jpg)
Interventional
Radiologist
New ACGME Training Program
• To facilitate optimal
patient care in IR
• To provide trainees
with the tools they need
to deliver this care - as
imagers, proceduralists,
and clinicians
Purpose
10
![Page 11: Training in Interventional Radiology: Update Residency... · Training in Interventional Radiology: Update ... intervention, patient care ... specialists •Diagnostic Radiology analogy](https://reader031.vdocuments.mx/reader031/viewer/2022022513/5af01a0b7f8b9ac62b8e4144/html5/thumbnails/11.jpg)
New ACGME Training Program
• More time to master the procedural and
clinical domains of IR (1 additional year)
• Greater focus on clinical care: outpatient
clinics, inpatient consultation and admission,
and critical care
• New opportunity for trainees to enter into IR
from medical school
Key Elements
11
![Page 12: Training in Interventional Radiology: Update Residency... · Training in Interventional Radiology: Update ... intervention, patient care ... specialists •Diagnostic Radiology analogy](https://reader031.vdocuments.mx/reader031/viewer/2022022513/5af01a0b7f8b9ac62b8e4144/html5/thumbnails/12.jpg)
New ACGME Training Program
• Maintain core competency in Diagnostic
Radiology
• Provide programs with as much flexibility as
possible to implement these changes at their
home institutions
Key Elements
12
![Page 13: Training in Interventional Radiology: Update Residency... · Training in Interventional Radiology: Update ... intervention, patient care ... specialists •Diagnostic Radiology analogy](https://reader031.vdocuments.mx/reader031/viewer/2022022513/5af01a0b7f8b9ac62b8e4144/html5/thumbnails/13.jpg)
• Clinical internship
• Residency
– PGY 2-4 standard DR imaging training
– PGY 5-6 IR training
• Outpatient IR clinics, admitting IR services
• 1 rotation ICU (critical care)
• Up to 4 rotations in DR (if needed)
– Nuclear medicine, Mammography
Program Requirements:
Framework
13
![Page 14: Training in Interventional Radiology: Update Residency... · Training in Interventional Radiology: Update ... intervention, patient care ... specialists •Diagnostic Radiology analogy](https://reader031.vdocuments.mx/reader031/viewer/2022022513/5af01a0b7f8b9ac62b8e4144/html5/thumbnails/14.jpg)
• 1 year fellowships will eventually be phased
out
• Timeline for conversion to the new training
program is long
– 1 more year for internal ACGME process
– 7 years for conversion from fellowship to
residency
Program Requirements:
Framework
14
![Page 15: Training in Interventional Radiology: Update Residency... · Training in Interventional Radiology: Update ... intervention, patient care ... specialists •Diagnostic Radiology analogy](https://reader031.vdocuments.mx/reader031/viewer/2022022513/5af01a0b7f8b9ac62b8e4144/html5/thumbnails/15.jpg)
Transition Timeline
2014 Program Requirements
2015 First residency applications
2022 End of 1-year fellowships
15
![Page 16: Training in Interventional Radiology: Update Residency... · Training in Interventional Radiology: Update ... intervention, patient care ... specialists •Diagnostic Radiology analogy](https://reader031.vdocuments.mx/reader031/viewer/2022022513/5af01a0b7f8b9ac62b8e4144/html5/thumbnails/16.jpg)
Program Requirements:
Draft Review and Approval (2/2014)
• RRC
Chair, Larry Davis
Jim Anderson
Duane Mezwa
Kristen Destigter
Gautham Reddy
Don Fleming
Val Jackson
Susan John
Bradley Carr
Liz Oates
Kay Vydareny
Felicia Davis 16
![Page 17: Training in Interventional Radiology: Update Residency... · Training in Interventional Radiology: Update ... intervention, patient care ... specialists •Diagnostic Radiology analogy](https://reader031.vdocuments.mx/reader031/viewer/2022022513/5af01a0b7f8b9ac62b8e4144/html5/thumbnails/17.jpg)
• Two training program formats are available.
– Integrated: residents are matched from medical
school and the entire educational experience is
provided during the residency
– Independent - residents enter at a later stage in
training and are given credit for prior training in
another field.
• This approach is used by three surgical
specialties: Plastic surgery, Thoracic surgery
Vascular surgery
Program Formats:
Integrated and Independent
17
![Page 18: Training in Interventional Radiology: Update Residency... · Training in Interventional Radiology: Update ... intervention, patient care ... specialists •Diagnostic Radiology analogy](https://reader031.vdocuments.mx/reader031/viewer/2022022513/5af01a0b7f8b9ac62b8e4144/html5/thumbnails/18.jpg)
• Residents complete 5 years of training
after a clinical internship year
– 3 DR, 2 IR under a IR PD
– Match out of medical school or transfer in
from DR residency at the home institution
– Match into the last 2 IR years after
completion of a DR residency. Qualifying
residents may enter the PGY6 year.
Integrated Programs
18
![Page 19: Training in Interventional Radiology: Update Residency... · Training in Interventional Radiology: Update ... intervention, patient care ... specialists •Diagnostic Radiology analogy](https://reader031.vdocuments.mx/reader031/viewer/2022022513/5af01a0b7f8b9ac62b8e4144/html5/thumbnails/19.jpg)
• Residents complete 2 years of training
after completing a 4-year DR residency
– Candidates may enter the second year of
the program (PGY 6 level) provided they
have adequate training experience including
at least 12 IR or IR-related rotations and
documentation of at least 500 procedures
covering the broad domain of IR.
Independent Programs
19
![Page 20: Training in Interventional Radiology: Update Residency... · Training in Interventional Radiology: Update ... intervention, patient care ... specialists •Diagnostic Radiology analogy](https://reader031.vdocuments.mx/reader031/viewer/2022022513/5af01a0b7f8b9ac62b8e4144/html5/thumbnails/20.jpg)
Entry Points: Integrated
* IR or IR-related rotations
Medical school
match
Radiology 3:2
Qualified
transfer
20
![Page 21: Training in Interventional Radiology: Update Residency... · Training in Interventional Radiology: Update ... intervention, patient care ... specialists •Diagnostic Radiology analogy](https://reader031.vdocuments.mx/reader031/viewer/2022022513/5af01a0b7f8b9ac62b8e4144/html5/thumbnails/21.jpg)
Entry Points: Independent
* IR or IR-related rotations
DR
Graduates
Qualified
PGY6 entry
21
![Page 22: Training in Interventional Radiology: Update Residency... · Training in Interventional Radiology: Update ... intervention, patient care ... specialists •Diagnostic Radiology analogy](https://reader031.vdocuments.mx/reader031/viewer/2022022513/5af01a0b7f8b9ac62b8e4144/html5/thumbnails/22.jpg)
Associate PD
• For Integrated programs, the program
director is responsible for the entire 5 year
residency but may designate an associate
PD with responsibility for the first three
years of training focused on diagnostic
imaging.
22
![Page 23: Training in Interventional Radiology: Update Residency... · Training in Interventional Radiology: Update ... intervention, patient care ... specialists •Diagnostic Radiology analogy](https://reader031.vdocuments.mx/reader031/viewer/2022022513/5af01a0b7f8b9ac62b8e4144/html5/thumbnails/23.jpg)
• For Integrated Programs, the distribution
of call in DR vs IR has not been specified
and is at the discretion of the program. In
particular, 4th year residents may take call
in diagnostic imaging as determined by the
individual program.
Call in PGY 5
23
![Page 24: Training in Interventional Radiology: Update Residency... · Training in Interventional Radiology: Update ... intervention, patient care ... specialists •Diagnostic Radiology analogy](https://reader031.vdocuments.mx/reader031/viewer/2022022513/5af01a0b7f8b9ac62b8e4144/html5/thumbnails/24.jpg)
• During PGY 5 and 6, training in IR content
can be achieved in the IR section or on
IR-related rotations outside of the IR
section proper.
Examples include rotations in vascular
surgery, medical oncology clinic or
interventional procedural rotations housed
within diagnostic radiology sections
IR and IR-related Rotations
24
![Page 25: Training in Interventional Radiology: Update Residency... · Training in Interventional Radiology: Update ... intervention, patient care ... specialists •Diagnostic Radiology analogy](https://reader031.vdocuments.mx/reader031/viewer/2022022513/5af01a0b7f8b9ac62b8e4144/html5/thumbnails/25.jpg)
Concerns
• Mandatory transition of fellowship to
residency
– Not what was proposed and endorsed
• Integration IR/DR with DR programs
• Funding
• Numbers of graduates
• IR training for non IR/DR residents
25
![Page 26: Training in Interventional Radiology: Update Residency... · Training in Interventional Radiology: Update ... intervention, patient care ... specialists •Diagnostic Radiology analogy](https://reader031.vdocuments.mx/reader031/viewer/2022022513/5af01a0b7f8b9ac62b8e4144/html5/thumbnails/26.jpg)
Concerns
• DR programs without VIR fellowships
– Disenfranchised
• Large VIR fellowships
– Decreased number IR/DR residents
• Complex resident selection process
26
![Page 27: Training in Interventional Radiology: Update Residency... · Training in Interventional Radiology: Update ... intervention, patient care ... specialists •Diagnostic Radiology analogy](https://reader031.vdocuments.mx/reader031/viewer/2022022513/5af01a0b7f8b9ac62b8e4144/html5/thumbnails/27.jpg)
Lots Of Activity Nationally
• ABR
• ACGME
• APDR
• SCARD
• ACR
• AUR
• SIR
• APDIR
27
![Page 28: Training in Interventional Radiology: Update Residency... · Training in Interventional Radiology: Update ... intervention, patient care ... specialists •Diagnostic Radiology analogy](https://reader031.vdocuments.mx/reader031/viewer/2022022513/5af01a0b7f8b9ac62b8e4144/html5/thumbnails/28.jpg)
Lessons From Others?
• Vascular Surgery Primary Certificate
2006
• Integrated: enter from medical school
– VS Certification only
• Independent: multiple entry points
– VS and General Surgery certification
28
![Page 29: Training in Interventional Radiology: Update Residency... · Training in Interventional Radiology: Update ... intervention, patient care ... specialists •Diagnostic Radiology analogy](https://reader031.vdocuments.mx/reader031/viewer/2022022513/5af01a0b7f8b9ac62b8e4144/html5/thumbnails/29.jpg)
VS Experience 7 Years Later
29
![Page 30: Training in Interventional Radiology: Update Residency... · Training in Interventional Radiology: Update ... intervention, patient care ... specialists •Diagnostic Radiology analogy](https://reader031.vdocuments.mx/reader031/viewer/2022022513/5af01a0b7f8b9ac62b8e4144/html5/thumbnails/30.jpg)
VS Experience 7 Years Later
VS Residents 30
![Page 31: Training in Interventional Radiology: Update Residency... · Training in Interventional Radiology: Update ... intervention, patient care ... specialists •Diagnostic Radiology analogy](https://reader031.vdocuments.mx/reader031/viewer/2022022513/5af01a0b7f8b9ac62b8e4144/html5/thumbnails/31.jpg)
Summary
• The Program Requirements are written with
training outcomes in mind. Programs will
have flexibility in implementing the PRs
provided the training outcomes and
objectives are met.
• The final version of the Program
Requirements will not be available for
approximately 1 year. Until then all elements
of the document are subject to change.
31
![Page 32: Training in Interventional Radiology: Update Residency... · Training in Interventional Radiology: Update ... intervention, patient care ... specialists •Diagnostic Radiology analogy](https://reader031.vdocuments.mx/reader031/viewer/2022022513/5af01a0b7f8b9ac62b8e4144/html5/thumbnails/32.jpg)
Thank you!
32